Karen Elmore is living in denial(s).

Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she’s had to deal not only with human payers, but artificial intelligence denials as well.

Karen’s organization has worked hard to stem this never ending tide, and found some success with uniform organizational clinical guidelines and consistent education and engagement.

We talk denials, appeals, preventing future denials through provider education, and Kansas City Chiefs football (still undefeated as of publish date), on this episode of Off the Record.

On this show we cover:

• Karen’s unique role as program manager for CDI at BJC, including responsibilities for physician education, engagement, and denials prevention

• Typical denials for sepsis, respiratory failure, and malnutrition: What payers are using for ammunition

• What payers are the worst offenders, and particularly creative (and egregious) tactics

• AI denials—how do you spot them, and combat a machine?

• Provider engagement strategies and relaying denials back to physicians

• Legitimate reasons for denial and ongoing documentation shortfalls

• Karen’s Kansas City Chiefs obsession—inside an average Sunday in the Elmore household (it’s crazy)

Following is part 2 of our interview with Revka Stearns, who joined us on Off the Record to provide an update of her first eight months on the job as a new inpatient coder.

If you haven’t listened to part 1 I’d recommend starting there, since we pick up mid-conversation. On this show we cover:

• The mechanics of working as a remote coder. Workplace setup and helpful recommendations
• Dealing with the physical challenges of working at a desk all day and breaking up the routine
• Unexpected consulting work coming her way ... from Canada!
• Unfiltered conversation about social media. Revka’s take on the social media landscape, dealing with negativity, dispelling persistent myths (there’s no coding jobs! It’s all being outsourced! Yes there are, and not it isn't—Revka is proof), and being a consistent, positive, and helpful online presence.
• Keeping sane through work-life balance, and her latest Off the Record Spotify playlist entry

Back in January I hosted newly minted medical coder Revka Stearns. For someone so new to the industry, Revka has made a big impact by the act of sharing--documenting her journey in detailed and open fashion on LinkedIn and Facebook, and a half dozen podcasts and programs.

At the time she was on the show Revka had literally been on her first job for about 3 weeks. Eight months later I asked her to come back for an update and share her successes, challenges, and unexpected side-ventures.

Revka has many strengths—smart, hardworking, diligent--but one of them is effective use of social media, creating a model for how I like to see these platforms used (and unfortunately often aren’t).

But she’s also had her share of struggles. Coding is hard.

This was a bit of a longer interview so I split it into two parts. On part 1 we cover:

• Eight months on the job as a first-time medical coder
• Specific challenges she’s encountered, including:

1. Making sure the organism causing an infection is clearly linked to that infection through documentation
2. Ensuring documentation is carried through to discharge, beyond the provider just copying and pasting
3. Recognizing query opportunities

• The reality of learning: Taking one step forward and two steps back
• Most rewarding aspects of the job
• What she knows now that she wished she knew back in January

With 25 years’ experience in medical/surgical, critical care, and emergency department medicine, Tonya Motsinger has seen her share of crises.

COVID-19 was a crisis of a far larger scale.

The pandemic wreaked havoc not only on patients, but her CDI department, resulting in staff shortages.

Today OhioHealth’s System Director of Clinical Documentation Integrity has come out on the other side stronger. You might even call her, a survivor.

We discuss lessons on staff retention, remote onboarding, and some great work she’s done to improve her organization’s Vizient clinical quality rankings. On this show we cover:

• OhioHealth’s CDI department including basic KPIs and department objectives, and Tonya’s role as System Director.

• Impact of the COVID-19 pandemic and department staffing devastation

• Putting things back together: Salary increases and short-term weekend coverage plan

• Challenges of remote orientation for new CDI staff

• All things Vizient: New Vizient calculator, CDI review nuances, and impact on actual organizational quality

• Onboarding a new hospital that’s never had a CDI program (I know, such places apparently still do exist)

• Being a new grandmother and her addition to the Off the Record Spotify playlist

Bridging the gap between clinical and financial worlds is the goal of CDI and coding, but it’s much easier said than done. One way to reconcile this schism is through data—objective numbers that don’t lie, but can speak to both sides of this seemingly irreconcilable chasm.

Associate Director of Coding and CDI at Yale New Haven Health (YNNH) Leif Laframboise believes in the power of data and uses it to structure the work of the coding and CDI departments under his oversight. But he marries that with a candidness and leadership style I admire, and an inner strength that has allowed him to persevere with a disability that might have ended the career of another.

Leif is not just a data lover but an all-around good dude that I got to know a little bit during my ACDIS days, and I’m pleased to have him on this episode of Off the Record. We discuss:

• An overview of the CDI and coding departments at YNNH

• Broad departmental KPIs, with present on admission as a north star in a sea of competing quality programs

• YNNH’s unique reporting structure to both finance and the chief medical officer, and how that works in practice

• Why and how Leif embraces data—what he looks for, how he uses it to drive improvements, educate providers, and focus his team’s chart reviews

• His thoughts on how CDI and coding must evolve with changing times

• His disability and how he’s worked around it in a visible leadership role

• Our first Foreigner selection on the OTR Spotify playlist (about time)

Robin Jones moved to Florida at the tail end of 2017 to pursue a burgeoning career in CDI. And ever since has done nothing but climb the professional ladder.

Leaving behind her home in Cincinatti Ohio and a decorated career in CDI at Mercy Health, Robin started over as Division Director of CDI at AdventHealth West Florida in November 2017. A few years later she was promoted to Director of Clinical Excellence. You might recall that she joined me for an episode of Off the Record in November 2022 to talk about this change.

Three months ago she was promoted again, this time to Vice President of Clinical Excellence & Education. And I knew it was time for a return visit. We get into her flourishing career and the broader CDI program at AdventHealth West Florida on today’s Off the Record.

On this show we cover:

• Promotion to VP of Clinical Excellence and Education and what it entails
• New VP level leadership responsibilities, and what new skills Robin had to cultivate to meet them
• What she had to give up to accept this new role, and the challenges of delegation
• Commitment to hybrid onsite/remote CDI and a unit-based model of coverage
• Winning a Leapfrog Emerald Award, AdventHealth’s emphasis on public report cards and how CDI can make an impact
• Retaining and building the workforce of tomorrow

Our two-part “Podcast on the Pirogue” miniseries concludes in this installment of Off the Record, recorded live in the backwoods of Pierre Part, Louisiana.

Here I wrest back my traditional host seat (after the takeover in part 1) and interview Jason Jobes, Senior Vice President of Solutions at Norwood, and Dr. Robert Oubre, aka, The Doctor of Documentation. We discuss their newfound roles as entrepreneurs in the throes of growing a business.

Jobes is building the Solutions arm of Norwood, driving new consulting engagements and managed services, while Oubre has launched a series of physician e-learning CDI courses and (most recently) a new online community. We cover lessons learned, mistakes made along the way, proudest achievements, the importance of mentorship, recommended resources, and ultimate goals and aspirations.

If you are looking to start your own business, take up a side hustle, or build your personal brand in the mid-revenue cycle, this is one you’ll want to listen to. Some great talk with two good dudes “BS-ing on the Bayou” with occasional lapses into profundity.

Enjoy!

I’ve hosted the Off the Record podcast since September 2022. Over that time I’ve recorded dozens of interviews with scores of great guests, with episode 50 right around the corner.

But I’ve never had the microphone turned on myself. Until now.

This past April I was hanging out at the ACDIS conference with my colleague Jason Jobes and Dr. Robert Oubre, CDI physician advisor at St. Tammany Parish Hospital. There the three of us hit on the idea of a podcast recorded in person in Louisiana, where both Jason and Robert live.

What would we talk about? Dr. Oubre decided it was time for me to go under the spotlight.

On this episode we talk about my unlikely career path from odd jobs and journalism to healthcare and Director of ACDIS, and eventually here to Norwood. It’s a revealing interview that made me sweat—and not just from the Louisiana heat.

So, I hope you enjoy this unconventional and very unscripted episode about my origin story, the early days of CDI and ACDIS, and some personal lessons learned along the way.

Pardon the sound quality. You will hear the authentic sounds of the Bayou on this episode. We recorded in Jason’s screened porch in Pierre Part, best known as home of the reality TV show Swamp People.

No guests were harmed by alligators during this recording.