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Presented by Rae Freeman, HCCS, Dr. James Dunnick, The Dunnick Group
Hospital Transformation ConsortiumClinical Documentation Improvement Series
“Four Key Roles for CDI: CDI Specialist”
July 18, 2017
A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE Iowa Small Hospital Improvement
Program (SHIP) Grant FY 17 IA Contract #5888SH01 and the Georgia Small Hospital Improvement Program FY17.
WEBINAR ETIQUETTE
Hospital Transformation Consortium
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WEBINAR RESOURCES
Hospital Transformation Consortium
As an IACET Authorized Provider, HomeTown Health, LLC offers
CEUs for its programs that qualify under the ANSI/IACET
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offer 0.1 CEUs/1 credit hour for this program.
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Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.
CONTINUING EDUCATION
Hospital Transformation Consortium
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CONTINUING EDUCATION
Hospital Transformation Consortium
HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conference and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org)
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ACTION ITEM: GROUP PARTICIPATION
Hospital Transformation Consortium
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Welcome & Introductions Desi Barrett,
HomeTown Health, LLC
Four Key Roles for CDI: The CDI Specialist Rae Freeman, Senior
Manager, Consulting -
HCCS
“Doctor’s Notes: Thoughts from a Physician” Dr. James Dunnick,
The Dunnick Group
Upcoming Events & Resources Annie Lee Sallee,
HomeTown Health, LLC
AGENDAClinical Documentation Improvement Series
Program Goals
Clinical Documentation Improvement Series
A CDI program’s purpose is to improve healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement. This series of continued ICD-10 support with a specific focus on C DI will bring together Physicians, coders, and others that have the ability to increase revenue by coding to t he highest level of specificity.
The goal of this program is to improve hospital financial processes by helping to develop a CDI program within small/rural hospitals through specif ic training to the four main roles within a CDI Progra m: CDI Specialists, Physicians, Nurses and Scribes.
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What You Told Us…
Clinical Documentation Improvement Series
“We have a Clinical Documentation Improvement (CDI) program
in place:”
ConsortiumPre-AssessmentSurvey Results
What You Told Us…
Clinical Documentation Improvement Series
In pursuit of a Clinical Documentation Improvement (CDI) program,
our hospital has: (select all that apply)
ConsortiumPre-AssessmentSurvey Results
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What You Told Us…
Clinical Documentation Improvement Series
Which of the following best describes the training/certification of
your coding/CDI team?
ConsortiumPre-AssessmentSurvey Results
What you Told Us…
Clinical Documentation Improvement Series
What are your hospital's greatest areas of need related to Coding or Clinical Documentation
Improvement? What specifically are you hoping to get out of this program?
ConsortiumPre-AssessmentSurvey Results
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Trainer BiographyClinical Documentation Improvement Series
Rae Freeman, RHIA, CDIP, CCS-PSenior Manager, Consulting at HCCS Healthcare Coding & Consulting Services
Rae Freeman is HCCS’s Senior Manager of Consulting. In this role Rae, an acknowledged HIM expert, performs speaking and education functions in addition to administering HCCS’s consulting services program.
Rae received a Bachelor of Science degree in Health Information Management from Southwestern Oklahoma State University and is an RHIA, a Certified Documentation Improvement Practitioner (CDIP) and a Certified Coding Specialist-Physician based (CCS-P).
Rae has worked in healthcare for 21 years in positions ranging from coder to Physician Office Manager and HIM Director. She is president-elect for the Florida Health Information Management Association and is a past president of the Texas HIM Association as well as the local Southwest Florida HIM Association.
Disclosure of Proprietary InterestClinical Documentation Improvement Series
HCCS does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event.
The education offered by HCCS in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant, Iowa FY17-18, Contract #5888SH01 and the Georgia SHIP Grant Program FY17.
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Presented by Rae Freeman RHIA, CDIP, CCS-P Senior Manager Consulting
Healthcare Coding and Consulting Services (HCCS)
CLINICAL DOCUMENTATION IMPROVEMENT SERIES: “Four Key Roles for CDI: CDI Specialist”
Learning Outcome Standard: Based upon
© 2017 Healthcare Coding & Consulting Services
F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :
Role #1 Role #1 Role #1 Role #1 –––– CDI CDI CDI CDI
SpecialistsSpecialistsSpecialistsSpecialists
Rae Freeman RHIA, CDIP, CCS-P
Senior Manager Consulting
Healthcare Coding and Consulting Services (HCCS)
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© 2017 Healthcare Coding & Consulting Services
Learning OutcomesLearning OutcomesLearning OutcomesLearning OutcomesA t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o :
Identify benefits of a CDI program in your hospitalIdentify benefits of a CDI program in your hospital
Define the four key roles of CDI and how they work togetherDefine the four key roles of CDI and how they work together
Identify other audiences that need to know and collaborate regarding the CDI programIdentify other audiences that need to know and collaborate regarding the CDI program
Summarize the role of a CDI SpecialistSummarize the role of a CDI Specialist
© 2017 Healthcare Coding & Consulting Services
AgendaAgendaAgendaAgenda
�Four Key Roles in CDI �Four Key Roles in CDI
�Implementing CDI Program�Implementing CDI Program
�Defining CDI Program�Defining CDI Program
�Models for CDI Programs�Models for CDI Programs
�CDI Basics�CDI Basics
When Coding is OutsourcedWhen Coding is Outsourced
�Program Benefits�Program Benefits
�Outpatient CDI�Outpatient CDI
�Positive Impacts�Positive Impacts
�Best Practices�Best Practices
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© 2017 Healthcare Coding & Consulting Services
Four Key Roles in CDIFour Key Roles in CDIFour Key Roles in CDIFour Key Roles in CDI
CDI Specialists
CDI Specialists
PhysiciansPhysicians
NursesNurses ScribesScribes
© 2017 Healthcare Coding & Consulting Services
Working TogetherWorking TogetherWorking TogetherWorking Together
PatientPatient
PhysicianPhysician
CDI Specialist
CDI Specialist
ScribeScribe
NurseNurse
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© 2017 Healthcare Coding & Consulting Services
Implementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI Program
Staffing the programStaffing the program
© 2017 Healthcare Coding & Consulting Services
Implementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI Program
Physician TrainingPhysician Training
Training Non-Physician Clinicians and CDI Program
Staff
Training Non-Physician Clinicians and CDI Program
Staff
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© 2017 Healthcare Coding & Consulting Services
Implementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI Program
Physician Queries
Physician Queries
ComplianceCompliance
© 2017 Healthcare Coding & Consulting Services
Defining a CDI ProgramDefining a CDI ProgramDefining a CDI ProgramDefining a CDI Program
MissionMission
GoalsGoals
•Monthly
•Quarterly
•Annually
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© 2017 Healthcare Coding & Consulting Services
Defining a CDI ProgramDefining a CDI ProgramDefining a CDI ProgramDefining a CDI Program
RegulationsRegulationsEthical
StandardsEthical
StandardsWorkflowWorkflow
© 2017 Healthcare Coding & Consulting Services
Models for CDI ProgramsModels for CDI ProgramsModels for CDI ProgramsModels for CDI Programs
SingleSingleHybridHybrid
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© 2017 Healthcare Coding & Consulting Services
EthicsEthicsEthicsEthics
Ethical Decisions
Ethical Decisions
© 2017 Healthcare Coding & Consulting Services
Role of CDI
professional
Role of CDI
professional
DocumentationDocumentation
CDI BasicsCDI Bas icsCDI Bas icsCDI Bas ics
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© 2017 Healthcare Coding & Consulting Services
CDI BasicsCDI Bas icsCDI Bas icsCDI Bas ics
Chart ReviewChart Review
PrioritizingPrioritizing
© 2017 Healthcare Coding & Consulting Services
CDI Program When Coding is CDI Program When Coding is CDI Program When Coding is CDI Program When Coding is
OutsourcedOutsourcedOutsourcedOutsourced
Remote SupportRemote Support
On-site SupportOn-site Support
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© 2017 Healthcare Coding & Consulting Services
CDI Program BenefitsCDI Program BenefitsCDI Program BenefitsCDI Program Benefits
Accurate patient
severity
Accurate patient
severity
POAdocumentation
POAdocumentation
© 2017 Healthcare Coding & Consulting Services
CDI Program BenefitsCDI Program BenefitsCDI Program BenefitsCDI Program Benefits
Improves bill hold daysImproves bill hold days
Reduce post-discharge queriesReduce post-discharge queries
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© 2017 Healthcare Coding & Consulting Services
CDI Program BenefitsCDI Program BenefitsCDI Program BenefitsCDI Program Benefits
Improves CommunicationImproves Communication
Lessen compliance concernsLessen compliance concerns
Reduce anxiety for auditsReduce anxiety for audits
© 2017 Healthcare Coding & Consulting Services
Outpatient CDIOutpatient CDIOutpatient CDIOutpatient CDI
Plan1
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© 2017 Healthcare Coding & Consulting Services
Outpatient CDIOutpatient CDIOutpatient CDIOutpatient CDI
Review2
© 2017 Healthcare Coding & Consulting Services
Outpatient CDIOutpatient CDIOutpatient CDIOutpatient CDI
Monitor3
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© 2017 Healthcare Coding & Consulting Services
CDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive Impacts
Documentation
Report Cards
Quality of Care
Financial Benefits
© 2017 Healthcare Coding & Consulting Services
PatientPatient
ComplianceCompliance
QualityQuality
FinancialFinancial
CDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive Impacts
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© 2017 Healthcare Coding & Consulting Services
CDI Best PracticesCDI Best PracticesCDI Best PracticesCDI Best Practices
VisionVision
Phys Education
Phys Education
P / PP / P QueryQuery
FeedbackFeedback
EducationEducation ToolsTools
TeamworkTeamwork
ACTION ITEMS & COLLABORATIONPUT EDUCATION INTO ACTION ACROSS YOUR SYSTEM
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© 2017 Healthcare Coding & Consulting Services
Action ItemsAction ItemsAction ItemsAction Items
�Schedule meeting with key stakeholders to discuss establishment of CDI program in your facility�Schedule meeting with key stakeholders to discuss establishment of CDI program in your facility
�Decide who will staff the CDI program�Decide who will staff the CDI program
�Schedule training for physicians and for non-physicians�Schedule training for physicians and for non-physicians
�Set program goals �Set program goals
�Schedule start date to begin the CDI program�Schedule start date to begin the CDI program
© 2017 Healthcare Coding & Consulting Services
AHIMA - Clinical Documentation Improvement: Achieving Excellence
• www.ahima.org
• www.hcpro.com
• www.acdis.org
ResourcesResourcesResourcesResources
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© 2017 Healthcare Coding & Consulting Services
Quality
Va
lue
W E W E L C O M E A L L Q U E S T I O N S
239.443.3900
www.hccscoding.com
T H A N K Y O U F O R Y O U R T I M E
© 2017 Healthcare Coding & Consulting Services
Learning OutcomesLearning OutcomesLearning OutcomesLearning OutcomesN o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : a b l e t o : a b l e t o : a b l e t o :
Identify benefits of a CDI program in your hospitalIdentify benefits of a CDI program in your hospital
Define the four key roles of CDI and how they work togetherDefine the four key roles of CDI and how they work together
Identify other audiences that need to know and collaborate regarding the CDI programIdentify other audiences that need to know and collaborate regarding the CDI program
Summarize the role of a CDI SpecialistSummarize the role of a CDI Specialist
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Recommended Resource:
“DOCTOR’S NOTES”Thoughts from a Physician
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Trainer BiographyClinical Documentation Improvement Series
Dr. James Dunnick, MD, FACC, CHCQM, CPC, CMDP The Dunnick Group, LLC
• Dr. James Dunnick is board certified in internal medicine and cardiology. He has 25 years of clinical practice experience specializing in congestive heart failure, cholesterol, hypertension, and the effects of heart disease in women.
• He has authored and published articles, medical textbook chapters and presented original research at national meetings.
• Dr. Dunnick attended IU Bloomington and IU School of Medicine in Indianapolis, where he placed in the Honors Division.
• He is a Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) and is also certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
THE DUNNICK GROUPHelping hospitals meet the demands of cost, care, and compliance.
www.dunnickgroup.com
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COMPLIANCE
Why should I be compliant?
Because the cost of non compliance is much greater than the cost of compliance.
The Physician will always ask, “What’s in it for me?”
The answer is, “Increasing your income and increasing your value to payers.”
WHY BE COMPLIANT
CMS processes approximately 5 million claims Per day
OR
1.8 billion per year
210,000 per hour
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CMS PAYMENTS
2015 Federal Budget
1. MC/MC 24%
1. SS 24%
3. Defense 16%
CMS $Medicare: Medicare spending growth was
projected as 5.0 percent in 2016 and is
expected to average 7.1 percent over the
full projection period 2016-2025.
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Medicare is in Trouble
The Government is not kidding about cost containment.
AAAANNNN AUDITAUDITAUDITAUDIT TESTTESTTESTTEST QUESTIONQUESTIONQUESTIONQUESTIONQuestion: What percent of charges submitted to Medicare are fraudulent?
A. 5%
B. 10%
C. 30%
D. 50%
Answer: C. Medicare believes that 30% of submitted claims are fraudulent.
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ECONOMIC PENALTIES•Civil false claims act:
1. $5,500 – 11,000 per claim
2. Three times the value of each claim
•Criminal false claim act:
1. Felony
2. Up to 5 years imprisonment
3. $25,000 fine
•MC/MC civil monetary penalties law:
1. $10,000 per claim
2. Three times the value of each claim
Other – CIA, Exclusion List
Entity $ Amount Fined
One Hospital 13,000,000.00
Physical Therapist 2,400,000.00
Physiatrist 1,500,000.00
ENT 750,000.00
Family Practice Physician 162,676.00
Dentist 84,00.00
Cardiologist Charged
Coders CIA, Fined
ECONOMIC PENALTIES
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“A 16-count indictment was unsealed in federal court charging a cardiologist, Dr. XX, 55, with performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare.”
August 21, 2014, U.S. Attorney Northern District of Ohio Steven M. Dettelbach
THE PHYSICIAN RISK
XX Hospital faces 15 lawsuits over improper heart procedures
Hospital is facing 15 lawsuits and is the subject of a federal investigation over improper interventional cardiology procedures, according to a recent Securities and Exchange Commission filing.
Written by Ayla Ellison (Twitter | Google+) | February 13, 2015
THE HOSPITAL RISK
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HOSPITAL PENALTIES
$13 Million Dollars for incentives for productivity and providing care not supported by documentation.
KKKKNOWNOWNOWNOW TTTTHEHEHEHE RRRRULESULESULESULES
•SOI
•WCC
•W/O CC
•MCC
•W/O MCC
•LOS
•COC
•CMI
•DD
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Three key E/M components
A. History
1. History present illness
2. Past medical family social history
3. Review of systems
B. Physical Exam
1. 1995-Body Parts or organ systems
2. 1997- General or specialty specific
C. Medical Decision Making
1. Problem points
2. Data points
3. Risk
KKKKNOWNOWNOWNOW TTTTHEHEHEHE RRRRULESULESULESULES
DDDDIDIDIDID YYYYOUOUOUOU KKKKNOWNOWNOWNOW
In your HPI:
How many elements do you need for the five billable levels?
How many problem points are needed for a 99203, 99204, 99205?
What happens if you document a 99214 and bill a 99213?
What is the difference between a consult and a referral?
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DDDDIDIDIDID YYYYOUOUOUOU KKKKNOWNOWNOWNOW
Physical exam
How many body areas must be examined for any given billing level?
Should you choose the 1995 or 1997 rules?
Which has the greater number of review of systems, 1995 or 1997 guidelines?
DDDDIDIDIDID YYYYOUOUOUOU KKKKNOWNOWNOWNOW
The liability of EHR false code level prompts falls on the physician?
The liability of errors by coding staff falls on physicians and hospitals?
What is the difference between a consult and a referral?
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YOU CAN IMPROVE
E/M and ICD 10 CM can be taught from physician to physician. It can be made easier.
You can increase your speed of EHR documentation.
More than just reducing delays and denials, you can increase your value to payers.
COMPLIANCE
The Cost of Non Compliance is Too Much.
Therefore accept the cost of compliance
We must understand the rules; they will be applied.
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WHAT’S COMING?
Title: Why be compliant-what’s in it for me? August 15, 2017
By: The Dunnick Group. www.dunnickgroup.com
With Hometown Health University www.hthu.net
UPCOMING EVENTS & RESOURCESHospital Transformation Consortium
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CONSORTIUM TRAINING
Clinical Documentation Improvement (CDI) Series
presented by HCCS , The Dunnick Group, LLC, & HTHJoin the Coding Team of Trainers for this series on Clinical Documentation Improvement for small hospitals,
including a discussion on the four key roles needed for a successful CDI Program. Training will be provided
for CDI Specialists, Coders, Physicians, Nurses, and Scribes in implementing a program in your hospital.
Webinars held at 10 am CST/ 11 am EST on dates below.
July 18, 2017: Four Key Roles for CDI: Role #1 - CDI Specialist Webinar Training 0.1 CEUs
August 15,2017: Four Key Roles for CDI: Role #2 - Physicians Webinar Training 0.1 CEUs
October 17, 2017: Four Key Roles for CDI: Role #3 - Nurses & Scribes Webinar Training 0.1 CEUs
March 2018: Rural Coding/CDI Specialist Certification Support Course 1 Support Course 0.1 CEUs
Rural Coding/CDI Specialist Certification Support Course 2 Support Course 0.1 CEUs
Rural Coding/CDI Specialist Certification Support Course 3 Support Course 0.1 CEUs
CONSORTIUM TRAINING
Quarterly Coding & ICD-10 Update Series presented by HCCS In order to help hospitals stay on top of the latest changes and ongoing challenges in coding
requirements, experts in the field come together to share their knowledge in the world of coding
and ICD-10. Recommended audience will include: Coders, HIM Managers/Directors, Business
Office Staff interested in the topic.
June 27, 2017: Hitting the Mark on Compliant OB coding in ICD-10 Webinar
Training
Sept. 26, 2017: Annual ICD-10 Updates, Complex Coding ScenariosWebinar
Training
January 30, 2018: CPT 2018 UpdatesWebinar
Training
March 27, 2018: Facility Coding E&MWebinar
Training
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CALENDAR OF EVENTS
View your Program Dashboard
GA/FL: www.hthu.net/htc17
IA: www.hthu.net/iahtcBoth are Password protected: contact Jennie Price at
[email protected] if you need your Dashboard password!
CONSORTIUM RESOURCES
There are on-demand training and certification programs available
in HTHU’s:
• School of Revenue Cycle Management
• PFS/BO Certifications
• School of Coding & Documentation• School of Clinical & Staff Compliance
• School of Physician Office Education
• School of Long Term Care
• School of HIT & Transformation
Questions?
Contact Meghan Williams at [email protected]
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TELL US HOW WE DID!
A survey will launch after this webinar
closes: please take a moment to give us
your feedback on the training, speaker,
content, webinar format, and anything
else you can share!
If there’s something we can help your
hospital with, please let us know!
Questions?
Questions about these resources or Upcoming Events?
Contact:
Annie Lee Sallee
or
Jennie Price, SHIP Program Manager
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