Off the Record with Brian Murphy

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:

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:

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:

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:

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:

One of the more promising developments I’ve seen over my career watching the CDI profession bloom is the creation of the CDI educator role.

CDI is often labeled by its critics as reactive, sending queries to the provider after he or she has already documented in the chart. This is an integral but limited part of CDI work.

The main work is getting physicians to document correctly in the first place.

It’s the kind of work being done by Kalee Vincent, my guest on today’s program. Kalee is the CDI Educator for WVU Medicine, West Virginia’s largest health system and largest private employer comprised of 23 hospitals.

Kalee joins me to discuss her path into healthcare, her important work and impact as an educator, and some proven strategies for teaching documentation lessons that stick with providers.

Listen in as we discuss:

Sepsis it seems is always in the news, never far from anyone who works in CDI or coding circles. And here we are again, back in the headlines due to its inclusion in the Office of Inspector General (OIG) Work Plan.

Sepsis has been discussed so much due to the complexity of disease, the cost of treatment, complexity of coding, and increased regulatory spotlight. What else is there to say? But with it back in the spotlight I wanted to turn from the usual insular conversations in the mid-revenue cycle to someone working on the front lines of care.

Amanda Hart is an ED nurse and a sepsis clinical nurse specialist at Tower Health, a regional integrated healthcare system based out of Pennsylvania. She spends a substantial amount of time battling this deadly disease, and her work has much to offer anyone who works to get it accurately documented and coded.

On this episode we discuss:

• Amanda’s background in the military and EMS, path into nursing and eventually the ED

• Her role as sepsis clinical nurse specialist and how it overlaps with CDI/coding

• Pathophysiology—clinical indicators of sepsis and what makes it such a deadly disease

• Problems inherent in lack of uniform definitions, what Tower Health uses, and her own take on Sepsis-2 vs. Sepsis-3 debate

• The importance of early screening, including processes, technologies and people. Are EHRs and alerts helping or hindering?

• Tower Health’s home-grown protocol that resulted in a 32% reduction in relative mortality rate in non-POA cases.

• Life on the front lines of care and how it changed Amanda as a person