Michelle Callahan, RN, BSN, CCDS, CRCR

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CDI From Home? How to Implement and Maintain a
Successful, Productive Telecommuting Arrangement

• Michelle Callahan, RN, BSN, CCDS, CRCR
• Regional Manager, Clinical Documentation
  Integrity
• Kaiser Permanente NCAL Revenue Cycle, Oakland, CA
• Jillian Fore, RN, MPH, ACM
• Clinical Documentation Integrity Senior
  Consultant Former Interim Director, Clinical
  Documentation Integrity
• Kaiser Permanente NCAL Revenue Cycle, Oakland, CA

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CDI From Home? How to Implement and Maintain a
Successful, Productive Telecommuting Arrangement
Electronic Health Records
CDI work-at-home options
Economic Pressures

• The presentation will detail
• Policies
• Procedures
• Productivity expectations
• How to manage relationships among the team and
  with providers
• Successful management of telecommuting staff

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About Kaiser PermanenteNorthern California

• Founded in Oakland, CA, in 1945, Kaiser
  Permanente serves a diverse population in
  Northern California
• Nationally, we currently serve 8.9 million
  members in nine states and the District of
  Columbia
• Northern CA serves more than 3.3 million members
  in 21 hospitals and 233 medical office buildings
• We have 7,129 physicians and 74,985 employees, of
  whom roughly 65 are represented by a labor union
• We have the largest civilian electronic health
  record in the world
• Kaiser Permanentes approach to the CDI program
  supports two important organizational goals
• Our support for work-at-home programs is in
  keeping with our long history of energy
  conservation and environmental stewardship
• KP is dedicated to being the best place to work,
  offering employees multiple options for
  fulfilling their responsibilities

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CDI Growing a New Program
In the Beginning
Growing Pains
Rethinking Initial Assumptions

• Regional program with regional accountabilities
• Place regional CDI staff in multiple local
  facilities

• Individual medical center characteristics
• Space challenges
• Staffing issues
• Interacting with local staff and physicians
• Day-to-day management

Ask ourselves What was the TRUE benefit of
having CDI staff located on-site?
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Back to the Drawing Board
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Who will do the job?
Consider telecommuting as an option
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Where will the work be done?

• Considerations
• Leadership approval
• Technological requirements
• Staff satisfaction
• Go green!

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Why should the work be done this way?
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How will you support this model?
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Telecommuting as a Win-Win

• Creating a recipe for success
• Intensive new hire training program
• Clear requirements around quality and
  productivity
• Practical tools and a safe work environment
• Detailed policies and procedures
• Regular connections and follow-up
• When possible, hire self-driven people with
  success working independently

Position work from home as an earned benefit,
not a guaranteed benefit.
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You Can Establish a Virtual CDI Function in Any
Organization
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Getting Started
Lay the Foundation
Establish the Framework for High Performance
Set Ongoing Performance Expectations and
Guidelines

• Ensure high performance before offering
  telecommuting as an option
• Support staff who require additional assistance
• Monitor performance trends
• Support staff performance with honest and timely
  feedback

• Telecommuting policies and procedures
• Equipment
• Home office assessments

• Performance expectations and guidelines
• Signed telecommuting agreements
• Performance management/ improvement processes

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Lay the Foundation

• Telecommuting policies/procedures
• Check with your human resources department to
  determine whether there are existing
  telecommuting policies/procedures
• Revise current HIM/coding telecommuting
  agreement/policy/procedure
• Equipment
• Determine which supplies/equipment your
  organization is willing to supply
• Identify a specific plan for IT issues
• Document accountability for damages to equipment
  supplied by employer
• Home office assessments
• Ergonomic evaluation
• Environmental safety assessment
• Adequate space/accommodations

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Establish Framework for High Performance

• Clear department policies and desk-level
  procedures
• Recommended accompanying procedures
• Absence notification
• Communication expectations
• Productivity and quality expectations
• Performance management/improvement process
• Telecommuting agreement
• Telecommuting procedure (including all
  requirements w/check-off list)
• Competency validation
• Provider query procedure/query compliance
  procedure
• Chart review completion

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Set Ongoing Performance Expectations and
Guidelines

• Productivity and quality
• Ensure high level of individual staff performance
  prior to allowing telecommuting
• Identifying performance opportunities
• Management monitoring of performance trends
• Ongoing discussion regarding comfort level and
  employee self-assessment of needs and areas of
  opportunity
• Supporting staff performance
• Give honest and timely feedback

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Staying on CourseBuilding and Maintaining the
Team

• Control the Things You Can

• Foster What You Cant Control

• Training
• Initial CDI training
• Continuing education
• Work flow and workload distribution
• Begin with specific work flow
• Allow personalization as staff become more
  experienced
• Identify opportunities to assign work based on
  areas of program focus

• Relationships
• With providers and facility staff
• Build opportunities for engagement
• Develop incentives for physicians
• More relationships!
• With other team members
• Institute daily connections and opportunities for
  team building

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Staying on CourseManaging Across Distances

• Management Adjustments
• Adjust management-to-staff ratio
• Clear, realistic performance expectations
• Make the extra effort to connect with individual
  staff members

• Performance and Data Sharing
• Work hours
• Identified performance metrics
• Performance data

• Staff Adjustments
• Goals include clear action plan for performance
• Take responsibility for education, as needed
• Remain connected to the home site
• Identify process improvement opportunities

• Retention Strategies
• Career paths
• Recognition programs
• Incremental work-at-home increases
• Peer-to-peer kudos cards
• Manager-designated awards

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Management Adjustments

• Staffing and responsibilities of management
• Will take more time and energy than traditional
  staffing adjust management-to-staff ratio
  accordingly
• Establish and document clear, realistic
  performance expectations
• Make an extra effort to connect with each staff
  member regularly

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Performance and Data Sharing

• Performance monitoring and communication
• Monthly review of work hours (through electronic
  systems)
• Weekly or monthly review of designated
  performance metrics
• Facility- or service-level performance data
  (response rate drilled down to provider level)
• Consider blind performance data sharing

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Retention Strategies

• Consider promotional level within
  organizational/departmental structure
• Increased accountability and additional
  responsibilities/special projects
• Employee recognition program
• Incremental work-at-home increases

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Staff Adjustments

• Increased staff accountability
• Clear action plan for performance under goals
• Education
• Returning to home site
• Staff responsibility to identify process
  improvement ideas

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Potential Pain Points

• The Right People
• Self-driven with high levels of personal
  accountability
• Professional
• The right experience
• The right temperament
• Skilled communicators

• The Right Performance Management System
• Performance feedback
• Ongoing communication
• Data sharing
• Remote education and mentoring
• Implement staff ideas for improvement

• The Right Sponsorship
• From regional leaders
• From local leaders

• The Right Places
• Proximity to home facility

• The Right Systems Support
• Downtime procedures
• IT escalation plan

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The Right People

• High level of personal accountability
• Professional
• Autonomous
• Chart review experience
• Experience and success with high-volume/high-stres
  s work environments
• Ideally not straight from inpatient floor nursing
• Expertise at public speaking, education,
  presentations
• Previous experience within the facility
• Previous experience with electronic heath record
  and high level of comfort with basic computer
  programs
• Consider new employee testing in this area

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The Right Sponsorship

• Gaining approval and acceptance
• Leadership
• Thorough and thoughtful plans prior to
  presentation
• Utilize current organizational goals and
  initiatives to support this work model
• Consider a trial
• Regular performance feedback

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• Michelle Callahan, RN, BSN, CCDS, CRCR
• Regional Manager, Clinical Documentation
  Integrity
• Revenue Cycle
• Kaiser Permanente, Northern California Region
• Michelle.L.Callahan_at_kp.org
• Jillian Fore, RN, MPH, ACM
• Senior Consultant, Clinical Documentation
  Integrity
• Former Interim Director, Clinical Documentation
  Integrity
• Revenue Cycle
• Kaiser Permanente, Northern California Region
• Jillian.S.Fore_at_kp.org

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Questions?

• In order to receive your continuing education
  certificate for this program, you must complete
  the online evaluation which can be found in the
  continuing education section at the front of the
  workbook.