Off the Record with Brian Murphy

Sepsis it seems is always in the news, never far from anyone who works in CDI or coding circles. And here we are again, back in the headlines due to its inclusion in the Office of Inspector General (OIG) Work Plan. Sepsis has been discussed so much due to the complexity of disease, the cost of treatment, complexity of coding, and increased regulatory spotlight. What else is there to say? But with...

If you’ve ever been a member of ACDIS you’ve almost certainly encountered Dr. Trey LaCharite’. ACDIS advisory board member? Check. Regular columnist for CDI Journal? Check. Author of the CDI Field Guide to Denial Prevention and Audit Defense? Check. Speaker at the physician advisor pre-conference every year since (at least) 2010? Yes, put a checkmark there, too. Trey is the Medical Director for CD...

Small community hospitals are the backbone of healthcare for most of the country, even today in this era of sprawling healthcare organizations and massive mergers. But while they’re critical to the health of our nation, resources are often scarce, and CDI is no exception. Jennifer Cummins, BSN, CCDS, is one of just two CDI professionals covering a 222-bed not-for-profit community hospital in rural...

I don’t know about you but I'm FASCINATED with Medicare Advantage (MA). Massive growth, fueled by its shrewd marketing of added benefits beyond traditional Medicare. But also chaotic, messy, a program in need of reining in.   It’s a bit of the wild west.  I like some things about MA, including its emphasis on preventative care and aligning patients outcomes with rewards. But I'm also routi...

Listeners of Off the Record may recall our episodes on the OIG audit of severe malnutrition directed at North Carolina based Vidant, now ECU Health. Vidant/ECU won a landmark case against the OIG in large part because it had a multidisciplinary clinical and coding team in place to ensure that severe and other forms of malnutrition were appropriately documented in the record and captured. That effo...

In 2009 ACDIS was growing. The association’s boot camps were taking off. We were at the point where we needed to hire our first full-time instructor and CDI educator. That person was Lynne Spryszak. Lynne had been in CDI since 2002 and volunteered as an inaugural ACDIS inaugural advisory board member in 2007. She married experience (rare in what was then a new profession) with passion and a desire...

If you’re an aspiring medical coding professional and on LinkedIn, you might know my guest today. In fact, you probably do. She’s positively burst onto the scene. Not necessarily as a content expert dropping coding or clinical expertise (although that’s coming, to be sure), but someone who has documented her journey to medical coding in remarkable detail and honesty. From entrepreneurial web devel...

Having worked in and around medical coding and CDI for almost 20 years, I can say for certain that few topics vex coders and CDI professionals more than the dreaded recertification process. Credential maintenance. CEUs. CEU fees. Conference CEU codes. Certificates. On and on. It’s a cottage industry unto itself. It can be frustrating and confusing, and if you’re not on top of it, costly. In my ACD...

The turn to a new year is the time to set new goals. And who better to set them with than a person who has achieved a career far beyond many of us ordinary mortals—but has the honesty and humility to reveal where she falls short. Dr. Nicole Fox is Associate Chief Medical Officer, Associate Professor of Surgery, Medical Director of pediatric trauma, and Medical Director of CDI for Cooper University...

The end of the year is a time to reflect, to look back on what we’ve accomplished and learned.   And enjoy the time away from the office and have some fun.   On today’s show I’m joined by couple of guests and friends from my home base at Norwood for remembrance, lessons learned, and some meaningful personal and professional successes. We also talk about the major themes that emerged over a year of...

Generative AI in healthcare is … truly wild. A technology in bloom with little to no regulations, with all the messiness and breathless optimism that entails. The accuracy of these products including ChatGPT are a work in progress. As this podcast debuts ChatGPT outperformed humans on a mock version of the American Board of Psychiatry and Neurology (ABPN) boards, but in another study nearly 75% of...

Technology. I’m of a mixed mind. Broadly, I think technology is a blessing for humanity. It saves lives. In my small corner of the world I interview guests from across the nation over Zoom, and deliver the final product via the magic of podcast. That may or may not be a blessing depending on your opinion of Off the Record. But it goes to show you its reach and impact. But it also strikes me as nai...

Off the Record recently featured a wide-ranging conversation with Vaughn Matacale, physician advisor for Vidant Health (now ECU Health), an organization that found itself on the receiving end of an OIG audit of severe malnutrition claims. On this episode I’m pleased to bring you a continuation of that story from the legal team that helped the organization win the case and strike a blow for clinica...

As a non-clinician I can think of few things more terrifying than having responsibility for the life of a fragile newborn in your hands, and your hands alone. Welcome to the early nursing career of Sandra Love . Sandra served a labor and delivery nurse in rural North Carolina and survived some harrowing experiences that continue to inform her work today as Director of Solutions for Norwood. Sandra...

It’s often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don’t understand A&P and pathophysiology, you will make mistakes. But what about those who take the opposite path? Katie McLaughlin became a registered nurse at age 23, then went back to school to earn...

Severe malnutrition is a major predictor of mortality/morbidity. In a five-year observational study cited by the National Institutes of Health, malnourished patients showed an eight times greater risk of harmful falls during hospitalization as compared to well-nourished patients. Further, malnutrition is associated with increased risk for septic shock, acute kidney injury, stroke, and intubation....

Stop hating on hospitals . It’s a sentiment most Off the Record podcast listeners would probably agree with. But not everyone. Hospitals are under assault in some corners, including the media and in the halls of government. We need a villain and hospitals often find themselves playing the role of fall guy. For example, many blame them for out-of-control healthcare costs, citing a lack of cost tran...

During my last conference as ACDIS Director in Oct. 2021 I had the pleasure of introducing Dr. Nicole Fox as our opening keynote. Nicole is not a professional lecturer but delivered one of the most impactful and inspiring speeches I’ve seen, covering her work as a pediatric trauma surgeon and her challenges as a single mother raising four children. Understatement: Nicole is an impressive human bei...

It’s not easy moving into Clinical Documentation Integrity as a new nurse or coding professional. But now imagine what it’s like if you’re from Maryland. And it’s 2006. These were pre-ACDIS days, in a state which used APR-DRGs. In other words, no best practice, little information, and no real community. But Dawn Diven, Enterprise System Director of Clinical Documentation Improvement for WVU Medici...

Most people envision and expect careers to follow a straight line, gently upwards and to the right, in one direction. Once you’ve found the type of work you want to do you get promoted as high as fortune and talents will take you, until the day you retire. Kim Higgins is an exception to this rule. A year ago Kim was serving as the interim CDI director for AdventHealth West Florida Division, a mass...

To be an effective leader you have to have a vision and be willing to implement changes that disrupt the status quo. But you also have to involve your team, and use diplomacy to obtain buy-in. In short, be a team player with a little bit of swagger. It's a delicate dance, but it describes the tightrope Sheri Blanchard, Senior Director of Clinical Documentation Excellence and Revenue Management...

Few CDI professionals are rising as fast as Faisal Hussain, Executive Director of CDI at Wellstar Health System in Georgia. Fewer still have come as far as he has, both literally and figuratively. A foreign medical graduate and native of Pakistan, Hussain has risen up through the ranks in a remarkable career in healthcare. In his current role he is responsible for overseeing the CDI strategy and o...

News flash: Many (most?) physicians aren’t on board with CDI initiatives and coding practice. It’s understandable; they’re busy with patient care, and in their remaining hours are swamped with chart completion. Answering clinical queries and documenting with greater specificity is either seen as a chore or falls by the wayside entirely. Sometimes it takes real-world impact to make the lightbulb go...

There comes a point in our life when we all need to take an adventure. For most that means a vacation to an exotic faraway continent. For others, that might mean taking a new job, or changing careers altogether. Or starting a family. All of these are adventures of one sort or another. All are wonderful. But then there is Howard Rodenberg. Howard decided at age 60 to take a real-life adventure. To...

After a short break that was not really a break because we were on the road at ACDIS 2023 we're back with another episode of Off the Record.  Today I’m joined by fellow conference-goer, presenter, and colleague Jason Jobes, senior vice president of solutions at Norwood.  On this show we dive into the recently concluded ACDIS 2023 national conference in Chicago, which was my 15th (yes, I’ve bee...