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)

Robin Jones moved to Florida at the tail end of 2017 to pursue a burgeoning career in CDI. And ever since has done nothing but climb the professional ladder.

Leaving behind her home in Cincinatti Ohio and a decorated career in CDI at Mercy Health, Robin started over as Division Director of CDI at AdventHealth West Florida in November 2017. A few years later she was promoted to Director of Clinical Excellence. You might recall that she joined me for an episode of Off the Record in November 2022 to talk about this change.

Three months ago she was promoted again, this time to Vice President of Clinical Excellence & Education. And I knew it was time for a return visit. We get into her flourishing career and the broader CDI program at AdventHealth West Florida on today’s Off the Record.

On this show we cover:

• Promotion to VP of Clinical Excellence and Education and what it entails
• New VP level leadership responsibilities, and what new skills Robin had to cultivate to meet them
• What she had to give up to accept this new role, and the challenges of delegation
• Commitment to hybrid onsite/remote CDI and a unit-based model of coverage
• Winning a Leapfrog Emerald Award, AdventHealth’s emphasis on public report cards and how CDI can make an impact
• Retaining and building the workforce of tomorrow