MedPartners NewsletterSummer 2016: Volume 2, Edition 2

2006 2016

CELEBRATING

YEARS IN BUSINESS

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03 MedPartners UpdatesFind out what we’ve been up to lately.

04 2017 Consultant Calendar ContestShow off your photography skills by entering our 2017 Urban Art Calendar Contest.

05 Case management - Quality careLearn about our transition to Quality Care.

08 Clinical documentation improvementGet the latest CDI news and travel tips.

11 Health Information ManagementBe sure to check out the new Coding Clinic.

16 MedPartners SolutionsInsights and advice from our MPS team.

19 Oncology data managementDon’t miss the new Consultant Q&A.

22 traumaOrange is the New Green for Trauma Performance Improvement.

26 Hot JobsHot job openings in the healthcare industry nationwide!

CONTENTS MEDPARTNERS QUARTERLY NEWSLETTER

Let’s Get Social:We like you, but have you liked us yet?

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Cut for a CureWe held our #CutforaCure shave event with the National Pediatric Cancer Foundation! We were honored to include special guests, Jackson Carter, osteosarcoma cancer survivor, and his family. They helped shave our volunteers and we had a great time watching them do it. Thank you to everyone who participated!

Our team has raised over $14k to fight cancer and we are almost to our goal of $15k. Click here to help out.

AwardWe are so excited we came in at #2 for Best Places to Work in Tampa Bay in the Bigger Category! We feel like #1!

MedPartners Updates

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Upcoming Events & Conferences

Date Event Location7/25 – 7/26:

Florida Cancer Registrars Association (FCRA) Annual Conference

Boca Raton Marriott at Boca Center in Boca Raton, FL

8/5: MedPartners 10 Year Anniversary

TBA

9/22: ACMA: The Missouri/Illinois Gateway Chapter’s 14th Annual Case Management Conference

Sheraton Westport Plaza Hotel in St. Louis, MO

10/3: ACMA: North Carolina Chapter’s 14th Annual Case Management Conference

Embassy Suites in Winston-Salem, NC

10/15 – 10/19:

88th Annual AHIMA Convention & Exhibit

Baltimore Convention Center in Baltimore, MD

11/5 – 11/7:

TQIP: Trauma Quality Improvement Program

Omni Orlando Resort in Orlando, FL

MedPartners 2017

Consultant Calendar Contest

Snap, Snap, Ch-Ching!Time is ticking! Don’t forget to submit your pictures for our 2017 Urban Art Photo Contest! We’re inviting

all of our valued consultants to show off their photography skills for a chance to be featured on the cover of our 2017 calendar and monthly spreads. Oh, and did we mention cash prizes?!

Calendar Theme: Urban Art (also known as street art is a style of art that depicts city life and is often done by artists who combine graffiti, to make artistic statements about urban issues).Submission Deadline: July 31st, 2016Submission Address: marketing@medpartners.comGrand Prize: Cover Feature, a $400 Visa Gift Card, and your image professionally printed and framed.Runner-Ups (11) Monthly Feature and a $100 Visa Gift Card

*Please note, all photographs must be submitted in full-size, high-resolution format. You can enter as many photos are you want.Good luck! We look forward to seeing all of your submissions.

Job AlertsSign up for our Job Alerts and receive new job opening delivered straight to your inbox or smartphone. Sign Up for Job Alertsm

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5

Case Management

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MESSAGE FROM THE DIRECTORDear team,

I would like to take this opportunity to introduce myself to those of you who I have not had the pleasure of meeting or speaking with yet. My name is Lora Clements and I am the Director of Quality Care at MedPartners. I have been with MedPartners

for almost five years and began my career here as a recruiter and founding member of our CDI Team. I’m very grateful and excited to have the opportunity to be a part of the Quality Care team. This is a team of hardworking professionals that strive to live up to our company’s core values on a daily basis.

For those of you who are wondering, Quality Care is the new name for our Case Management Division. The name change came about to ensure that we were encompassing all the service lines we support in our division, including, but not limited to, acute care case management, discharge planning, utilization review and social work.

This division has grown exponentially in a VERY short amount of time (three years). We started with two employees and today we have 13 in-house recruiters and account managers focused solely on OUR service lines. This does not include the countless Business Service Organization members who are here to attend to your travel, HR, payroll and education needs.

One of my first acts in my new role was to plan our theme and participation at the 2016 ACMA Conference. For those of you who have witnessed MedPartners at con-ferences, you know that we like to have fun! We are definitely not your khaki pants & polo shirts type of company. We pick a theme, whether it be a movie or otherwise, and dress up in character as part of the draw to our booth.

For this year’s ACMA Conference, we chose to go with a 60’s Pan Am theme with a tagline of “At Your Service.” We had all the ladies in the traditional cornflower blue pencil skirt suits, complete with pill-box hats and jump seat bags. The gentlemen were in the traditional pilot garb topped off with aviator hats & sunglasses. I know some of you were a little disappointed that they weren’t in their baseball uniforms again, but alas, we must move on.

Having never been to ACMA before, I wasn’t sure what to expect. Being an exhibitor, I appreciated the scaled down exhibit hours, which allowed us to participate in the sessions. The session content was relevant and fascinating. Everything was covered from peds to elder care, home health, psych and even human trafficking. Pretty much anything you could be interested in learning and more, was represented. The presenters were all engaging and knowledgeable.

I definitely learned a lot. Most importantly, I learned the impact of Case Managers on healthcare. Yes, you read that right… all of healthcare. Case Managers don’t just stop at the hospital, they are all over. They are in homes. They are in insurance. They are in rehabs. They are everywhere. With Case Managers, patients are informed and educated about their care in and out of a hospital setting, physicians are reminded of their responsibility to provide quality care and insurance companies are guided by something other than the bottom line. Case Managers are a lifeline between the patient and the business of healthcare. They have an especially hard job and are not always appreciated, but they still do it. Why, you may ask? Case Managers CARE.

Warmest Regards,Lora J. Clements

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ACMAOur team helped clients take their careers to new heights at the Annual Case Management Conference!

Consultant Spotlight: Deitra W.1. What drew you to MedPartners

originally?The opportunity to travel as a Case Manager.

2. Before working at MedPart-ners, what was the most un-usual or interesting job you’ve ever had? HIV research.

3. What advice do you have for prospective MedPartners can-didates?Don’t freak out! When you are first assigned, give yourself at least a week to get adjusted.

4. What are 3 words to describe MedPartners? More than 3! Dependable, team players, always available, Kind, smart, nice, dedicated, support-ive, flexible.

5. What do you find the most challenging at MedPartners?No challenges identified.

6. What have you gained from working at MedPartners? How to be responsible for my traveling schedule, how to nav-igate from hotel to assignment, how to book my travel, etc.

7. What is your proudest moment at MedPartners?Being nominated for the employ-ee spotlight!

8. Any favorite line from a movie? “You had me at hello.”

9. Best vacation you’ve been to? New York.

10. Do you have an office nick-name? What is it? D Wade (as in the basketball star).

11. Do you recall any embarrass-ing moment at work?Missing my flight several times.

12. What do you like best about being a Case Manager?I like the opportunities that are available for case managers. As a young nurse, I worked hard at the bedside. Being a case manager gives me the opportunity to visit patients in an indirect patient care atmosphere. I also love working as a UR nurse and as a discharge planner.

13. What do you like best about being a MedPartner?I love the flexibility, my recruiter, and the travel opportunities. The staff always complements and supports us. My recruiter always keeps me abreast of new oppor-tunities and he took the time to get to know me as a person. So when new opportunities come up, he already knows if it is a good fit for me or not. That is my favorite part about MedPartners, they know me as a person first.

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Clinical Documentation Improvement

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ACDISWe had a great time at ACDIS 2016 in Atlanta!

Going the Extra MileKaren D., RN, CDIP

I began to write this article in a very familiar place… the airport. I spend a lot of time in airports - even more so these days with those extra-long TSA security lines!

After traveling for work for the last 8 years, I sometimes wonder why I keep traveling. Why wouldn’t I want to go to the same job, with the same people day after day and week after week? There’s a lot to be said for consistency, familiarity, and continuity. On occasion, I have had fleet-ing thoughts of stashing away my suitcase and cashing in my frequent flyer miles. But at the end of the day, I am still enjoying the variety, the challenges and the other benefits of this wonderful job that I have with MedPart-ners. I am not ready to quit just yet. Some people may think I am crazy, but I enjoy the travel (except for those long TSA lines). I have had the opportu-nity to work in dozens of hospitals across the US over the last 8 years. I have met some awesome people: other clin-ical documentation specialists, consultants, nurses of all types and even some physicians. Selfishly, I have learned a lot from the other CDIs, coders, HIM directors, Physi-cian Advisors and Chief Medical Officers that I have had the opportunity to work with. As you work beside them, some people even allow you a peek into their personal lives as they share their personal stories. It makes you feel special when that happens. I have continued to stay in touch with some people I have met. Some I text, some I call and some I communicate with on Facebook. My life is much richer because of all my experiences, all the places

I have been and all the great people I have met.Getting so much out of my travel makes me want to give back. As I work on each assignment, I always try to bring some extra value to the client. After all, they pay a premium price for our services. Of course, each hospital has varied needs and the staff can be anywhere on the spectrum in terms of levels of experience in clinical documentation. So what we bring to the table varies, but I always find that everyone is interested in how “other hospitals do things,” and look to our opinions as to what works and what doesn’t. Our varied experiences accrued as we travel will continue to set us apart.The government also plays a role as it continues to support our value by the number of mandates that have been added by CMS as they move from payment for services to value. Value based purchasing, hospital readmission reduction, patient safety indicators and hospital acquired conditions, to name a few, have required us to “go the extra mile” as we assist hospitals in our CDI role to help meet all of these growing requirements. Improving needed documentation and clarifying complications has increased our scope and will continue to provide us with job security in this ever-changing environment. We will carry on and gladly expand our role as we support hospitals via our MedPartners assignments and as we grow as specialists that hospitals find that they can no longer do without.

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5. How has your transition from ICD-9 to ICD-10 been?It has actually been very smooth.

6. Do you feel it is better to keep CDI specialists tied to one particular specialty or to rotate them through different areas of the hospital? As a CDS, I like the variety of working through differ-ent areas of a hospital, it keeps me up to date with my skills in all units.

7. Do you have any advice you could give to a CDI who is considering a travel job with MedPartners? Go in with an open mind and be flexible. Commit to sticking with it for a certain period of time no matter what happens because it will take a few months to adjust to traveling.

8. Do you have any travel tips to share that you learned while on the road? Get TSA Precheck. Carry disinfectant wipes and wash your hands frequently.

1. How long have you been here at MedPartners?Since August of 2014.

2. What is your favorite part about working for Med-Partners?MedPartners is a great company! They have education available and travel support. They try their

best to find assignments that fit my needs and I have a great recruiter who treats me well!

3. What is your favorite part about traveling?I love flying (take off to landing), meeting new people and exploring the city and state that I am working in. I have also had the privilege of working with other MP CDI consultants who I am happy to now call my friends!

4. While on the road, how do you spend most of your free time?I love to shop and I like to take local Pilates or Yoga classes or find a place to hike or walk. I do try to explore a historical site at least once to appease my husband.

Employee Spotlight: Heidi T.

In Remembrance

For the better part of 20 years, Dr. Gold has been a fixture in the HCPro and the ACDIS community, authoring countless articles, several hand-books, and speaking on numerous webcasts and audio conferences.

He served two terms on the ACDIS advisory board, helping ACDIS get off the ground by serving as an inaugural board member from 2007-2010.Dr. Gold cared about the clinical truth. He cared about medical codes and the powerful truths they can convey when reported with accuracy. But most of all he cared about people. And for that, we’ll miss him.

- Brian Murphy, ACDIS Director

Read the full article here: http://blogs.hcpro.com/acdis/2016/05/the-passing-of-an-industry-great/

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Heath Information Management

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Coding ClinicMarcia K., MBA, RHIA, CCDS

A surgeon will frequently give us a diagnosis for a procedure he has performed and we think,

“I have no idea what he is talking about!” Going into the encoder does not help because the diagnosis is not there. What do you do?This article demonstrates the need to understand new publications of our Coding Clinic. The broader application is to show new coders that they need to avoid being encoder dependent. There are also numerous articles on this topic posted online with clear, concise explanations, some including videos. This article was the first at MPS designed to encourage apprentice coders to perform literature searches and utilize critical thinking skills at MPS.

Coding Clinic: 2nd Quarter, 2016Question: A patient with median arcu-ate ligament syndrome underwent by-pass graft from the distal descending aorta to the celiac artery with Dacron graft. What is the correct qualifier for this procedure?Explanation of the diagnosis:Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, celiac axis

syndrome, or Dunbar syndrome, is often misdiagnosed due to its relative scarcity.1 The classic triad of post-prandial abdominal pain, weight loss, and epigastric bruit is likely to be incomplete. Due to a wide differential diagnosis, includ-ing peptic ulcer, gallbladder disease, appendicitis, IBD etc., most patients will have undergone multiple radio-logic investigations or procedures including esophagoduodenoscopy or even diagnostic laparoscopy.1 Once diagnosed by magnetic resonance angiography (MRA) or CT angiogra-phy (CTA), the symptomatic patient usually requires surgery. While the traditional open approach still dom-inates, minimally invasive techniques are increasing in frequency.

Ref #1The celiac artery (or the celiac trunk) provides oxygenated blood to the foregut; it supplies blood to the stomach, the liver, the spleen and the part of the esophagus that reach-es into the abdomen. It also supplies the superior (or upper) half of the du-odenum and the pancreas. For illus-trations of Median arcuate ligament syndrome (MALS), click here.

References: 1. Journal List Hawaii J Med Public Health v.72(8); 2013 Aug PMC3848179

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PDX:Please refer to Chart A.Coding Clinic Answer: According to the operative report, a bypass was not performed. Although the surgeon referred to the procedure as a ‘bypass,’ the route of passage was not modified. The surgeon used the term ‘bypass graft,’ to refer to the device he used. At surgery, he released the celiac artery, excised the diseased portion of the artery, and replaced it with a Dacron® graft. Assign the following ICD-10-PCS codes:

04N10ZZ Release celiac artery open approach04R10JZ Replacement of celiac artery with synthetic

substitute, open approachPlease refer to Charts B & C.

CHART A:

CHART B:

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CHART C:

CHART D:

The surgeon’s use of terminology may not exactly reflect the ICD-10-PCS terms or definitions, making it necessary for the coder to understand the intent of the procedure performed. According to ICD-10-PCS Guideline A11, “It is the coder’s responsibility to determine what the documentation in the medical record documentation equates to in the PCS definitions.”Medical coding is a rewarding career, but correct coding sometimes requires a Sherlock Holmes approach!

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MESSAGE FROM THE DIRECTOR

Dear MedPartners Family,

Welcome to the “post rush” of the ICD-10 staffing market! (Yes, we can all breathe a

little easier!) As we all know, starting last summer, many hospitals across the country were leaning on staff-ing firms such as MedPartners to help keep bill holds at a minimum while educating staff on ICD-10 (Pre ICD-10). The second wave of staffing needs developed in October 2015 when ICD-10 went live and staff were needed as EVERYONE became to with the new code set (GREAT JOB! YOU DID IT!). The demand for additional staff lasted throughout the holidays for most hospitals. Then, the industry started to feel a little bit better about coding productivity and accuracy- their ship was buoyant once again! Hospitals are starting to see challeng-es in several areas never felt before due to ICD-10 and MedPartners is trying to capitalize on staffing those needs. For example, we are finding that ICD-10 slowed down outpatient coders coding surgical records. This slowdown created backlogs at sev-eral hospitals and MedPartners was able to come to the rescue. Second, we are seeing an increased need for coding reviewers/auditors to spot check records prior to sending out in-correct bills. Lastly, several hospitals are finding that their denials were increasing and we have been able to supply them with support staff in this area too.

Although we are not see-ing a large surge in the areas men-tioned, a small trend is growing. We didn’t have these needs before ICD-10 and coding needs have stabilized in the industry since the be-ginning of the year. We are confident that the market will start to see more demand for coders as we move into the summer months. Many hospital calendar year-ends are June 30th and they will want to increase staff to close out the year with a low DNFB. Second, with a new ICD-10 code set being released October 1st, we antic-ipate more needs emerging through-out the remainder of the year. Congratulations, Coders, for surviv-ing one of the biggest changes our business has experienced in over two decades! MedPartners Coders, you should be very proud of your-selves for pressing forward to learn the new code set! Take a moment to reflect on your accomplishments and help each other when in doubt. The more we know, the stronger we will be together!

Sincerely,Doug Montgomery

Consultant Corner Rachel B.,

University of Utah“Rachel has been an excellent em-ployee from the very beginning! She is very intelligent, always pos-itive, and a consummate profes-sional. I’ve called on her multiple times to be a resource for her co-workers and she does it gladly. Rachel’s work ethic is beyond re-proach. She is also just a great per-son to talk and laugh with!” - Dawn Eskridge, Recruiter

“I have worked with Rachel for nearly 5 years now and never sent her to an ‘easy’ coding department to help. Her attitude is always a ‘can do’ attitude and she is always willing to help out anyone on the project. She is an excellent coder and consultant as well as a delight-ful person. Our clients equally love her!” - Pete Coryn, Account Manager

“Rachel has been on assignment with University of Utah Health Care since 2014, and we don’t plan on letting her go anywhere else. ;-) Rachel is known as our ‘go to girl’ for complex and high dollar cases, and we can always count on Rachel to follow through. She is depend-able, accurate, has great communi-cation skills, and is SO easy to work with. We couldn’t be happier!” - University of Utah, client

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MedPartners Solutions

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Message from the Director

MedPartners Solutions (MPS), the newest division within MedPartners, had the pleasure of exhibiting at the 2016 MDHIMA & DCHIMA annual conference in May. MPS is an

innovative solution to an age-old problem: HIM program graduates struggle finding positions within HIM mostly because they have little hands-on training and little hands-on experience. To date, we have trained over 400 recent HIM program grads and hired 40 as coding apprentices. As a division leader, it was a thrill to meet some of our supporting HIM Program Directors, students and potential students. No other company offers a program as robust as MPS. The HIM community represented at the conference is thankful such a program exists and grateful to MedPartners. I look forward to reporting on the success and progress of MPS next quarter. Until then, KEEP CALM AND CODE ON.

Christine PoleonDirector, MedPartners Solutions

Employee Spotlight: Donna B.1. Describe your experience with the MedPartners apprentice

program.I gained valuable experience while making a living.

2. How do you think your career has been affected (either pos-itively or negatively) by your participation in the MedPart-ners apprenticeship? What do you think you would be doing had you not joined MPS?So far my career has been entirely MedPartners, but going from school to the training they provided and then direct to work will prove to be a positive start to my career. I would probably be driving at least 80 miles round trip to some facility, which would put more strain on my time and family.

3. What career goals have you currently achieved?First of all, experience. Then there is the chance to work on many different types of files.

4. What career goals are you currently working on?I am studying for my RHIT certification test and trying to be more accurate in my daily work.

5. How do you feel the MedPartners apprenticeship prepared you for coding in a live environment?Experience, and all of the coding "how to" resources they gave us have helped me to be prepared for the live environment.

6. What are the top 3 things you like about working for MPS and what are the top 3 things you wish you could change?I, of course, like working at home, being there when the kids go to school and when they come home. All of the MPS staff are very helpful with feedback, guidance and providing resources for coding. The only thing I can think of is that I wish we had gotten feedback right away as to whether we were correct in our coding or not while in our training period. It would have helped to be better prepared for the live charts.

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I got into HIM in kind of an off-hand way. I worked in a hospital for 13 years doing hardware repairs on

computers. I started out at the hospi-tal doing registration and then work-ing in the business office posting accounts receivable, adding charges to accounts, dong accounts payable and working with the billers to make sure the accounts were credited the way they should be. By doing this, I gained a better understanding of how the revenue cycle worked. I also did month-end report compilation of statistics for the CFO and CEO.After Epic was implemented, our de-partment was consolidated with our parent company and my position was eliminated. It was during the time after leaving the hospital that I explored other options. I had worked with every department in the hospi-tal at some point and I knew that I enjoyed working in the medical envi-ronment, just not as a hands-on per-son.I explored my options and discovered that our local college was offering a new program in HIT. I felt it would be a perfect opportunity to use the skills I already had and expand on them in the medical field. I signed up for the program and graduated in May 2015 with my Associate’s in HIT.

After graduation, our program direc-tor sent emails out telling us about MedPartners training in ICD-10-CM/PCS and how if we did well, we could have a chance at a position with them. I felt that any additional train-ing I could get would be a huge ben-efit to my career, so I signed up for the training.

I missed out on the first session, but was lucky enough to get into the sec-ond session. On the day that I start-ed working at a temporary position through an agency, I was contacted by MedPartners and informed that I was being selected for an offer of a position with the company. I felt truly blessed that I had been chosen for this opportunity and knew that my hard work was paying off, so of course, I took the opportunity. I knew that this was my chance to gain ex-perience in my field, and after doing some research on MedPartners, I ac-cepted the position. I am so glad that I did!

Michelle's MedPartners JourneyMichelle G.

That was additional experience that I probably

wouldn’t be getting elsewhere.

““

This apprenticeship has been a tru-ly positive experience for me. I am learning so much about coding. It provides me with additional train-ing, an auditor-mentor to guide me through my questions, and an op-portunity to work with a great group of people. I have had one live assign-ment, which I thought went pretty well, and that was additional expe-rience that I probably wouldn’t be getting elsewhere. Now that we are a part of the AHIMA apprenticeship program, there is opportunity for even more training.Businesses are very reluctant to hire someone with little or no experience, so the fact that MedPartners was will-ing to take on someone with no ex-perience and provide more training is truly an indication of a dedicated employer that wants to see you suc-ceed. It is not only a benefit for me, the employee, but for MedPartners as well.I am currently pursuing my RHIT cer-tification and hope to secure it soon. After that, I plan to study for my CCS. Eventually, I would like to study more to pursue a career as a cancer regis-trar and get my certification as a CTR.

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Oncology Data Management

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Message from the Director

The 2016 NCRA conference in Las Vegas has come and gone, and once again we are reminded how many great individuals we work with every day, including consultants,

clients, business partners and friends - both old and new! As always, we want to thank the NCRA committee and staff for their assistance before, during and after the conference. They are extremely dedicated and organized, which really makes the conference run smoothly for everyone!

It’s great coming back from NCRA with all the new industry in-formation, and the excitement that comes with meeting your clients face to face and seeing good friends we normally only see once a year! We all came back to the office with a renewed passion for what we do every day and we were anxious to get on the phone to connect with clients and consultants who didn’t make it to the conference.

Our ODM Division released the James Bond themed video “Rogue Cells” prior to the conference and had the video on loop at the booth. It was a big hit with attendees and really empha-sized the point that quality data comes from quality CTRs. We also rolled out our $1,000 referral bonus program (which was extended to employees and non-employees of MedPartners), by holding a drawing for $1,000 cash. The winner was Mary Ann S. from Pennsylvania!

There were many great presentations this year. Melissa R., Senior Consultant, presented multiple times regarding “AJCC TNM Staging,” and Jennifer R., Director of ODM Compliance, hit a home run with her presentation on the final day regarding “How Productive are Productivity Standards?” We are so grateful to have both Melissa and Jennifer on our MedPartners team!

We can’t wait until next April when we head to Washington, DC again for the 43rd Annual Educational Conference (NCRA 2017)! See you there!

Clint GrissomDirector of ODM

CONSULTANT SPOTLIGHTRenee S., BAS, RHIT, CTR

Cancer Registry Coordinator Consultant

Renee has been in the medical field since 1992 and in 2004, she became an RHIT. That same year,

she had the opportunity to apply for a cancer registry position and decided to begin a career in Cancer Registry, versus coding. Just one year later, Renee became a Certified Tumor Registrar.

Renee’s passion for cancer registry work was instantaneous and has only deepened over the last 12 years. There are many accomplishments to Renee’s credit, both professionally and personally. Four years ago, Renee became a MedPartners Consultant, and her professional growth through consulting is extraordinary.

Renee has taken 3 facilities in Maine, Connecticut, and Wisconsin through successful CoC surveys. She works hard and smart, never complaining, and always collaborating, in order to do the very best job for her team, our clients, and our company as a whole.

While committed to producing high quality work and leading others to the same standard, Renee has recently earned her BAS in Business Administration with a minor in Health Administration from University of Maine at Augusta. Additionally, Renee starts graduate school in the fall.

Renee believes that her most important accomplishments are raising her two sons, now 19 and 20, as a single mom, watching them go off to college, and encouraging her younger son’s interest in pursuing his own career in cancer registry. Falling in love with her Prince Charming 8 years ago is a close second and falling in love with her MedPartners family might just be a third.

NCRAVegas was a blast! The National Cancer Registrars Association conference was a huge success.

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CONSULTANT Q&AJennifer R., BS, CTR

Director of ODM Compliance

6. When you select a histology in the cancer registry database, do you type the code and accept any verbiage that appears? In oth-er words, there are many terms within the same code; do you take care to ensure that the ver-biage is correct for the histology identified on the pathology re-port?

7. Can anything you record in a can-cer registry database be directly supported by evidence in the medical record? Do you include dates, documents, physicians, etc. in your text?

8. Can anything you code be direct-ly supported by a state or nation-al standard coding manual? So, if you were meeting with a group of physicians and administrators and had to defend your abstract-ing, can you support/prove that each and every code is correct as stated in a manual? (Not a we-binar, seminar, workshop or co-worker).

Last week was an eye opening week of data quality/QA. MedPartners has some great CTRs!

The QA did, however, inspire a few thought-provoking questions. They are not meant as a test, but to chal-lenge each of you as CTRs to think about how YOU abstract. 1. Is “DZ” an accepted abbreviation

for disease as determined by the NAACCR approved abbrevia-tions?

2. Did you look it up?3. Do you record surgical proce-

dures as they are printed on the operative report?

4. Really? You type the text for the entire procedure as printed on the operative report?

5. Do you look up systemic therapy, or do you assume because a phy-sician states that chemotherapy was administered that the drug administered was “chemothera-py”?

A physician, nurse, research and clinical/administrative professional who were using data directly from a cancer registry database this week encountered these very issues. I saw myself on occasion in one or more of the instances aforementioned.Please remember that there are many others utilizing cancer registry data now (before it has been through QA, corrected and/or edited). Data entered in a cancer database must be as accurate as possible at all times. There shouldn’t be the need for ex-planation, however if an explanation is needed, it should be as simple as referring to a name, section and page in a manual or medical record.These are standard and minimal ex-pectations of any CTR, within any fa-cility, cancer registry and state.Self-examination and commitment to best practices will make you a better CTR and positively affect outcomes.

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Trauma

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Orange is the New Green: A Review of the Orange Book Requirement for Performance Improvement

Robert C., ASN, CSTR, Senior Trauma Consultant

Trauma Performance Improvement Transition Through the Orange Book Era.

Let’s start with some history. When the American College of Surgeons (ACS) formed the Committee on Fractures in 1922, it began a continuous effort to improve care of injured patients. It is now named the Committee

on Trauma (COT) and continues to focus on Performance Improvement and Patient Safety (PIPS) by replacing provider variation with best evidenced stan-dardized processes. Current day trauma activities are administered through Committee on Trau-ma, overseeing a force of Trauma Fellows working to develop and implement meaningful programs for trauma care in local, regional, and national arenas.Trauma services strive to improve the care of injured patients before, during, and after hospitalization, with emphasis on specific trauma-related activities aimed at education, advocacy, professional development, standards of care, and assessment of outcomes. These are circulated through a variety of pro-grams and subcommittees, such as the Trauma Quality Improvement Pro-gram (TQIP) and trauma center verification. The hospital trauma service should be viewed along two separate lines; the first being a clinical path including physicians, nursing, therapy services, social work, and case management, the second being the performance improve-ment functions. This second function consists of the Trauma Peer Review (for provider review) and systems/operational committees (TOPIC, PIPS, etc.). It is supported by a group specially trained in performance improvement relating

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to trauma. This group, generally referred to as the trau-ma administrative staff, consists of a Trauma Program Manager, Trauma PI Coordinator and Trauma Registrar. They are directed by the clinical-based Trauma Medical Director, who must be actively caring for patients within the trauma service. The trauma PIPS function must be co-ordinated with the hospital-wide QI/QA department and should have the same authority, responsibility, and re-spect as the hospital-wide QI/QA program with straight-line accountability to the hospital medical executive com-mittee.One of the underutilized benefits of the trauma perfor-mance improvement function is the capability of viewing a smaller, more condensed version of the hospital’s pa-tient population. As the trauma patient population inter-sects with every entity within a medical facility, the review of the quality of care can be a very accurate barometer of the quality of patient care provided within the hospital as a whole.The primary function of the trauma administrative office is PIPS (Performance Improvement Patient Safety). As PI immaturity is a leading criteria deficiency, it has to be the principal focus of the entire trauma administrative staff. The overriding concept is that if the PIPS process is al-lowed to influence optimal care of the injured patient, then ACS verification will be forthcoming.

The two major areas of impact from the Orange Book changes are found in chapters 15 (Trauma Registry) and 16 (PIPS). One strengthens the quality of the data that performance improvement decisions are based on, while the other identifies core measures that prescribe clinical practice guidelines to be used to review and provide care.The foundation of trauma PI is the trauma registry as ev-idenced by CD 15-3: “The trauma registry is essential to the performance improvement and patient safety (PIPS) program and must be used to support the PIPS process.” There are many criteria requirements addressing the database, however none as essential as C15-3; all oth-ers support this requirement. There are as many varied registry processes as there are trauma hospitals, but all must focus on the database meeting PI needs.Quality trauma registrars are an essential asset to the trauma registry, as the database starts with strict ad-herence to abstracting guidelines that only experienced trauma registrars consistently provide. These individuals come to trauma from varied backgrounds and are in very short supply. If we truly accept that providing resources for optimal care of the injured patient includes utilizing the best registry staff possible, our ACS visits will be pain-less. Until next time “keepum between the ditches” ‘cause the only other option is traumatic.

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Message from Julie, Sue & Robert

Employee Spotlight Sue S., CSTR, CAISS

Senior Trauma Registry Consultant

Sue has been a Trauma Regis-trar for nearly 15 years. She got her start working at a Level I

trauma facility in Des Moines, Iowa, her hometown. During her tenure there, Sue received the Shari Zougras Award for Trauma Registry from the American Trauma Society. Since be-coming a consultant, she has worked for hospitals as a Trauma Registry Consultant in Washington, D.C., Indi-anapolis, Anchorage, and New York.Sue’s career with MedPartners is highlighted by leading 4 hospitals to achieve their goals of becoming Level I ACS verified Trauma Centers in addi-tion to completing her Certified Spe-

cialist in Trauma Registry (CSTR) and Certified Abbreviated Injury Scoring Specialist (CAISS) qualifications. Sue also recently had an abstract accept-ed for poster presentation at the Au-gust 2016 World Association of Medi-cal Law meeting regarding open lines of communication between hospital trauma registries and medical exam-iners.MedPartners has been privileged with Sue’s creation, along with Rob C., MedPartners Senior Consultant, of an education module to coach and develop skills of trauma regis-trars, and a comprehensive educa-tion program for individuals to be-

come trauma registrars. This module encompasses medical terminology, anatomy and physiology, electron-ic medical record, fundamentals of trauma registry, ICD-10 trauma-spe-cific education, and basic chart ab-straction. We are in the process of completing a beta test in New York City for a trauma registrar who start-ed with no experience in trauma reg-istry. When Sue isn’t cultivating and grow-ing the MedPartners trauma busi-ness, she loves cultivating her gar-den, walking her dog and cooking.Thank you, Sue, for all you do!

For many years, a comprehen-sive trauma registrar training course has been missing from

the industry. Many trauma registrars happen into the industry from other fields, and as a result their on-the-job training is diverse. MedPartners is excited to launch an online educa-tional program through MedPartners University (MPU) that can fill the need of individuals with little or no training in trauma, as well as fill in the gaps for a trauma registrar who has been identified as in need of education in specific areas.This course starts out with the basics of medical terminology, anatomy and physiology, major stepping stones in trauma education. It then progresses on to review of an Electronic Medi-cal Record (EMR) to foster familiarity with an EMR for those who have nev-er used one.Fundamentals of Trauma Registry then provides the foundation for

what being a Trauma Registrar en-compasses. This is followed by trau-ma-specific ICD-10 training. The last step in this course is abstraction, which includes general abstracting guidelines as well as some basic chart review.For a person who has some knowl-edge of trauma registry, a typical timeline will be 3 to 4 weeks. The full course requires 3 to 4 months for a person who has no background in trauma registry. For client facilities, the full course can include onsite mentoring as the registrars prog-ress to actual chart abstraction in their hospital environment. If you are interested in enrolling in either the refresher or comprehensive trauma training program, please contact education@medpartners.com.

Julie Bodnar, Sue S. and Robert C.

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