Off the Record with Brian Murphy

What the heck is a cancer registry professional?

How can they impact quality (and even revenue, indirectly) in your hospital?

And why do Harley Davidson and Indian owners despise each other (and is it possible to like both brands)?

If you’re at all curious about these incongruous questions, the latest episode of Off the Record has answers.

This week I’m joined by the one and only Ren Garcia, Oncology Data Manager and Registry Quality Analyst for Norwood. We cover:

Why your hospital needs oncology and trauma registry professionals

The CTR (Certified Tumor Registrar) credentialing exam—what it is, what the test is comprised of, and why this profession might be a calling for you

Why Maine is such a great state (beer and lobsters? Enough said.)

Motorcycles and the motorcycle lifestyle

This is probably the most fun I’ve had hosting an episode of Off the Record, and is definitely the most I’ve learned while conducting an interview (I knew nothing about the cancer or trauma registry professions prior; now I do, and I’m a fan). Ren has an infectiously likeable personality: Warm, talkative, curious, and above all, interesting, with an utterly unique origin story. When Ren’s father suffered a debilitating injury she found herself needing to step in and run his fencing company, a young woman with no management experience in a male-dominated industry.

Not easy, but that experience helped shape who she is today.

We cover all of these stops, spanning an interesting career with many unexpected detours and turns. Eventually leading to a career that seems tailor-made for Ren Garcia: One you can’t imagine her not doing.

So, listen in. Learn something new, have some fun. This episode goes off the record, even for Off the Record. Then get your motor running, and head out on the highway. Just maybe not to Maine this time of year though, a bit cold for that.

HIM professionals and nurses can get along, after all.

There has long been a divide in the clinical documentation integrity (CDI) profession over who can/should serve in the CDI role. Though it has lessened with the passing of years, that divide still exists today.

Recent ACDIS survey data shows that 72% of CDI professionals are nurses. Nothing wrong with that; nurses make wonderful CDI professionals. But I know of many fine CDI professionals with HIM/coding backgrounds who have also succeeded in the role. As well as MDs, even the occasional respiratory tech or CPHQ.

With this episode of Off the Record I wanted to prove that an RN and an RHIA can not only exist side-by-side, but get along, quite amicably. As friends, even.

Turns out I did not have to look far or dig too deeply.

At a reception at the ACDIS national conference earlier this year I ran into Andrea Smith and Rebecca McDade. I made my way over to their table, and a half hour of conversation (and a bit of wine) later, invited them on to a podcast that did not yet exist, except in my mind. What struck me was that they were friends, despite their very different backgrounds.

Five months later I had them on Off the Record. And can now bring you this show, and revive a part of the conversation we had that evening at ACDIS.

Andrea is the CDI Director at Washington Regional Medical Center in Fayetteville, Arkansas, a nurse who moved into CDI eight years ago. Rebecca meanwhile is Director of Revenue Cycle Integrity for the same organization, and an RHIA. Despite their differences they work very well together, complimenting each other’s unique strengths and skills in adjacent roles (note: Rebecca is not directly in CDI but works closely with that department).

We cover the lay of the land at Washington Regional Medical Center, including the staffing of its CDI and coding programs, metrics for success, and assistive software. Then a day in a life of each, their roles and responsibilities, and respective origin stories.

Things get interesting when we talk about the historical RN/HIM divide, how they’ve bridged that gap, and the unique strengths each profession brings to the table (this starts at about the 37-minute mark of the show).

Hosting this conversion reinforced that we can get along, at least some and perhaps most of the time, if we’re willing to acknowledge differences and be generous. Andrea and Rebecca are proof.

Twitter is an … interesting place right now, due to the purchase of the platform by the lightning rod known as Elon Musk.

Love or hate the platform, there is some great content being produced in some corners. Light, rather than heat. Which speaks to me.

One such lantern-bearer in the storm is Dr. Robert Oubre, my guest on this week’s episode of Off the Record.

Dr. Oubre is a hospitalist and part-time CDI medical director for 280-bed St. Tammany Parish Hospital in Covington, LA. He’s up to his neck in patient care, and to a lesser degree CDI and coding issues.

But what really makes Dr. Oubre unique is the social media following he’s built. And not through Tik Tok dance videos or cutting memes, but sharp, well-written threads on Twitter. Material that includes 3 tips for writing a better SOAP note, which as of today has received over 5,000 likes. Bulletproofing your respiratory failure diagnosis. And simple, effective strategies for combatting denials.

Mixed in among the education are fun and revealing personal posts about family (Oubre is a father of two, and a third child on the way), work-life balance, burnout, self-development and more. Which makes it all feel real and personal, and well-rounded.

As a result of his generosity and ability, this “CDI guru of MedTwitter” caught my attention. As it turns out he was a terrific podcast guest as well. And accommodating. He’s a busy dude, with a full patient caseload, a family, and a growing online presence. When I needed to reschedule our first recording after experiencing my first case of COVID (whose aftereffects I’m still battling) Dr. Oubre made it happen.

If you’re looking to build a brand, publish good content, and explore a side-hustle, this episode has all that in it, too.

I think it was worth the wait. I’ll let you decide. Subscribe and listen on your favorite podcast player (Spotify, Apple Podcasts, Amazon Music).

Follow Dr. Oubre on Twitter: https://twitter.com/Dr_Oubre

What prompts a nurse working at the bedside to get into clinical documentation integrity (CDI)? Long, draining shifts, and burnout, are among a few that I’ve heard. Others include a desire to put their clinical acumen and physician communication skills to work in a different, less physically demanding capacity, but one that still engages the intellect.

Robin Jones’ origin story is one worth hearing. It’s powerful, the most moving I’ve heard of to date on Off the Record. I won’t spoil it any further, you’ll have to listen yourself.

This was a great interview. I’ve known Robin for many years, and we get into some good topics and conversation.

While the move these days is toward 100% remote CDI and coding, Jones, Executive Director of Clinical Excellence for the 13 hospitals in the West Florida Division of AdventHealth, spearheads a quality-focused program, one that places a particular focus on Leapfrog and other quality measures. To help with these intensive initiatives, its CDI program is hybrid and maintains an onsite/physician-facing component.

Although she’s left the bedside behind Jones has not abandoned nursing—far from it. In fact, she oversees all clinical education in the organization’s West Florida division, including its graduate nurse residency program. She is actively giving back to the next generation of caregivers.

We cover her decision to pack up and move halfway across the country, from Ohio to Florida. That decision meant a minor recent brush with Hurricane Ian. We discuss introversion vs. extroversion (introverts—shout out!) and empty nesting.

Finally, Jones is a massive Cincinnati Bengals fan, who may or may not think Joe Burrow may be our nation’s president one day. Or maybe that was the host egging her on. I don’t recall.

What’s most interesting about Jones’ football obsession is not the Xs and Os, or painted game face, but the fact that she uses this great game to teach lessons and lead a diverse group of people. She offers up some great advice on leadership, giving me three bullets with practiced ease that each have a lot behind them.

Give episode 5 of Off the Record a listen, and please let me know what you think of this episode and the podcast in general. Guest ideas and other suggestions welcomed.

“I like unique. Tell me something I don’t know.”

That certainly describes this week’s guest.

Tracy Boldt is the Director of CDI and Utilization Management at Essentia Health in Minnesota.

Since September 2016 Boldt’s role has included providing leadership, direction and support in the development and management of CDI and UM at multiple Essentia Health sites. In this role Boldt collaborates closely with the utilization team, physician partners, and coding manager system wide.

Recently she helped implement a successful outpatient clinical documentation improvement program with an emphasis on Accountable Care Organization (ACO) partnership, risk adjustment, and population health.

Tracy’s path into healthcare did not follow a straight line. Admittedly she was not the most dedicated student. She started as a hairdresser before she got (mostly) serious, and healthcare became a calling.

We review Tracy’s career stops in nursing, CDI, a detour into consulting (for a firm, and then launching her own personal company), and her current entry into Essentia.

Tracy also has a rich personal life. I’ll go ahead and plug Cedar Point Resort and Campground, not only because I’m hoping I can parlay some free advertising into a discounted cabin, but it’s also an incredibly interesting chapter in her life that has broader applicability to effective project management and staff leadership.

If you want to learn how to succeed in a challenging role, listen to people that struggled and overcame adversity. And then, having succeeded, have refused to settle, but continue to seek out new ways to create impact.

That certainly describes Tracy.

Oh, and we discuss KISS. Everyone’s favorite face-painted 70s rockers. Talk about unique.

Enjoy!

Tami McMasters-Gomez, BS, CCS-P, CDIP, CCDS, (MHL), is the Director of CDI and Coding Operations at UC-Davis Health in California. She has ultimate oversight of 80 employees, a team that is busy querying, coding, and abstracting data for a huge organization that includes its flagship 646-bed multispecialty academic medical center.

Tami is a bright light in the field in all respects, and the accolades have been rolling in. This past May she was given the Recognition of Professional Achievement Award from ACDIS at its national conference in Orlando, and the year prior her organization won ACDIS’ first-ever award for Diversity in CDI award, as well as similar recognition for its efforts in diversity from Forbes Magazine.

It’s hard to believe she ended up in this position after initially studying to be an event planner at Sacramento State University, majoring in marketing and communications and ultimately earning an event planning certification. But the world works in mysterious ways, and a part time job as a file clerk at a small rural hospital ultimately led her to health information management.

UC Davis Health is the real beneficiary of that decision. According to a 2010 study, UC Davis Health generates more than $3.4 billion in annual economic output and more than 20,000 jobs. The organization is ranked in 9 specialties in the U.S. News and World Report Best Hospitals—data that of course is derived, in part, from Tami’s work.

We cover Tami’s stops over 30 years in healthcare, including 17 (wow) in CDI. Along the way we discuss its outpatient CDI program roll out and current progress, UC Davis’ decision to discontinue DRG reconciliation (and why you might want to follow its lead), and also its strong commitment to diversity, both in the CDI/coding departments and organization-wide.

Get inspired by an HIM professional who is doing cutting-edge work and building a CDI department that is committed to diversity of race, gender, ethnicity, and professional backgrounds (RN, HIM, MD, and more).

We cover a lot more too, including the reality of CDI technology and how smart it actually is (UC Davis is a big adopter in this space, and is currently piloting provider-facing tech), tips and suggestions for progressing from coding into leadership, the importance of CDI-coding collaboration, and the usual fun asides.

Despite her considerable responsibilities Tami hasn’t given up on her event planning dreams, and is actively looking to buy a wedding venue in California. I can neither confirm nor deny if the weddings will be CDI themed. Stay tuned.

Take a trip with me to the west coast for episode 3 of Off the Record. I hope you enjoy it.

To say LifePoint Health is a large healthcare system is like saying Nashville has a few good country music bands. Per its website, LifePoint’s healthcare delivery network spans 29 states and includes 62 community hospital campuses, 33 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum including acute rehabilitation units, outpatient centers, and post-acute care facilities.

With that size and diversity comes incredible complexity and challenges. These include multiple EHRs (Epic, Cerner, MEDHOST, Meditech) and upwards of 16 different versions of said EHRs, including 9-10 versions of Meditech alone.

Fortunately Angie Comfort is there to help run the show.

How does she manage it all? How did she go from coal miner’s daughter in the Appalachian Mountains of Virginia (no relation to Loretta Lynn) to Assistant Vice President of HIM Operations where she oversees a staff of 300? And find time to work on her Doctorate’s in Business Administration, in progress? You can’t call her Dr. Comfort—yet. That’s coming soon.

We talk about an incredible career arc that has taken her from reviewing ER documentation for missing signatures, to outpatient coder at Stuttgart Regional Medical Center, to Community Health System’s very first coder at the corporate office (where she ultimately trained 600 coders in ICD-10), to Senior Director of HIM Practice Excellence at AHIMA, and finally to her present role.

With many fun side detours along the way, as I’m wont to do.

Angie has seen it all but is not stuck in the past—80s nostalgia aside—and thinks remote coding and CDI work has been a blessing for the industry. She talks about what got her to make the leap to leadership, including the help of a mentor. Hers is a story of paying your dues in a remarkable climb to the top—and using her influence to give back, including in her personal life with The General Federation of Women’s Clubs.

What is Angie’s EHR of choice and, just as importantly, what is her favorite Def Leppard song and first ever concert?

Tune in to find out.

Susan Fantin, MSA, BSN, RN, CCDS, CDIP, is the Vice President of Integrated Care Management for McLaren Health in Grand Blanc, Michigan.

A one sentence description that is a woefully inadequate descriptor of what she does.

All of CDI, case management, utilization management, and denials run through Susan’s capable hands. Think, massive responsibilities. A staff of more than 300. Every new initiative, including a recent system-wide reorganization that aligned case management and CDI under one roof, despite the obstacle of multiple EHRs. Impressive stuff. 

We don’t know how she finds the time to sleep. She admits she’s working on that.

We talk about McLaren’s program and metrics for success before turning to her career and an early hair-raising nursing experience, her rapid ascent up the ladder at St. Joseph Mercy Health System, a detour into consulting and what it taught her, then present day challenges and the importance of mentorship.

Oh, and MTV, back when it used to play music.