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.

I have to say it’s very inspiring being around my guest on today’s show. Prior to this episode of Off the Record I had never met Keisha Wilson ... and within minutes I felt like we were friends.

Something about her warmth and spirit that grabbed me right way. I hope you will feel it too.

Keisha is an entrepreneur, the founder and CEO of KW Advanced Consulting. But she’s also a volunteer and a mentor to many in the coding industry and beyond. And she’s made a niche for herself in telehealth, recently presenting a well-received session on the topic at the recent AAPC National Conference.

We talk about all this and more on the episode, covering:

• Keisha’s unique life journey into the U.S. and eventually healthcare and coding
• Getting pushed by life circumstances to start her own business—much earlier than planned
• Working with early telehealth adopters, the explosion of telehealth utilization during the public health emergency (PHE) of COVID-19, and future projections of the service
• Coding fundamentals and nuances of telehealth, missed opportunities, and compliance issues
• Using telehealth to augment risk adjustment, including the requirement for “face-to-face encounter” to capture HCC diagnoses—does a computer screen count?
• Keisha’s recommendations: One book and one song

It’s often been said that the only constant in life is change. And the mid-revenue cycle is no exception.

As new regulations emerge and new technologies develop, professions get radically transformed—or even erased altogether. The antidote is a commitment to lifelong learning, and embracing the discomfort that accompanies growth.

That describes the mindset of Crystal May, my colleague and a Risk Adjustment Consultant for Norwood.

This program was originally broadcast as a webinar interview but was just too good not to share with a broader audience. So I’m pleased to publish it on the podcast.

On this show we discuss:

• Crystal’s unique career path that began in transcription, profee coding, and ultimately risk adjustment
• Her current work including audits of organizational documentation and code assignments
• Common documentation and coding pitfalls (strokes are a major source of error—hear why)
• How organizations can use findings from audits to drive continuous learning and improvement
• MEAT criteria—examples of adequate MEAT criteria (and what happens if you’re MEAT-less)?
• Getting comfortable with discomfort to grow your skillset and insulate yourself from industry layoffs
• Our joint heavy metal obsession and recommended bands

What the heck is a trauma registrar, anyway?

Once upon a time even my guest asked that question. After starting a career in nursing in 1987, Stefanie Arp became a trauma nurse specialist in 2001. And quickly became tasked with the responsibilities of trauma coordinator, a position she knew very little about but found herself immersed in, whether she wanted to or not.

Trauma registry opened up a new world of data abstraction, quality improvement, trauma center designation, high-pressure American College of Surgeons site surveys, and much more, including medical coding and the use of trauma activation codes. And opened Arp’s eyes (and now, mine) to an under the radar profession that plays a huge impact on patient outcomes and organizational quality.

We get into all of that on today’s Off the Record, covering:

• What is a trauma registry professional and why should an organization invest in them?
• The nitty-gritty of the role including data abstraction process, record review and productivity expectations
• American College of Surgeons and facility specific requirements, including trauma center designation levels
• Revenue implications including the use of trauma activation HCPCS code G0930
• Arp’s fascinating origin story, from nurse to national consultant
• What makes for a good trauma registrar--desired background, skills, and mindset, and Arp’s advice for folks looking to break in
• Finding meaning in her work (no shortage of that)

Earning your RHIA (Registered Health Information Administrator) is a huge accomplishment, and for some marks the end of a four-year academic journey and an entry into HIM.

For Richelle Marting, it was only the beginning.

In pursuit of her RHIA, which she eventually earned, my guest on today’s episode took a class on the legal aspects of HIM. That course planted the seed for a career in law—and eventually led her to start her own law firm.

All while raising two twin girls.

I don’t know how she managed all this, but that’s why I got Richelle on Off the Record.

On this show we discuss:

• Richelle’s story from RHIA to JD. How difficult was the bar exam?
• Becoming an entrepreneur and starting her own law firm
• Most frequent type of healthcare cases: Clinical validation audits and DRG validation
• The coding guidelines she sees most frequently ignored or twisted to the payer’s benefit, and other shady tactics
• What do healthcare organizations make too big a deal out of—and what are they not worried about enough?
• Qui Tam and the recent spate of cases initiated by organizational whistleblowers, in particular Medicare Advantage organizations
• Managed care contracting: Legal issues around contract negotiation, how claims get paid, timely filing, and payment policies. How quickly must plans respond to appeals, and should you put a diagnosis definition in a payer contract?
• What advice would she give to someone who is in HIM and considering a career in law—what does she know now that she wishes she knew then?