Review & Query Question
For the CDI Programs which are not adequately staffed to cover 100% of your inpatient admissions:
1. How do you decide which patient population to review? By payor? By service line? Intensive Care Units?
2. How do you decide when to query - is the decision based upon certain metrics such as: CC/MCC capture rate? MS-DRG change? Severity/Risk impact?
Thanks in advance for your responses!
Donna Fisher, CCS, CCDS
CDI Coordinator
Shands @ UF
fishdl@shands.ufl.edu
1. How do you decide which patient population to review? By payor? By service line? Intensive Care Units?
2. How do you decide when to query - is the decision based upon certain metrics such as: CC/MCC capture rate? MS-DRG change? Severity/Risk impact?
Thanks in advance for your responses!
Donna Fisher, CCS, CCDS
CDI Coordinator
Shands @ UF
fishdl@shands.ufl.edu
Comments
For us here at RCRH in Rapid City, (there are 3 of us), and we can only review about 60-70% of the cases. For us, believe it or not, it often depends on the 'diagnosis or physician/provider'. We know with certain diagnosis that we usually/normally have to query for those issues that may need clarity related to an associated condition/diagnosis....(CHF/CARDIAC ISSUES/STROKE). Those also seem to be the conditions we have to query for MCC and CC capture.
As far as physicians-sad to say, but there are certain providers who happen to have "poor" documentation who we "KNOW" we will more than not need some sort of query on (surgeons are notorious for this because as we all know surgery fixes all existing co morbid conditions!
We work with a consulting group (Claro/CDR2) and get semi-annual reviews with them, and they hone in on areas of focus for us where we need to work on MCC/CC capture as well as issues with any certain diagnosis.
Hope this sheds some light-although I am sure each institution uses their own metrics!
Juli Bovard RN CDS
I didn’t know you were using CLARO/CDR2, so do we!
Our program is fairly young and we currently have about half the required staff and are in the process of hiring one more. We review based on payer right now. I freely admit that this is not the best way to identify the best cases from the perspective of potential need for documentation clarification. However, this is what the hospital has decided for reimbursement purposes. We currently review all Medicare and BCBS. We used to review traumas but it didn’t take long to get our Trauma NP's on track and we felt it was no longer the best use of our limited resources. We also try to review those patients on Palliative Care for SOI/ROM purposes. I personally review all death charts retrospectively as well.
Our queries are not based on impact (DRG, SOI/ROM). We query on charts we review whenever we see a need. If you are reviewing the chart, you might as well query if you see opportunity, in my opinion.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Just curious of your bed size or average daily census? Approximately how many charts does a CDS review daily?
Laura Bohls, RN CDS
Prairie Lakes Healthcare System
I guess I should have clarified and said we only review Medicare pts at this point. There was talk of adding Wellmark to our reviews, but we would need more FTE's to do that!
I too do death reviews daily for our institution and so we do capture some issues retrospectively.
For the patients we don’t "get to" daily, (and are discharged to the dark side before we have a chance to review them)-they drop off CDR2 to the coder side, and if the coders need something clarified, we then query for those accounts as well. So we do catch all the Medicare accounts for documentation issues between the coders and CDS staff, but we prefer to do it concurrently as obviously then, it does not hold up billing, shows SOI/ROM right off the bat~
We too query whenever we see a need and many times it does NOT change the DRG/ROM or SOI, it is just the right thing to do so that the chart represent the whole picture. With ICD 10 coming we have tried to start querying on issues we know we will encounter-just to get the providers used to documenting more severity, location etc. so, in my opinion, YOUR opinion is right!
For us, Claro will be coming out in July. We implemented them in Jan 2010 and the first follow up was July 2011. We learned so much at the follow up about things we should/could query for. We are a fairly new CDI program and as you know there is a HUGE gray area. They have been a really good resource for us!
PS...I am studying for my CCDS exam, and take the test on June 25...ugh dreading it...but I want to pass it and set a precedent for our Institution and the other CDI's here to follow! I love my job! (some days more than others
Juli Bovard
Rapid City Regional Hospital
We have been fortunate to have our new COO support the growth of our program and are now hiring 1.5 FTE's (the .5 of course allowing our PT to go FT). Our plan with 4 FTE's is 100% review with the exception of Mother-Baby Unit. Hoping to add a 5th CDI for this and to expand to ED within the next 6-9 months.
Vivian
Our bed size is 329. We are very rural and are the largest hospital (there are clinics) in a several state region. There are 3 of us who are CDI's and are hoping to get funding for a 4th in December (Yahoo!). I have been in this capacity as a CDI the longest of the 3 of us-2.5 years for (I was a prior ONS nurse).
Our daily census changes. The largest of our Medicare "admits" happen to be admitted by our "Hospitalist" service-which is very helpful for compliance and physician buy-in, as they are employed by the Hospital. Our Physician Champion is also a Hospitalist which helps too! We average anywhere from 10-30 admits daily. I don't think I have ever seen less than 8.
Per our consulting group Claro/CDR2 we should only have 30 patients on our profile daily, and be seeing roughly 15 a day- between new reviews and re-reviews of existing patients. With only 3 of us here we very rarely/almost never "clear the board" of all existing patients. I generally will give myself up to 35 patients though depending upon acuity. I would MUCH rather add a new patient than see a patient who has been here for over a month with no changes, and whom I already have multiple MCC's on, or has capped out with a trach.....so that is variable!
Hope that helps! How many do you see?
Juli Bovard
Rapid City Regional Hospital
Our numbers vary but the FT CDI is probably reviewing 30-40 charts a day and I am probably review 10-20. We think with 4 FTE's we can cover the hospital (except maternity) and we are in the process of hiring one now.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Laura Bohls, RN CDS
Prairie Lakes Healthcare System
Juli,
I'm just on the other side of the state in Watertown
Here is my email laura.bohls@prairielakes.com. Contact me directly anytime; I'm sure we encounter a lot of the same issues.
don't' review all). Best opportunity is with new admits, but we
try to f/u if no CC or MCC.
Our best allies, in my opinion, have been the Hospitalist Group and the
Residents - they 'get it' and understand the linkage of documentation to
quality scores, initiatives, continuity of care, etc.
We hope to recruit at least on more soon, but not sure if/when will
occur? This would be someone totally new to the CDI profession.
We review an average of 15-20 per day including new admits and f/u. I
spend too much time performing other required tasks - more than I would
like - but can sometimes get 15 done per day. The other team members
focus more on reviews and can get more cases done than I.
I also review expired cases - I also do all of the financial
reconciliation. Our entire small team collaborates very nicely on
matters such as education of staff and query formulations.
Overall...I like the job much more than 'just coding' or being a coding
mgr- CDI is much more rewarding and production coding is undervalued and
under appreciated.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org