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

The presentation will detail: Policies Procedures Productivity expectations How to manage relationships among the team and with providers Successful management of telecommuting staff Electronic Health Records Economic Pressures CDI work-at-home options

About Kaiser Permanente Northern 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 Permanente’s 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

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

Back to the Drawing Board ? ? Who will do the job? Where will the work be done? Consider telecommuting as an option Considerations: Leadership approval Technological requirements Staff satisfaction Go green! Why should the work be done this way? How will you support this model? ? ?

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.

You Can Establish a Virtual CDI Function in Any Organization

Getting Started Lay the Foundation Telecommuting policies and procedures Equipment Home office assessments Establish the Framework for High Performance Performance expectations and guidelines Signed telecommuting agreements Performance management/ improvement processes 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

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

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

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

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 Control the Things You Can Foster What You Can’t Control Staying on Course Building and Maintaining the Team

Staying on Course Managing Across Distances Management Adjustments Adjust management-to-staff ratio Clear, realistic performance expectations Make the extra effort to connect with individual staff members 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 Performance and Data Sharing Work hours Identified performance metrics Performance data Retention Strategies Career paths Recognition programs Incremental work-at-home increases Peer-to-peer kudos cards Manager-designated awards

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

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

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

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

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 Places Proximity to home facility The Right Sponsorship From regional leaders From local leaders The Right Systems & Support Downtime procedures IT escalation plan The Right Performance Management System Performance feedback Ongoing communication Data sharing Remote education and mentoring Implement staff ideas for improvement

The Right People High level of personal accountability Professional Autonomous Chart review experience Experience and success with high-volume/high-stress 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

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

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

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. Questions?