Off the Record with Brian Murphy

CDI, coding, and clinical medicine are involved in a tug-of-war over a complex, life-threatening medical emergency that seems resistant to all forms of consensus. I'm talking about sepsis of course, and on today’s show I got to talk about sepsis with someone as qualified as anyone in the world to do so. Steven Simpson, MD, is Professor of Medicine at the University of Kansas in the Division of Pulmonary, Critical Care, and Sleep Medicine. He has done research in all areas of severe sepsis, from molecular and cellular mechanisms to translational and quality improvement studies. He is currently chair of the board of directors for the Sepsis Alliance and an author of the 2016, 2021, and 2025 reviews and updates of the Surviving Sepsis Campaign Guidelines. I’m also joined by James Kennedy, MD, CCS, a familiar name and voice for anyone involved in CDI and coding circles. Listen in as we cover: Dr. Simpson’s deep and rich background in sepsis, including early clinical days with septic patients, working with Drs. Bone and Balk who created Sepsis-1, and his role on the Sepsis Alliance. Co-authoring the 2026 Surviving Sepsis Guideline that defines sepsis as a “life-threatening acute organ dysfunction to infection”: His stance on sepsis-2 and sepsis-3. The politics of definition and diagnosis: Who gets to write these definitions. The struggle: Reconciling sepsis-2 with sepsis-3, further complicated by CMS’ use of sepsis-2 in its new sepsis readmission measure. What’s the right answer for this, if there is one? Looming sepsis proposal to create codes for “impending sepsis,” the role of AI-technologies (e.g., Sepsis ImmunoScore, TriVerity) in identifying these patients, and what the University of Kansas is doing to identify and intervene on infected patients before they evolve into organ dysfunctions. Plans for future work for other sepsis-related concepts, payers and denials, and a pair of songs for the Off the Record Spotify playlist.

Rose Bernards is a believer in value-based care. It’s been a driving force in her career. But it was put to the test when she suffered a family tragedy in late 2025. She wrote about that experience in a three-part series for LinkedIn I highly recommend: The Good, the Bad, and the Ugly. Link in the show notes. We get into those ups and downs, Rose’s wide-ranging educational career, and expert insights and opinions of all things risk adjustment and the mid-revenue cycle in today’s episode of Off the Record. Listen in as we discuss: Where are we today, nationally, with the state of value-based care. Is it fulfilling its mission of improving health outcomes, enhancing patient experiences, and lowering overall costs by rewarding doctors for the quality of care they deliver rather than the quantity of services they provide? What do people consistently misunderstand about risk adjustment?  Common audit findings Rose is seeing in her daily work related to documentation/coding/regulatory adherence. Great example of acute MI. Career stops at high profile organizations including Optum, First Choice Health, and working as an adjunct professor at Pacific University. The common thread? Education. What makes for a good educator? Advice for educating providers with a lesson that sticks. The story of her personal loss and how it changed her views on the healthcare system What she’s most proud of in her career, one do-over she wishes she had back, and a fine guitar-forward selection for the OTR Spotify playlist  Rose’s article “The Good, the Bad, and the Ugly (part 1 of 3)”: https://www.linkedin.com/pulse/good-bad-ugly-part-1-3-rose-bernards-l57fc  Part 2: https://www.linkedin.com/pulse/good-bad-ugly-part-2-3-rose-bernards-s3fpc/  Part 3: https://www.linkedin.com/pulse/good-bad-ugly-part-3-rose-bernards-y3ofc/  

When you work deep in the hospital mid-revenue cycle there can be an unfortunate but understandable tendency to divorce your work from the patient. To become separated from clinical care and outcomes, and even, in the case of value-based care, from its intended objective of improving affordability and quality. Those points are not lost on Dr. Sunita Varghees or Carrie Horn, who spearheaded an outpatient CDI program at Baylor Scott & White Health. One that is truly patient-centric and focused on reducing ER utilization and delivering the right level of service, not just the most profitable. Listen in as we discuss: Baylor Scott and White Health—Lay of the land of the organization and how and when they got started in outpatient CDI. “Successful risk adjustment starts with the patient”--the why of OP CDI and how their work ties into chronic condition management, not just capture. We discuss KPIs and financial metrics, too. New heart disease screening initiative—what it is, what it entails, and early successes. Is knocking down ER visits and IP admissions and getting the right level of care at the right price at odds with hospital revenue gains? Are they making it up with shared savings or care funding? Tech enabled/tech forward approach including ambient AI. Biggest success and biggest do-over, if they could do it all over again. What’s next on the OP CDI roadmap? Favorite song for the Off the Record Spotify playlist...

Cheryl Ericson is a veteran, in every sense of the word. Someone who has seen and experienced a lot in the CDI profession—and so has a wealth of knowledge and wisdom to confer. I go back a long way with Cheryl, to early ACDIS days when she was the lead educator of the CDI Boot Camp and developed the organization’s educational curriculum. She’s had a few stops since then but settled in nicely as Senior Director of Clinical Policy and Education at The Brundage Group. Cheryl is a shrewd, incisive observer of the CDI field, with a rich history of where we’ve been but also where we need to go. Recently she’s weighed in on some big mid-revenue cycle topics for ICD-10 Monitor which I read with avid interest (and recommend you do too).  In this week’s episode we hit on a few of those topics, along with a bit of a look into her life and career. Listen in as we discuss:  Formative background in nursing and entry point into CDI at MUSC. Thoughts on the new/2026 ACDIS/AHIMA query brief (currently in draft stage)--concerns with clinical indicators, her belief they are unique to each patient and may not meet guidelines established by payers: “It is not about determining if a condition exists; it should be about deciding if the physician has a reasonable expectation to treat the condition,” she writes. “Rather than asking if the condition exists, CDI and coding professionals should determine if it ‘was it reasonable for the provider to diagnose and treat the condition as if it exists.’” Pushing query compliance down to the end user—is this how the new brief reads, and if so, is it a fair expectation? Artificial intelligence: State of current tools and limitations. “GenAI tools show great promise in many areas, but for now, it does not appear capable of performing the type of complex critical thinking required for accurate inpatient coding and billing,” Cheryl observes. (Incorrect) payer allegations of hospital “upcoding,” using the example of acute blood loss anemia ACDIS heydays: A look back on teaching and educating. Her personal health journey, story of breast cancer and her husband’s simultaneous serious illness, and how it transformed her outlook on life.  Sharing wisdom and lessons learned: Career advice to a new or young CDI professional—what has she learned to pass along to the next generation?

At ACDIS 2026 I delivered an unofficial episode of Off the Record with my guest today: Tracy Ferro, Executive Director, System CDI for Medical University of South Carolina Health (MUSC). The “podcast” was delivered on stage, at the outpatient symposium. MUSC’s OP CDI program is new and being built in flight, and Tracy and I presented on it together, running the session a bit like an episode of #OTR. Full disclosure: Norwood partnered with MUSC, large academic health system, to implement OP CDI. That was a challenge! As was the Chicago presentation. On today’s episode we talk not only about MUSC’s OP CDI efforts but the presentation itself, including the prep and leadup and “game day.” And much more on Tracy’s unique leadership style and the importance of storytelling to drive home lessons (she’s wonderful at this). Listen in as we discuss: Tracy's healthcare background, a memorable nursing experience, and path into CDI. The art of leadership: Style and lessons learned from childhood and beyond MUSC’s outpatient CDI origins: The why behind the program What a pre-visit review looks like, including the use of Epic’s Enhanced Risk Adjustment Framework. Governance, workflows, reporting, and early outcomes. Outpatient CDI impact and next steps for the new program Presenting at ACDIS 2026, including tips on prep and combatting stage nerves An unexpected Sharpie arm signature and a song for the OTR Spotify playlist...