Off the Record with Brian Murphy Brian Murphy

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:


What is a trauma registry professional and why should an organization invest in them?
The nitty-gritty of the role including data abstraction process, record review and productivity expectations
American College of Surgeons and facility specific requirements, including trauma center designation levels
Revenue implications including the use of trauma activation HCPCS code G0930
Arp’s fascinating origin story, from nurse to national consultant
What makes for a good trauma registrar--desired background, skills, and mindset, and Arp’s advice for folks looking to break in
Finding meaning in her work (no shortage of that)

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:


Richelle’s story from RHIA to JD. How difficult was the bar exam?
Becoming an entrepreneur and starting her own law firm
Most frequent type of healthcare cases: Clinical validation audits and DRG validation
The coding guidelines she sees most frequently ignored or twisted to the payer’s benefit, and other shady tactics
What do healthcare organizations make too big a deal out of—and what are they not worried about enough?
Qui Tam and the recent spate of cases initiated by organizational whistleblowers, in particular Medicare Advantage organizations
Managed care contracting: Legal issues around contract negotiation, how claims get paid, timely filing, and payment policies. How quickly must plans respond to appeals, and should you put a diagnosis definition in a payer contract?
What advice would she give to someone who is in HIM and considering a career in law—what does she know now that she wishes she knew then?

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:


Shifting from CDI chart reviewer to educator in January 2023—challenges and rewards, advice for those considering a similar move
CDI as an RHIA: Addressing misconceptions about clinical knowledge as a non-nurse (Kalee dissected a cat in college—for real—as part of her studies)
Keys to being a good physician educator: What works in a 1:1 setting vs. a medical staff meeting, how to get time with busy docs
Lots of interesting examples where gaps exist and education is needed—CKD, sepsis 2.5, ASPEN, shock, heart failure and more (Kalee came PREPARED)
New WVU malnutrition coalition: Why this initiative began, what the work includes, and her role on the coalition
Hamming it up with ex-ACDIS directors, what downtime in the Vincent household looks like, and her Off the Record Spotify playlist selection (Taylor Swift has cracked the lineup—you knew it had to happen sooner or later)

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

If you’ve ever been a member of ACDIS you’ve almost certainly encountered Dr. Trey LaCharite’. ACDIS advisory board member? Check. Regular columnist for CDI Journal? Check. Author of the CDI Field Guide to Denial Prevention and Audit Defense? Check. Speaker at the physician advisor pre-conference every year since (at least) 2010? Yes, put a checkmark there, too.

Trey is the Medical Director for CDI and Coding and Clinical Associate Professor for University of Tennessee Medical Center. He’s got the holy trinity of credentials—a MD, plus CCS and CCDS (and others). On this show he brings his unique clinical and coding perspective, combined with real-world applications and trademark tell it like it is/no-nonsense perspective, in a candid interview.

Note: This show was recorded prior to the 2024 ACDIS conference in Indianapolis last week, where Trey presented the session “Beyond Problem Lists: How to Document Is Just as Important as the What.”

On this show we discuss:

• Trey’s path from hospitalist to CDI

• Problem lists: How UTMCK uses them and keeps them updated

• Denials and creating a “defendable narrative” using the patients’ clinical story

• Trey’s opinion on sepsis-2 vs. sepsis-3, now back in the news due to the recent OIG Work List update

• What ACTUALLY resonates with MDs, regarding the eternal question “what’s in it for me”?

• CDI pet peeves, proudest career accomplishment, things to do in TN, and an unexpected OTR playlist addition

Small community hospitals are the backbone of healthcare for most of the country, even today in this era of sprawling healthcare organizations and massive mergers.

But while they’re critical to the health of our nation, resources are often scarce, and CDI is no exception.

Jennifer Cummins, BSN, CCDS, is one of just two CDI professionals covering a 222-bed not-for-profit community hospital in rural Kentucky. Advanced technology and sophisticated AI are not in her toolbox, but that doesn’t mean Jennifer doesn’t take pride in her work.

In fact, she and her colleague are making a big impact with some old-school methods. Their CDI work helped the hospital earn the title of one of the 100 Greatest Community Hospitals in America. Proof that determination, creativity, and teamwork are still more important than tech, even in this day and age.



On this show we cover:

• Jennifer’s origin story—ICU and ER nurse, finding her way into CDI with the help of a nursing colleague

• CDI program--when it began, focus of reviews, and success metrics

• Conducting chart reviews with a basic encoder, books, creativity, and the help of other departments

• Logistical challenges as a small community hospital, including weekend coverage and PTO in a department of two, and rising to meet new initiatives with limited resources

• Expansion to mortality reviews: Identifying the need, process, early successes, and conducting deeper, more intensive reviews

• Fun things to do in Kentucky (aka., Bourbon Trail). Plus Jennifer’s addition to the Off the Record Spotify playlist (Kentucky bluegrass? Find out)