Improving the Documentation QA Process, Actionable Strategies to Reduce Burnout w/ Christine Munna

Erik Sunset: [00:00:00] Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, of course, we deliver healthcare solutions that take the pain and cost out of broken workflows. From the ASC to the clinic to on call at the hospital, DocBuddy helps providers access, create, and move data seamlessly all from the point of care You can learn more about DocBuddy and all of our solutions at DocBuddy.com.

Erik Sunset: Today, we’ve got a special guest. We’re joined by Christine Munna. Christine is the Director of Quality Assurance and Staff Development at Abode Care Partners. And I should add, also a longtime DocBuddy user as well. Christine, thanks so much for joining us.

Christine Munna: Yes, thank you for having me.

Erik Sunset: It’s good to chat with you again. I know we got together just a few weeks ago to do, um, a little bit of a different type of video.

Erik Sunset: So really glad to have you on the podcast. Today, I know there’s a few different things that we wanted to talk about that are right in your wheelhouse as that Director of Quality Assurance and Staff Development with Abode Care. But [00:01:00] before we get into it, is there anything else the listeners should know about you?

Christine Munna: Um, I guess I would just add to my background. Um, you know, I, I am now our, uh, director of quality assurance and staff development, but I started, um, as a primary care nurse practitioner, um, specifically chain, uh, trained in geriatrics, um, and have worked in many different settings. Um, but, um, really most recently and, um, majority of my experience in the skilled nursing, uh, setting.

Erik Sunset: Yeah, and I know it comes at you thick and fast. Abode Care is a large organization with a lot of patients to keep happy and healthy. So thanks for carving out a little bit of your time to join us today. And one of these topics that’s right in your wheelhouse is around, uh, quality assurance or QA ing.

Erik Sunset: Provider documentation. Um, let’s start by by peeling that back a little bit. What are some of the [00:02:00] keys for you, uh, whether you’re the one doing the quality assurance, you’re providing instruction to your providers. What are some of the keys around? optimizing provider documentation.

Christine Munna: Yeah, so I think, um, reasons why we really focus, um, on the importance of this, um, it’s very important to accurately reflect, um, the patient’s care in, in the medical record, um, and, you know, really number one, I think reason for documentation is really conveying the chronological story of the patient and having, um, that accurately reflected in the patient’s story.

Christine Munna: their, their patient charts, the medical services that, that we provide, um, some things that we really, um, focus on, um, and the importance of this, um, you know, number one, uh, this [00:03:00] helps us communicate with other healthcare providers. Um, so very important to have high quality documentation for that purpose.

Christine Munna: Um, a lot of our, our notes and documentation that may be shared with the patients. You know, specialists like they’re, they’re cardiologists or a pulmonologist. So always very important to, to keep that in mind. Um, you know, kind of, um, relating to that as well. Um, it helps us improve our patient care outcomes when we have better.

Christine Munna: High quality documentation, very specifically as that relates to any kind of transition of care for the patient. Um, so anytime they’re moving from, um, you know, 1 kind of care setting or location to another, um. And they’re obviously at higher risk for things kind of falling through the cracks or, or getting lost.

Christine Munna: So, you know, just, um, one very important area, um, when patients have transitions, maybe from [00:04:00] the hospital to the skilled nursing facility or from skilled nursing facility to home. Um, one area that we really focus in on, um, having high quality, um, documentation. Um, Another might be advanced care planning for our patients, um, as this does, uh, communicate their health care wishes and needs to other providers, um, very important to, to have good documentation, um, when we have those goals of care discussions and advanced care planning, uh, discussions with our patients and families.

Erik Sunset: Yeah, that makes total sense. You’ve got a longitudinal view of the patient, at least for the amount of time that you’re treating them, as opposed to, you know, something that’s cut and paste and then goes off to their specialist, like you mentioned, that doesn’t really help anybody.

Christine Munna: Absolutely.

Erik Sunset: And then when you’re looking at provider documentation or looking through provider documentation, I would say, whether it’s something that comes to you from a referring provider or something [00:05:00] that you know that you’ll be sending out, what are some of the keys? for really crystal clear documentation. What do you look for?

Christine Munna: Um, yeah, so we, we look for, um, a lot of, uh, key areas in our documentation. Um, I guess number one would probably be supporting the medical necessity, uh, for the patient encounter and really capturing what are the most relevant Um, elements to document in the patient’s HPI, like in their history of present illness.

Christine Munna: Um, how are we describing that patient to support the medical necessity and to describe the status of, uh, whether this be a chronic condition that we’re addressing? Um, or an acute issue, um, that we may need to manage. Um, I think one thing I really see providers kind of struggle with, um, is what to include in their documentation when the patient doesn’t really have [00:06:00] any complaints.

Christine Munna: Um, this is something I, I just spoke, um, on this in one of our training sessions the other day. Um, you know, I’ve kind of seen in some recent reviews that providers will be like, well, I don’t know. What to say if my patient is feeling well, like, what, what are we addressing today? Um, so that’s, uh, one kind of common area.

Christine Munna: I think that, um, providers, especially newer providers, new grads, um, tend to struggle with, um, and just kind of figuring out how do I describe this patient, um, you know, in my notes and what important things should I focus on there. Um, Some other areas that we tend to look at, um, in documenting relevant areas of, um, maybe the patient physical exam, um, in, in our documentation, um, as it relates to the presenting problem that we are evaluating and managing.

Christine Munna: Um, I think one common, um, kind of mistake or, or pitfall that we see, [00:07:00] um, a provider might be evaluating a patient’s wound, for example. And then they might forget to put, um, their examination of the wound in their documentation. Um, so, you know, one, one big area that we look at in our reviews and, um, you know, kind of providing some support and reminders on that.

Christine Munna: Um, and lastly, you know, I think another, um, really big one is documenting. Our assessment and plans for the patient, um, and really focusing on the medical decision, making details, um, and, and really capturing that in our documentation. Um, a lot of times, um, I will. C notes where we’re kind of missing what our assessment is as the medical provider of the patient’s problem.

Christine Munna: Is it controlled? Is it worsening? Um, you know, what, what is the status of that? What do we think of it? Um, and then describing, you know, what are the rationales or, or why, [00:08:00] um, how we’re making our medical decision making to treat, um, the patient’s problems. Um, for example, you know, are we continuing Anti coagulation for this patient because it’s still supported by the latest evidence based guidelines for, you know, what we’re treating for the management of that.

Christine Munna: Um, and maybe documenting that they haven’t had any adverse effects, um, related to their medication, no bleeding episodes, that kind of thing. Uh, when we might follow up on this again and reevaluate that treatment, um, are all very important, um, points, I think, to capture in our documentation.

Erik Sunset: Yeah, those, those all sound like critical points to capture for me. And, you know, certainly providers treating a large volume of patients in a given day, over weeks, over months, and then over years, you know, it certainly is just that. human oversight, unfortunately. But I would imagine that happens, you know, across a bell curve.

Erik Sunset: You have some, maybe some frequent flyers, you know, just the career observation. There may be [00:09:00] some frequent flyers that regularly overlook like a disposition type notes and then those that, that always adhere to it. What does an intervention look like? Doc, provider, PA, NP, whoever it is. You just treated this patient.

Erik Sunset: I happen to be familiar with them. What’s going on with this? What, what’s the texture of that conversation like?

Christine Munna: Um, yeah. So in our training processes, we, um, we have a lot of kind of trainings upfront when, um, providers start with our practice, uh, where we really focus on high quality documentation. Um, so during like the provider’s onboarding period. Um, we, every couple of weeks, we have, um, these training sessions where we do a live note review.

Christine Munna: So I’ll actually pull, um, a very recent note that’s been written by one of our, uh, nurse practitioners or, um, [00:10:00] PA’s positions. Um, and we will go through, um, that note as a, as a small group. Uh, it’s usually our, our new hires who are on these sessions. Um, and we review the documentation. Um, we talk about areas where, you know, we might could have improved that documentation or maybe areas that were done very, very well, um, and that serve as a good example.

Christine Munna: Um, So we, we review that and we talk about, um, the clinical decision making kind of best practices, um, you know, for our patients and, and even look at the coding aspects, um, of, of that documentation to, to, to do some training on, on billing and coding. Um, Our kind of ongoing processes to provide support in that area.

Christine Munna: So even once our providers are off of their, their orientation and onboarding period, We have ongoing documentation [00:11:00] reviews with our providers to, to provide support. Provide support, kind of do some check ins, um, let them know how they’re doing, um, any areas that they might need improvement in, or even if it’s just a, you know, congratulations, you’re doing very well, um, in these areas, you know, keep up the good work.

Christine Munna: Um, and we also have a lot of educational kind of sessions and opportunities, uh, with our team, um, throughout the year, um, usually at least one a month, um, that they have options to, to join and, um, you know, kind of learn, um, As far as any kind of, um, you know, patient, uh, clinical areas that they may, um, you know, need education in, um, and documentation, billing and coding as well.

Erik Sunset: Yes, there’s obviously a lot of aspects to good documentation. You know, clear plan for the patient, maybe their, um, their family or their caretakers, referring providers, and then organizationally you mentioned billing and coding. You obviously want to have the [00:12:00] appropriate documentation to support the claim.

Erik Sunset: Um, and he said something that, that stood out to me is that you really want high quality documentation. And I think in some of the, some of the audience’s minds, They may flash to visions of their EHR and spending a lot of time charting and high quality means I have to go in and out of every section of the software.

Erik Sunset: Obviously that’s not so much of a concern for you using DocBuddy, but the point of invoking all of that is that really robust documentation may give people fits because they’re thinking about how burned out they already are. I’ve just gone through my entire day treating patients. Now I have to document or I’ve been documenting all along.

Erik Sunset: So how do you balance that Christine, that need for really high quality documentation for all of the stakeholders of that visit note versus alleviating some of the symptoms of burnout where you can.

Christine Munna: Yeah, and I, I think that that’s a really tough one. Um, and it’s [00:13:00] obviously just kind of trying to find a balance between the two. Um, and, and that can be really challenging when. You’re seeing patients all day, um, and providing very important care. And then you get to the end of your day and you just have all of this documentation to do.

Christine Munna: Um, you know what? I think one, um, Area in which we have been able to streamline that, um, including, uh, an option of dictation, um, along with our, our EHR and, um, you know, we’ve, we’ve created a DocBuddy, which has been amazing. But really just, um. Being able to dictate our documentation cuts workflows in half, if not more, um, so, I mean, I could spend 20 or more minutes documenting a patient note, um, before I learned how to dictate, um, Learning how to do it was a bit of a, of a learning curve and kind of a mind shift.

Christine Munna: Um, I had never done it [00:14:00] before. Um, so trying to incorporate that into my workflow, um, was a little challenging at first, but you know, once I really got the hang of it, um, it was, it was worth the investment and time in, in learning that. Um, so that’s been one way that we’ve really tried to, to streamline things and, um, just make it easier, you know, on, on our providers.

Christine Munna: Um, some other kind of initiatives and, um, things that, that we’ve done, you know, with our company and kind of speaking to burnout, um, we have created, um, what we call our culture of joy. Um, which is a committee that we have that is, um, dedicated to really supporting our providers and, and our colleagues, um, and, and trying to provide some support to them and hopefully decrease, um, you know, things related to burnout and, and just make, [00:15:00] you know, work, work life balance a little bit better and, and easier.

Christine Munna: Um, one kind of, um, and thing that the art culture of joy, uh, committee has focused on is connecting our providers to other colleagues in the company, um, who are success champions or kind of mentors. Um, maybe those who have been with the company for a long time, um, who can help kind of provide some support and guidance.

Christine Munna: Um, I know for me, when I started, um, with the company, I had that, um, mentor, kind of success champion, um, that I worked very closely with and she personally helped me so much. Like, I don’t know how I would have learned, um, the ins and outs of the nursing home world, which I’d never worked in skilled nursing before.

Christine Munna: Um, so this was all a new environment to me. Um, so she personally helped me a lot, um, learning the rules and [00:16:00] regulations, um, in the skilled nursing facility, which can be very challenging to navigate, um, and, and how to handle that, um, especially as a, a new graduate provider. Um, so that was very beneficial to me personally.

Christine Munna: Um, and also I, I like to encourage providers to join, um, some kind of professional society, um, that, uh, that they, you know, would like to be a part of, um, like a nurse practitioner, um, society like Gapna or, um, the one that, um, I’m very passionate about, um, Pelt Med, uh, which was previously AMDA, um, but I find a lot of, um, support in, Um, and that with other colleagues and, um, Tends to, I think, help me with burnout issues.

Christine Munna: Um, being able to talk to other people, um, who do the same work that we do kind of bounce ideas off of each other and, and just provide support, um, I, I think is huge for that.

Erik Sunset: Yeah. And [00:17:00] you’re, you’re hitting on, I don’t know if you know it or not. I bet you do. You’re hitting on what all of the surveys say are the best ways to curb burnout. So organizationally have a culture of wanting to defeat burnout. So the culture of joy and your success champions, that’s, that’s really important that the place you work for cares that you are not burning out.

Erik Sunset: It’s obviously, and then having a group to discuss it with, to be able to, like you said, bounce ideas off of each other. Uh, there’s a few other sort of core drivers of burnout You see, um, in the studies over the years. A lack of staffing is kind of the hot one in, in 2024. And, you know, there’s part of that ties back into culture.

Erik Sunset: Part of that sort of a macro economic or workforce, uh, issue. A little bit tougher to solve, but it sounds like you’re controlling all the things that you can control, and that’s huge.

Christine Munna: Yeah, absolutely. Um, and just one other thing I would add to that, um, Some of like the fun things that we try to do as a company and [00:18:00] creating, you know, we really strive for a culture of joy, which is why we named our committee that, um, but, you know, trying to, um, incorporate other like fun things for, um, our, our company, which we are very spread out.

Christine Munna: So it can be hard to see each other in person or, you know, being able to, um, to meet up with, with other coworkers. So. Um, we try to have like virtual team meetings or like a virtual holiday party or something like that, um, to really just kind of, you know, get together with, with others and kind of have those fun things that we might do in person if we all worked. together.

Erik Sunset: Yeah, and it matters, and I can, I can agree with that sentiment being at DocBuddy. We’re a pretty widely distributed team. We’re, we’re based in Denver. I’m in Miami, Florida. So it’s kind of few and far between that you can be together. Although we are coming up on a set of team meetings where we’ll have most of the group together, which is great.

Erik Sunset: But it can be as, as small as like, turn your camera on during a Zoom call. Like, you don’t have to [00:19:00] just be the black square on the screen. Like, let’s, let’s show face. You know, that’s the next best thing to be together in person. That’s really cool. And Christine, we’re kind of at the tail end of 2024 here.

Erik Sunset: We’re, uh, we’re recording before, uh, the week before Thanksgiving. And that’s kind of signifies. Basically the effective end of the year. You got a few weeks left before that break between Christmas and new years. What are some highlights from your 2024? What are you looking forward to in the new year?

Erik Sunset: What’s on the horizon for you?

Christine Munna: Yeah, I think, um, us personally as a company, some things that, um, I’m very excited about, um, expanding into some of the new markets, um, that we’re going into and just impacting more patient lives. Um, expanding our, our business, um, is very exciting. Um, and one thing that we’re really going to be focusing on, um, in, in the, uh, following [00:20:00] year.

Christine Munna: Is, um, we are initiating, um, the guide program, um, with, with CMS. Um, so if, if you’re not familiar with guide, um, it is a program, a new program that is being established, um, by CMS, um, where we provide very comprehensive, Um, in more coordinated care for patients with dementia, um, aiming to, you know, really focus on their quality of life and improving that, um, hopefully reducing caregiver strain, um, and providing additional support services, um, for.

Christine Munna: patients, um, caregivers, patients who have dementia, helping them remain in their homes and that kind of thing. Um, so that’s something that we are really, um, going to be focusing on in the next year. Um, I’m going to be doing a lot of training, um, in education with our staff on this program. So [00:21:00] very excited to, um, be participating in that and, and to get it, to get it going.

Christine Munna: Uh, we’re, we’re additionally kind of expanding some of our, our value based care models as well. So also pretty excited about that.

Erik Sunset: Oh, that’s fantastic. That is really, really big news. And that is, you know, the best type of care somebody in that situation could get remaining in home for as long as, as practical. A little more, uh, A little more nose to the grindstone question for you here, with the new CMS program, I would imagine there are some either different or new documentation requirements.

Erik Sunset: Have you gotten all that mapped out to be in compliance with CMS?

Christine Munna: Yes, there, there will certainly be, um, we’re kind of in the beginning stages of, uh, really rolling out, uh, how this program will work for us. Um, I’ve started planning what our educational and training, uh, kind of. Curriculum is going to look like. So that’s kind of what I’m focusing on [00:22:00] now. Um, but absolutely.

Christine Munna: I’m, I’m sure that there are going to be certain. documentation components, um, that we will need for this. So probably looking at creating some templates to kind of standardize that for our team, uh, probably using DocBuddy for that as well, creating some voice commands. Um, so yes, we will absolutely be, uh, looking at that and planning for it.

Erik Sunset: Well, I, that took a load off of my shoulders. It’s really easy to throw spears at CMS. It’s they’re in a tough position. Admittedly, it’s tough to make everybody happy all the time, but that is a really positive, uh, sounding program to me. So I’m excited for you. And then Christine, one of the, one of the other sort of hot topics as we look to close out this year, it’s been a hot topic.

Erik Sunset: For the entirety of the year, I remember about this time last year, chat GPT was really starting to catch on with sort of your off the shelf consumers. And of course, that’s an AI driven, uh, large language model [00:23:00] software. The topic around AI in healthcare. Really hasn’t ever been hotter. I don’t think it’s going to cool off either.

Erik Sunset: It can mean a lot of different things to a lot of different people. Where do you see AI and healthcare going? Are there any use cases that you’re keeping an eye on? Anything that would be meaningful to you either in your day to day or for evode care?

Christine Munna: Yeah, um, I think what I’ve seen, it just all looks very exciting. Um, and we’ve been talking a lot about burnout. Um, so I think one of the main areas that I would be most excited about is documentation support and, um, AI generation of documentation notes. Um, you know, just making that easier for our providers.

Christine Munna: Um, I feel like documentation can be very monotonous, um, and that makes it very hard. Um, so [00:24:00] having any kind of. AI support to provide some relief on that. Um, I mean, I, I think that that is going to be huge and I’m really excited to see, to see where that goes. Um, additionally clinical decision support as well.

Christine Munna: Um, so I’ve, I’ve heard some exciting things, um, where AI is kind of built into EHRs, where, um, it might, um, suggest like a potential treatment plan for a patient, um, we’re treating them for pneumonia, for example, um, might suggest like, Hey, you should consider using this antibiotic or, you know, consider adding this to your treatment plan.

Christine Munna: Um, that’s something I would have loved as a, as a new grad. Um, so I, I think that that would, would be amazing. And, you know, we’d kind of love to see how that evolves in the future. Um, and also, you know, 1 thing that I think this is probably the most exciting, but really, just to see improvement and how are [00:25:00] different systems.

Christine Munna: We all use so many different EHRs and different systems. Um, but as time goes on, I assume that systems will be better able to communicate and talk and integrate with each other. Um, and. Um, you know, I’m excited to, to see how that evolves over the next couple of years as well. Um, because it’s hard when all of our different systems are so segmented and, you know, you go from this login to that login, or you’ll, you know, we will never have access to that other person’s EHR to be able to look up something about your patient.

Christine Munna: Um, so, you know, I, I hope, I have high hopes in the future that, you know, that’s something that will majorly improve.

Erik Sunset: Yeah, that, that interoperability piece has been a long time coming. I remember all the way back to 2009, that was the goal of EHRs for everybody. And a lot of important work has taken place, obviously, with health alliance and assure scripts has a national record locator service and bringing everybody to fire standards.[00:26:00]

Erik Sunset: Uh, the key there, I mean, sitting on the vendor side, it’s, uh, it’s easy for me to say not as a certified EHR, but rather as a, uh, Provider workflow tool, you know, the, the lack of standardized APIs across the marketplace, you know, if you could wave a magic wand, you could have that interoperability tomorrow.

Erik Sunset: And I don’t think tomorrow is all that far away.

Christine Munna: I hope not.

Erik Sunset: Well, yeah, we’ll be keeping an eye on some of those same, uh, AI developments, Christine, and kind of on our, on our way out, is there, is there anything else, uh, to cover that maybe we glossed over?

Christine Munna: Um, no, I, I don’t think I have anything else, um, to add to that.

Erik Sunset: Well, let me ask you this then, where can listeners connect with you or maybe with Abode Care? Any, any spots online, social medias, websites? We’ll

Christine Munna: Uh, yes. So, um, abode care partners, um, very active on, on LinkedIn and some [00:27:00] of the other popular, um, social media accounts. Um, so absolutely look us up. You can follow, uh, what some of our practitioners are, are doing, see the care that we’re providing in our homes and our communities. Um, we would love for you to follow us.

Erik Sunset: definitely get a link to, uh, the Abode Care accounts in the show notes. And I’ll be keeping a close eye on updates around that guide program. That is, uh, that hits close to home and that’ll be, uh, that’ll be a really cool thing. Cool thing to watch out.

Christine Munna: Yes, absolutely.

Erik Sunset: Well, Christine, I want to say thank you again for joining us. And on behalf of the entire DocBuddy team, thank you for listening. Be sure that you’re subscribed on Apple podcasts, So you always get the newest episodes of the show and until next time, I’m your host, Erik. Thanks again.

Christine Munna: Thank you for having me.