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 its answers to drug-related questions were incomplete or wrong, including some outright...

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 naive to paint technology as a universal good. Does anyone think smartphones and social media...

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 clinical truth. It’s not every day you get to hear a lawyer’s perspective on coding and...

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 learned that infants are not just small adults—they have their own unique clinical profiles....

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 her doctorates before becoming a nurse practitioner in 2007. Today—at least until very...

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. So it’s important to get severe malnutrition documented and coded. Unfortunately, doing so...

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 transparency and exorbitant charging practices. Jugna Shah, MPH, founder and president of Nimitt...

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 being. In addition to a heavy clinical rotation, she’s the Associate Chief Medical Officer,...

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 Medicine, is used to taking on difficult challenges—and overcoming them. And she’s got a track...

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 massive health system (West Florida has 13 hospitals alone). Her responsibilities included...

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, had to walk. And she did so skillfully. After taking over the Clinical Documentation Excellence...

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 operations for the entire Wellstar health system, comprised of nine hospitals and more than 300...

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 off and touch a match to tinder. Tom Brazelton, MD is a practicing pediatrician and the CDI...

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 the South Pole, where today he is serving as a physician at the Amundsen-Scott South...

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 been to every single one from 2008-present, not including the virtual event of 2020, and I think I’m...

CDI and coding professionals typically recoil from the dreaded word, “payer.” After all, provider-payer relationships are often adversarial at best, hostile at worst. Clarify the diagnosis or procedure with the physician, apply the medical code … only to have the payer downcode or outright deny the claim.  My guest on today’s podcast understands the frustration because she once worked in the hospital setting. Today she works on the payer side. But here’s where things get...

How long have you been in CDI, oh listener? Three years, five, 10? Maybe as many as 16, if you started back when CMS adopted MS-DRGs and ACDIS began, in the hazy, pre-Tik-Tok days of 2007? My most recent guest on Off the Record has been in CDI for 24 years, starting in 1999. Longer than she served at the bedside as a nurse. It’s possible some of my listeners are 24. She’s been there, done that, but still driving her program forward, never settling. Tamara Hicks is the Director of...

Denials are a reality of life in the mid-revenue cycle. And they're not going anywhere. As Medicare Advantage (MA) grows—MA Organizations statistically deny more care than traditional Medicare—the volume of denied claims will only keep growing.   I wanted to talk about this subject with someone who not only understands the current mine-filled landscape, but knows how to overturn a denial like a lawyer—because she happens to be one.   Sarah Mendiola is the senior vice president of denials...

“The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” – John C. Maxwell    It’s been said that there is no constant in life except for change. Jami Woebkenberg is proof. Jami is the Senior Director of HIM operations at Banner Health. Or at least, that’s her title now. She has had a few twists and turns over 19 years at the organization, which recently acquired a couple hospitals and clinics and added them to the system’s EMR last...

When I started Off the Record, I wanted to launch a program that served the broader industry that serves the health record. That means, most of my guests work in the HIM/coding, CDI, case management, and trauma/oncology registry fields. But I also host folks who support the mid-revenue cycle—consulting, staffing, sales, legal, tech, and from time-to-time, members of my own company. And share their personal stories, too. On the latest episode of OTR Mike Behringer and I start with his unique...

Since taking on the CDI director role at Brigham at Women’s Hospital in October 2017, Deb Jones has made big changes with big impact. These include: A deep focus on risk adjustment and mortality reviews. Boston is an incredibly competitive healthcare environment with 25 hospitals operating within the city. Patients have a choice of where to shop for care, which makes rankings in the likes of U.S. News and World Report absolutely critical for survival. In a 2022, Brigham made the honor roll...

CDI Director for Tufts Medicine. Recently went back to school to earn her MBA. Contributor to, and co-author of, the latest ACDIS-AHIMA physician query practice brief. Speaker at the upcoming ACDIS conference. And all-around cool person. Keisha Downes, BSN, RN, CCDS, CCS, joined me recently to talk about her impressive career in healthcare, a path that started from humble beginnings at Wal-Mart, then to nursing, travel nursing, and finally CDI, which took her from her home state of...

Chris Petrilli is the Medical Director of Strategic Initiatives and Operations at NYU Langone Health. He’s an Associate Professor of Medicine at the NYU Grossman School of Medicine. … and he happens to have been a one-time stand-up comedian, whose gift for gab and comedic timing I can attest to. And may have been on the butt end of, a time or two. We get into all of this on a memorable episode of Off the Record. One of the reasons I started this podcast was to bring more people,...

You’ll find few CDI/coding personalities as big and colorful as Adelaide LaRosa—and fewer still with a broader and bolder vision for what mid-revenue cycle professionals can do, and should do, to improve the quality and financial health of their organizations. Catholic Health’s VP of HIM, CDI, EMPI, and DRG Appeals reordered the entire heart of coding, compliance, and reimbursement at the six-hospital system in New York, consolidating HIM and CDI into a seamless team led by three system...

For our final episode of 2022 we’re going off the record (even for Off the Record) with a couple interesting guests you may recognize from Brian’s home base at Norwood. This week we’re joined by CEO and Founder Justin Satterfield, and VP of Consulting Jason Jobes. As you might expect at the holidays the conversation is reflective, expansive, and personal. We look back at some of the common themes shared by Brian’s guests, including the importance of mentorship, discussing mentors who have...