Here we are, at the end of the year. And the end of another season of Off the Record.

For reasons that will soon become clear, I wanted to wrap up 2024 by pushing myself out of my comfort zone. Because this episode is about personal growth.

So here I am, doing my first ever solocast.

I bring you the Top 5 lessons learned over the year of Off the Record. These apply to mid-revenue cycle leaders, our core audience for #OTR, but they’re broad enough for anyone to adopt.

This is a tidy episode, just 26 minutes of distilled wisdom from several guests that I was honored to host.

Enjoy, Merry Christmas and Happy Holidays, and I’ll see you in 2025.

Last month I wrote a post about the four stages of a career, using the analogy of seasons. I was inspired by the wonderful fall weather I was experiencing while on a walk here in New England, but also by changes I have been experiencing in my life and how these have caused me to re-evaluate what’s important in my career.

The post got a good reaction, including from Nicole Fox, Associate Chief Medical Officer, Medical Director of Pediatric Trauma, Medical Director of CDI, at Cooper University Health Care. Which led to this show.

Nicole and I are in the “fall-ish” of our careers. Which might sound like we’re getting ready for pasture, but not really. I’m 51 and Nicole is 48, so we have many more years to work—but our priorities are changing. You might say, they are better aligning with the new people we are becoming, as human works in progress.

Nicole has done a lot with career coaching, both as recipient and mentor, and we get into all that on today’s show—and bare our souls a little bit about what is holding us back.

This was a terrific conversation with an amazing person and I suspect you’ll enjoy it, and maybe come away a bit more reflective about your own career and priorities.

On this show we discuss:

• An update on Nicole’s work as a pediatric trauma surgeon and hospital executive—and the need for changes

• Her experience with a career coach and what she learned about herself

• Career “saboteurs”—how do you discover them, and what can you do to diminish them? I highly recommend taking the free assessment linked below (my top 3 saboteurs are avoider, hyper achiever, and pleaser)

• Is it possible to shape your career, and how does that look in practice?

• The “seasons” of a career and using it as a framework for discovering what is most important (with an emphasis on the fall season)

• Nicole’s forays into coaching and mentorship, and prioritizing health and work-life balance in a demanding clinical career

Show notes

• Four stages of a career: https://www.linkedin.com/posts/brian-murphy-13800b11_i-love-the-fall-especially-here-in-new-england-activity-7253050994937212932-2QFY?
• Career saboteurs assessment: https://www.positiveintelligence.com/saboteurs/

With 23 years and counting in CDI, Rhoda Chism has seen a lot. The rise of new regulations and reimbursement mechanisms, and the advent of new technologies that have radically transformed chart reviews.

Rhoda has not only weathered these changes and navigated the turbulent waters, but remains as warm and personable, and pro-person, as you will ever meet.

But not anti-technology.

Today she is the Director of Clinical Excellence and Adoption for the software company Iodine, a new position she’s held for just two months. But I think she could be called Chief People Officer. We get into the blending of human and machine, discussing the following:

• Rhoda’s journey into healthcare and nursing at the tender age of 19.

• The transition from bedside nursing to CDI in 2001

• Melissa Varnavas and the lasting impact of a simple message of encouragement and belief

• Using authentic, personal stories to communicate difficult CDI concepts and education, including heart failure and AKI

• How technology has radically transformed CDI over the last two decades

• AI driven technology as human amplifier, not replacement, and the importance of emotional intelligence in CDI work

• Career advice for young professionals in a world of rapid change

Karen Elmore is living in denial(s).

Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she’s had to deal not only with human payers, but artificial intelligence denials as well.

Karen’s organization has worked hard to stem this never ending tide, and found some success with uniform organizational clinical guidelines and consistent education and engagement.

We talk denials, appeals, preventing future denials through provider education, and Kansas City Chiefs football (still undefeated as of publish date), on this episode of Off the Record.

On this show we cover:

• Karen’s unique role as program manager for CDI at BJC, including responsibilities for physician education, engagement, and denials prevention

• Typical denials for sepsis, respiratory failure, and malnutrition: What payers are using for ammunition

• What payers are the worst offenders, and particularly creative (and egregious) tactics

• AI denials—how do you spot them, and combat a machine?

• Provider engagement strategies and relaying denials back to physicians

• Legitimate reasons for denial and ongoing documentation shortfalls

• Karen’s Kansas City Chiefs obsession—inside an average Sunday in the Elmore household (it’s crazy)

Following is part 2 of our interview with Revka Stearns, who joined us on Off the Record to provide an update of her first eight months on the job as a new inpatient coder.

If you haven’t listened to part 1 I’d recommend starting there, since we pick up mid-conversation. On this show we cover:

• The mechanics of working as a remote coder. Workplace setup and helpful recommendations
• Dealing with the physical challenges of working at a desk all day and breaking up the routine
• Unexpected consulting work coming her way ... from Canada!
• Unfiltered conversation about social media. Revka’s take on the social media landscape, dealing with negativity, dispelling persistent myths (there’s no coding jobs! It’s all being outsourced! Yes there are, and not it isn't—Revka is proof), and being a consistent, positive, and helpful online presence.
• Keeping sane through work-life balance, and her latest Off the Record Spotify playlist entry

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)