Back in January I hosted newly minted medical coder Revka Stearns. For someone so new to the industry, Revka has made a big impact by the act of sharing--documenting her journey in detailed and open fashion on LinkedIn and Facebook, and a half dozen podcasts and programs.

At the time she was on the show Revka had literally been on her first job for about 3 weeks. Eight months later I asked her to come back for an update and share her successes, challenges, and unexpected side-ventures.

Revka has many strengths—smart, hardworking, diligent--but one of them is effective use of social media, creating a model for how I like to see these platforms used (and unfortunately often aren’t).

But she’s also had her share of struggles. Coding is hard.

This was a bit of a longer interview so I split it into two parts. On part 1 we cover:

• Eight months on the job as a first-time medical coder
• Specific challenges she’s encountered, including:

1. Making sure the organism causing an infection is clearly linked to that infection through documentation
2. Ensuring documentation is carried through to discharge, beyond the provider just copying and pasting
3. Recognizing query opportunities

• The reality of learning: Taking one step forward and two steps back
• Most rewarding aspects of the job
• What she knows now that she wished she knew back in January

With 25 years’ experience in medical/surgical, critical care, and emergency department medicine, Tonya Motsinger has seen her share of crises.

COVID-19 was a crisis of a far larger scale.

The pandemic wreaked havoc not only on patients, but her CDI department, resulting in staff shortages.

Today OhioHealth’s System Director of Clinical Documentation Integrity has come out on the other side stronger. You might even call her, a survivor.

We discuss lessons on staff retention, remote onboarding, and some great work she’s done to improve her organization’s Vizient clinical quality rankings. On this show we cover:

• OhioHealth’s CDI department including basic KPIs and department objectives, and Tonya’s role as System Director.

• Impact of the COVID-19 pandemic and department staffing devastation

• Putting things back together: Salary increases and short-term weekend coverage plan

• Challenges of remote orientation for new CDI staff

• All things Vizient: New Vizient calculator, CDI review nuances, and impact on actual organizational quality

• Onboarding a new hospital that’s never had a CDI program (I know, such places apparently still do exist)

• Being a new grandmother and her addition to the Off the Record Spotify playlist

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)