OHIMA Board President's Thoughts on AHIMA's Leadership Symposium 2019

I had the pleasure of attending my first AHIMA CSA Leadership Symposium in Chicago, Illinois on July 12-13, 2019.  This was 1½ days of networking and information.  The symposium started with Dr. Wylecia Wiggs Harris and Dr. Valerie Watzlaf providing us with AHIMA’s Transformation story: Mission, Vision and Strategy.  The goal is for AHIMA to be known globally as the House of Health Information.  In order to achieve this AHIMA’s broken system has to be revamped.  Some of the challenges that AHIMA faces are:

• Technical Disruption

• Increased complexity of the ecosystem and proliferation of data

• Disruption of the HIM profession

• Financial instability

• Gaps in the infrastructure to support change

• Customer service and usability challenges

Essentially, AHIMA has been a crumbling organization that needs an overhaul.  The new leadership team with the support of the CSAs and their membership will lead us in the direction in which we need to go.  This collaboration will help AHIMA to become better known outside of our industry as well as making the organization a more reliable source to its members.
 
There are three thought impact areas that will bring upon change.  Those areas are:

• Integrity

• Privacy & Security

• Connectivity

These three areas are an immediate focus.  OHIMA will work alongside AHIMA to ensure our alignment with the transformation plans.  I strongly believe that this will be beneficial to all of us HIM professionals.  This endeavor will open AHIMA and HIM professionals up to the world.

The closing remarks by Dr. Wiggs Harris were “Safeguard Your Personal Brand.”  That is what we as HIM professionals need to do. We must embrace the upcoming changes and make sure we make ourselves as marketable as possible in this ever-changing field.

About the Author 

Tonya L. Bates, RHIA is the currently Board President of the OHIMA FY 2020-21 Board of Directors.  She can be reached at tla511j2@att.net.

Are You Ready to Put the Past Behind and Focus on The Future?

The American Health Information Management Association (AHIMA) held its annual Leadership Symposium on July 12-13, 2019. The symposium was an incredible learning experience and engagement opportunity for me as well as for my colleagues. It was amazing to hear about AHIMA’S strategic direction, the healthcare industry and how critical of a part that we as Health Information Professionals play and innovative ideas within the HIM profession. 

I attended the State and Federal Advocacy Overview breakout session presented by Lesley Kadlec, MA, RHIA, CHDA and Lauren Riplinger, JD. This was a panel discussion of professionals who represented Tennessee and Florida. They shared their true feelings of not wanting to be an advocate but accepting the responsibility and falling in love with the work. The goal of advocating in our profession is to make sure our voice is heard regarding issues that are important to us. The ladies also expressed how important the Legislative Aides are and that they bridge the gap between us and either the state representative or senator.

I also attended the Listening Session that was facilitated by Valerie Watzlaf, PhD, MPH, RHIA, FAHIMA and Shawn Wells, RHIT, CHDA. The session had some intense moments when the discussion of why there was only one person selected for President-Elect as well as the criteria for write in candidates. There were also members that felt that the new vision was rolled out to slowly. Overall, the majority felt that we are head down the right path and want to be a part of the new strategy. 

The most impressive part of the symposium was the presentation by Wylecia Wiggs Harris PhD, Certified Association Executive  and AHIMA’S CEO and Valerie Watzlaf discussing AHIMA’s Transformation Story. The ladies discussed the recognition that AHIMA was in an unacceptable state of decline and that it would need to overcome internal challenges and external disruptors to begin transformation and greater relevance and impact. AHIMA’s 2020-2023 Strategic Plan was shared with us, which outlines the steps AHIMA will take to move toward future growth and relevance. The belief is with change we will see the membership grow as well as becoming welcomed by new audiences. If this doesn’t happen, the full value of AHIMA and its members won’t be recognized by the ecosystem, credentials are devalued, our reputation is weakened, and we will suffer a loss of market share. What our members have to understand is that the problems that we have will not be fixed overnight. It will take time and sustained energy and urgency as well as unwavering focus on the vision. Wylecia and Valerie expressed how we need to model vulnerability as a leadership quality and strength. The way  forward will be the strategic planning that was laid out which involves alignment, deliberate choices, adaptive flexibility and brand differentiation. They expressed this vision with transparency and sincerity and I am on board!

The future role for AHIMA is that it will be an organization that delivers an unparalleled experience for it audiences and partners with industry leaders to achieve its vision. This will require strong partnerships among members, staff and external audiences and organizations. This also will include advancing the way accurate quality information is created, stored, protected, accessed and use to improve care at all touchpoints across the health care field. 

Will you be able to put the past behind and focus on the future? Based on this Leadership Symposium, I can and I will! 

About the Author 

Alonzo Blackwell, RHIA is the currently a 1st Year Director on the OHIMA FY 2020-21 Board of Directors, in charge of the Privacy & Security strategy.  Alonzo is a Manager of Health Information Management at Metro Health System in Cleveland, Ohio.

How to Advance Your State, Federal and Regulatory Advocacy Strategy

I had the privilege to attend the CSA Leadership Symposium in Chicago this July with several of the OHIMA board members. This conference which focuses on strategic direction and leadership in the ever evolving HIM profession is a wonderful opportunity to pause and reflect on what it truly means to lead. One important avenue of being an HIM leader is advocacy. Advocacy can be defined as an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions. I appreciate that the definition includes both individual and group because that means we as HIM professionals have a two-fold opportunity to make a difference.

During the advocacy breakout session, it was wonderful to hear what other CSAs are doing in the realm of advocacy. I found that OHIMA aligned with much of what other CSAs are doing such as having an advocacy director on the board, being a member of CQ State Track, implementing a state advocacy day in the fall every other year, and sending members of the board to AHIMA’s annual advocacy summit in Washington D.C each spring. In addition I got some great ideas for things I personally would like to be more educated on as well as items that I feel OHIMA and the Executive Board should think about exploring over the next year. One idea that the state of Oklahoma has been successful at implementing is coffee talks with state representatives and congressmen. These brief and informal meetings discuss what we do and why it is important as well as any current events.

At the individual level, I encourage you to visit AHIMA’s Advocacy Action Center at http://cqrcengage.com/ahima/home to find up to date information about AHIMA’s advocacy efforts before Congress and the federal agencies. Subscribe to AHIMA’s advocacy email list to receive grass-roots action alerts and discover what you need to know on Election Day in the state of Ohio. In order to be as educated as possible research state legislature including who holds leadership positions and when the state legislature is in session. This will help you decipher state legislative priorities and the political climate in which bills are considered. Lastly, volunteer for AHIMA’s advocacy and policy council which will allow you to be a subject matter expert on federal legislation and proposed regulations as well as public policy positions that impact HIM professionals.

At the OHIMA and board level, I am hopeful that we can establish tighter connections by inviting state officials to speak at our annual meeting on a legislative or regulatory topic. Having consistent face to face contact is invaluable. Another item that I am already investigating is identifying a liaison to the board at the Ohio Hospital Association. I feel this relationship will foster a partnership when policy interests align.

To sum up, it is imperative we as HIM professional have our eyes peeled, ears to the ground, and be the voice for the patient’s privacy and health information. Through education and networking we can ensure we always have a seat at the advocacy table.

 

About the Author 

Kristin Nelson, MS, RHIA is the currently President-Elect on the OHIMA FY 2020-21 Board of Directors, in charge of Membership Engagement strategy.  Kristin is a Clinical Instructor at The Ohio State University School of Health and Rehabilitation Sciences HIMS Division.

OHIMA FY19-20 Board President Message

Hello!!  Welcome to the 2019-2020 Ohio Health Information Management Association (OHIMA) New Year!  The OHIMA Board of Directors is preparing for another exciting year. 
 
The continued success of OHIMA is partly the result of the phenomenal volunteers that serve on the Board.  Each Board member brings to the table a great deal of knowledge, talent, skills and passion for Health Information Management as a whole.  The second aspect of our success is you as a member!  Your support, feedback, encouragement and involvement with OHIMA helps to continue to make us one of, if not the best Component State Association.  It is very important to us that you let us know how we’re doing and how we can do even better.  Communication is the key to our continued success.

The Board members are working very hard to bring you another great year.  Each Board member brings a unique skill and mindset that will be noticeable in our endeavors as an organization.
 
I am looking forward to this upcoming year.  I am honored to serve as your President for the 2019-2020 Association year.
 
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”  ~Maya Angelou

Sincerely,

Tonya L. Bates, RHIA 
OHIMA Board President FY 2019-20
tla511j2@att.net

Treating Fractures and Dislocations

“Spotlight on CPT” this month will focus on treatment of fractures/dislocations.  The CPT manual provides two areas of notes that can assist coding professionals when coding treatment of fractures or dislocations.  The first of these notes appears at the beginning of the Musculoskeletal System section of codes.  The other is found later in the section, just before the codes related to casts and strappings, which begins at 29000.

The first set of notes explains the difference between open and closed treatment.  Closed treatment means that the fracture did not require an incision for viewing or treatment.  Closed treatment occurs with or without manipulation or traction.  On the other hand, open treatment means that an incision occurs either at the fracture site or away from the fracture in order to visualize and treat.  Internal fixation or intramedullary nails or rods may be utilized to repair fractures in an open manner.   

Another type of treatment is percutaneous fixation, where imaging is used to visualize the fracture and then fixation is placed.  This differs from the other types of fixation: either internal (plates, rods, pins) or external (an external fixator with pins and device). 

Coding professionals need to recognize that the method of fracture repair (open, closed, or percutaneous) does not necessarily correlate with the type of fracture (open, closed).  For example, an closed Colles’ fracture of the left wrist may require an open reduction and internal fixation.
Manipulation is synonymous with reduction when discussing fractures and dislocations.  Either are attempts to restore proper alignment.  

Casts and strapping codes present challenges for coding professionals.  The first thing to remember is that if any restorative treatment is performed for the injury, the provider will code only for the restorative treatment (i.e. reduction, external fixation, etc.) rather than assign a cast/strap code. 
Casts or strapping should be coded when:

• It is a replacement procedure
• It is an initial service if no restorative treatment takes place 
• Provider only provides initial care (ER doctor)

If a provider performs both the initial cast and then follow up care, they must use a treatment code rather than a cast/strapping code since again these the first cast/strap/splint is included in the treatment code.

If we keep in mind that casts/strappings are considered part of fracture/dislocation care, it makes it easier to decide when to assign those codes. 
   
Now, light has been shed on coding fracture/dislocation treatment.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

In My Rearview Mirror

I am truly fortunate and not because of money, position, or title.  No, I am fortunate because I was able to live in moments of meaning that mattered to the Health Information Management (HIM) profession.  My year as President on the Board of Directors of the Ohio Heath Information Management Association (OHIMA) has been a time of serving the HIM membership in Ohio and advocating for patients throughout the United States.  The entire 2018-2019 year has been a string of moments of meaning for our profession.  It amazes me to look in my rearview and see myself in those moments.  It has been an honor for me to serve the profession I’m passionate about and you, the HIM professionals in Ohio who make our work so meaningful.

I only want to highlight some of the moments of meaning in my rearview mirror:

·         I began my year as President by participating in the 2018 American Health Information Management Association’s (AHIMA) Leadership Conference.  Component State Associations (CSAs) send first-time Board members from each state to listen, learn, and participate in general session and breakout session activities designed to communicate the AHIMA mission and strategies.  CSA participants then go back to their state associations and align their Board strategies with those of AHIMA.  It is important for all HIM professionals to be on one accord throughout the United States.  What a wave of service we create!  The 2018 Leadership Conference was even more meaningful because participants heard from our new AHIMA Chief Executive Officer, Dr. Wylecia Wiggs Harris.  It was thrilling to hear her plan to move AHIMA forward in a direction of usefulness and purpose.  She encouraged us all to participate in strengthening our desire and resolve to work with her to keep the HIM profession relevant, useful, and prosperous.

·         In September 2018, I attended my first AHIMA Annual Convention and Exhibit.  Our national convention begins with the convening of our House of Delegates (HoD) Meeting.  The HoD includes Executive Board members and elected Delegates from each state and tasks them with addressing HIM industry issues while using the parliamentary governing process of making decisions for AHIMA. The following day, the opening ceremony for the Convention was held at the newly completed Miami Beach Convention Center in Florida.  AHIMA was the first organization to hold an event there!  Many were moved many to tears when the Marjory Stoneman Douglas High School Eagle Regiment Marching Band as they performed the music for the opening ceremony.  The remainder of the Convention was filled with nationally known keynote speakers as well as leading HIM professionals facilitating the breakout sessions.

·         During the year, Board members were hard at work on a project that would have a positive impact on the people who live in Ohio and across Ohio’s healthcare industry.  The project was led by Kristin Nelson, your President-elect, and our OHIMA Executive Director, Lauren Manson.  With collaboration and brainstorming sessions during all board meetings, the “What is HIM?” video was created!  It debuted on Monday, March 18, 2019, the first day of the 2019 OHIMA Annual Meeting!  The OHIMA Board received so much positive feedback which prompted us to submit the video for the AHIMA Triumph Award in Innovation!

·         The week after the conclusion of the 2019 OHIMA Annual Meeting, I flew to Washington, D.C. for the 2019 AHIMA Advocacy Summit.  Nearly 200 CSA members were in attendance to advocate for HIM issues on Capitol Hill.  We met with our Congressmen/Congresswomen and Senators bring awareness to and advocate change in legislation.  Our “asks” were to align HIPAA Right of Access with the ONC Health IT Certification Functionality; to extend the HIPAA Individual Right of Access to Non-Covered Entities; to encourage Note Sharing with patients in real time; and to remove language in the 1999 Omnibus that prohibits the Department of Health and Human Services (HHS) from collaborating with HIM industry leaders to develop a unique health identifier (UHI) for a national Patient Matching system.  AHIMA does a phenomenal job coordinating appointments with each congressional office.  It was an incredible experience to see so many HIM professionals representing AHIMA converging over Capitol Hill in its entirety with a unified goal in their hearts.  Our voices were heard because on June 12, 2019, the U.S. House of Representatives considered “a bipartisan amendment offered by Representative Bill Foster (IL) and Representative Mike Kelly (PA) to HR 2740, the Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2020 which seeks to strike language in the Labor-HHS Appropriations bill that prohibits the US Department of Health and Human Services from spending any federal dollars to promulgate or adopt a national patient identifier.” (AHIMA Policy and Government Relations Team; Email, June 11, 2019) 

·         April 26, 2019 marked the 2019 Educator’s Day event in Columbus, OH.  As a first time attendee, I was fortunate to be with the top HIM educators in Ohio.  The presentation by the Commission on Certification for Health Informatics and Information Management (CCHIIM) clarified the near-future changes coming to the certification and recertification standards and procedures of Health Informatics and Information Management (HIIM) programs throughout the United States.  Watching and listening at this event strengthened my respect and admiration for those who are dedicated to teaching, instructing, and mentoring the HIIM professionals of the future.

During this year of serving you, the gifted and talented members of OHIMA, I have experienced so many emotions; inspired, excited, grateful, and passionate are just a few.  Mostly, I am thankful to each of you for allowing me to represent you during the moments of meaning this year.  Take good care of yourselves and each other.  Thank you!

Krystal

Krystal Phillips

2018-2019 OHIMA Board President

About the Author

Krystal Phillips, RHIA, CHTS-IS is a HIM coder at OSU Veterinary Medical Center and an adjunct professor at Columbus State Community College in Columbus, Ohio.  Krystal currently serves on the OHIMA 2018-19 Board as President and Delegate. 

Juggling Definitions for Sepsis

by Adriane Martin, DO, FACOS, CCDS

Sepsis’ complexity and frequent definition updates propose challenges for CDI and coding professionals but it’s also a gray area in clinical medicine.

The most recent definition of sepsis, also known as sepsis-3, was proposed by the Third International Consensus Definitions Task Force in January of 2016 as “a life-threatening organ dysfunction resulting from a dysregulated host response to infection.” A change of greater than or equal to 2 from the baseline Sequential Organ Failure Assessment (SOFA) score was noted to be representative of organ dysfunction. This group also recommended that the terms septicemia, severe sepsis, and sepsis syndrome be eliminated from the definition.

The task force went on to outline septic shock as sepsis with persistent hypotension, despite adequate fluid resuscitation, requiring vasopressors to maintain a mean arterial pressure greater than or equal to 65 mmHg and a serum lactate level greater than 2 millimoles per liter (mmol/L). The Third International Consensus Definitions Task Force seems to have clearly defined sepsis and identified the SOFA score as a tool to determine the presence of organ dysfunction.

Sepsis confusion

So why the confusion? The Third International Consensus Definitions Task Force’s view on sepsis has not been adopted by all societies, physicians, or payers. Many of these groups and individuals still hold to the sepsis definition put forth by the 2001  International Sepsis Definitions Conference, also known as the sepsis-2 definition.  

The definition of sepsis was originally published in a 1992 article based on discussions from the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. In this consensus opinion, sepsis was defined as a clinical syndrome in the presence of infection and a systemic inflammatory response (SIRS) unexplained by anything other than infection.

In 1992, the criteria to define SIRS included two or more of the following: fever/hypothermia, leukocytosis/leukopenia/bandemia, tachycardia, or tachypnea.

In 2001, the expansion of criteria used to define systemic inflammation was introduced, which included the original four SIRS criteria plus several others, including altered mental status, hyperbilirubinemia, and thrombocytopenia. Severe sepsis was defined as sepsis with associated organ dysfunction. Septic shock was defined as a sepsis-induced hypotension, despite adequate fluid resuscitation, along with organ dysfunction or hypoperfusion abnormalities.

These two different consensus definitions are not mutually exclusive, and often the diagnosis of sepsis is supported by criteria from both consensus definitions. The real issue becomes what happens when the diagnosis of sepsis is met by one consensus definition but not the other.

From a coding standpoint, the 2019 ICD-10 CM Official Guidelines for Coding and Reporting state that “the assignment of a diagnosis code is based on the diagnostic statement that the condition exists. Code assignment is not based on the clinical criteria used by the provider to establish the diagnosis.”

Based on this guideline, it would seem the criteria used to define sepsis should not be a point of dissidence for CDI or coding professionals but , this is not the case since payer requirements vary.

For example, CMS supports the sepsis-2 consensus and has not adopted the sepsis-3 consensus definition. On the other hand, some commercial payers and non-traditional Medicare payers are using the sepsis-3 consensus definition which leads to confusion and potential denials

CMS’ Early Management Bundle, Severe Sepsis, and Septic Shock, which is a process measure related to quality of care initiatives represents another challenge. The intent of this sep-1 bundle is to ensure healthcare providers follow  best practices for patients with severe sepsis or who have diagnosis for sepsis with criteria for severe sepsis present.

The sep-1 bundle uses the sepsis-2 criteria to establish the presence of severe sepsis. Using criteria to define sepsis/severe sepsis other than those outlined by the sepsis-2 consensus might result in the bundle not being appropriately implemented therefore negatively affecting performance under this measure.

The sepsis controversy will continue as long as there is more than one definition of sepsis being used by payers, institutions, and providers. Communication amongst coding teams, CDI specialists, and providers, is a must to ensure accurate capture and reporting of sepsis.

Editor’s note: This article originally appeared in JustCoding. Dr. Martin is vice president of Enjoin in Eads, Tennessee. She has provided clinical insight and education as part of the pre-bill review process since 2014. She is board-certified in general surgery, assists with documentation improvement, and provides specialty-to-specialty physician education in areas related to ICD-10, with a focus on surgical procedures and ICD-10-PCS. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.

Copyright Association of Clinical Documentation Improvement Specialists (ACDIS).  Article reprinted with permission.