Competitive pay

Hi everyone-I'm reaching out to this community to try and gain some
perspective on compensation for clinical documentation specialists. I am
starting to see a trend with more facilities going to a complete EMR
spawning more job opportunities for remote CDI positions. Remote CDI
really isn't feasible with a hybrid medical record, but retention
becomes more difficult with remote opportunities out there.



In your facilities, how is your pay scale structured? Do you have a
scale based on years of experience, certification, licensure, etc., or
are you paying based on outcomes?



Please feel free to email me privately if you wish. I'm also interested
in retention strategies you may have developed. I have read the ACDIS
salary survey.







Cathy L. Seluke, RN, BSN, ACM, CCDS

Supervisor Clinical Documentation Compliance

MaineGeneral Medical Center

Augusta and Waterville, Maine

P. 207.872.1796

F. 207.872.1594

Cathy.Seluke@mainegeneral.org

Comments

  • Cathy,

    Most of our CDS's were existing staff at the hospital, with many years of service (with salaries to match). Generally, this was a lateral move for them, so no significant change in salary.

    All are salaried, with M-F & very flexible hours (likely the biggest influence on retention).
    We are working toward (part time) remote (once implemented, will also be a big influence).
    We try to support education/conferences, professional membership.

    For an external candidate, I expect CDI experience is likely a large driver, along with total professional years of experience.

    Paying based on outcomes -- need to be careful on which outcomes are chosen to avoid perceptions of salary being influenced by any financial impact achieved. That can lead to hot water.

    Our annual evaluations (with attached merit raises) are in part connected to firm metrics (productivity, query rate, response rate ...)

    I know that one or two organizations have sought to develop clinical ladders for CDS's. That might be something to consider. There was a presentation at the conference a couple of years ago.

    Certainly very interested to see what others contribute.

    Don


  • Cathy

    Good morning! For us at Regional Hospital in Rapid, all the CDI staff are Registered Nurses. We are paid according to time with the institution. We are "salary" with an hourly rate. I am the only CDI that has my certification, but make less than one of the other CDI because she has been with the hospital longer than I have-even though I have been in this department and role longer. Getting my certification really did nothing towards an increase in salary. Having seen that, at this point, I don't think the other 2 CDI staff will get their certification unless it becomes mandatory.

    I have been in the role for 3 + years and the other CDI staff for 2 years and one year respectively. We just hired a fourth CDI, and I take the lead for training, educating each new CDI staff. I am contemplating getting my CDIP with the knowledge the expense will come out of my pocket and having it, is a personal and professional goal for me only, as it will not benefit me financially.

    Hope that helps.

    juli
    Juli Bovard RN CCDS
    Certified Clinical Documentation Specialist
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    719-4390 (work)
    786-2677 (cell)
    "No Limit to Better......"
    [CCDS_pin_1inch]

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens






  • Hello all. In a sort of addendum to the recent post by Cathy regarding EMR and the possibility of working as a CDI "remotely", does anyone know of anyone hiring for a "remote" CDI or CDI employment where you work from home-since there are so many hospitals going to EMR? I don't know where to begin to search for this!

    Thanks in advance!
    Juli

  • edited May 2016
    I pretty much echo the thoughts of the previous emails. We are salaried-based on length of time at hospital- with flexible schedules. CCDS is on your own, ACDIS membership is on your own.
    As manager, I try to promote the age old idea of professionalism with ACDIS membership and achieving certification. We are not just doing a job. We are professionals in a cutting edge industry and should do what we can to promote success for ourselves and for our organizations.

    Maybe I am too old-fashioned, but I remain of the mindset that coders could be remote but CDI must remain in house. I believe that nothing can take the place of face-to-face communication. I think a cornerstone of CDI must encompass the power of relationship-building.

    -Jane

  • edited May 2016
    One more thing! To speak to the retention issue, I personally give perks to my team as in time off, longer lunches, and leaving early. This is the only way that I can reward them for productivity and meeting our target goals. The hospital budget cannot support more incentives and I respect that. I think people respond well ( and productively) to being appreciated and treated professionally.

    -Jane

  • We just changed departments and everyone was moved to an exempt status (salaried). I have been salaried from the beginning. I believe that the pay scale is based off of nursing experience, not necessarily CDI. So we get basically similar pay as we would if we were working the floor.
    When recruiting, we push a flexible schedule as a key feature. Few to no holidays (we may begin covering holidays soon). Weekends by choice, allowing for a 'swing' shift, etc.

    Incidentally, I work remotely but I am the only remote member of the team and I don't do many concurrent reviews anymore. I have no concurrent 'assignment' currently. We are fully electronic and I am able to review remotely without issue though. We have allowed staff to review from home during severe weather, mild illness, sick kiddos, etc and we are set up to support that. With a rapidly expanding team, I am not sure if we will continue to do this as we will be able to cover those things fairly easily. With a small team, we felt it was worth it to support remote work in these scenarios because the other option was no reviews getting performed that day.

    I see value in on-site staff and think the face-to-face contact is key. However, I think there are ways to make it work remotely too. Especially if not every staff member is remote. Or, if they are not fully remote. I can see it working well (for example) in a 4-5/person team for each member to work 2 days/wk from home or something similar.

    Retention is important and flexibility with staffing will encourage staff members to stay. There is a lot of demand out there especially for a well-rounded candidate. My position was not supposed to be remote. I was on-site for 18mo when I moved cross-country. It was either loose me entirely or make something work. I am happy to say that they decided to make it work. I (of course!) think it was a great decision :)

    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

  • I think this is great! our leadership does the same. As a working mom, my employers have also supported work-family balance, which I am very appreciative of. When I worked on-site it was so nice to know that if I got a call that my daughter was sick, I could just leave and know that no one would be upset. I also was allowed to work from home if my kids were too sick for daycare. If my son had something at school that I need to step away and go to for an hour, that was fine too.
    We like to say "there are no documentation emergencies". It's important that our staff know the goals of the program and are engaged and invested in our success. However, whether they take an hour lunch break or need a half-day on Friday is not a huge deal as long as the work is getting done. I think trusting employees to do their jobs without micro-managing fosters independence and promotes job-satisfaction. I actually think you end up with more committed staff this way.

    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

  • I forgot to touch on the ACDIS/CCDS issue. In the job description, ours states that you must attain your CCDS within 2 years of hire. They do not pay for the exam but do provide an paid education day to take it (we have to drive 6 hrs round trip to take it). It is treated just as any other certification at our hospital so we get the equivalent raise as you would if you achieved your CCRN or something similar. Its only $0.75/hr BUT at least it is being valued just as other certifications. I was the first to attain certification at our hospital and I had to advocate for this to be considered. One of the things I included in my spiel about why it should qualify for the certification raise was that it is now recognized for Magnet status. If your hospital is currently working on or considering trying to attempt attaining Magnet status, this is an important factor that may make them see it as being more valuable.

    Just a thought....

    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

  • Hi folks,

    What follows below is applicable to a program or organizational perspective, not all who read CDI Talk are interested in this type of program management discussion.

    I think hospitals that base CDI pay on Nursing or HIM pay scales are not taking into account the value of CDI to the bottom line. We, as CDI Professionals, have to continually advocate for the value we bring to the organization. (we are "value-add", not "net-loss" employees). I can understand a hospital offering a lower salary for a person new to CDI, but, within 1-2 years, that employee becomes very valuable in the CDI world.

    Lets make this easy for the acountants and the CFOs in our hospitals to understand (lets talk quality afterwards, the numbers guys and gals want "hard financial numbers" to justify their investment)

    Think about it this way.... The Advisory Board states that a high performing CDI Specialist (2+ years experience) brings about $1.2 million to a 250 bed hospital. An "average" CDI is about $700-$800k.

    Lets do some math. (all salary numbers are assumptions, not based on mine or any other numbers)

    Costs:
    Lets assume 30% overhead on salary for benefits, space, utilities, education costs etc and build this in to the salary equation. Lets assume 3 employees with the same salary and the manager with 20% additional salary.

    It appears that the "going rate" (National Average) for a CDI Specialist is $75k and is $90k for a CDI manager. Personnel costs= $315k, include overhead = $409.5k
    Lets add $60k for your software to both scenarios and $40k for a part-time physician advisor (1/4th - 1/5th time).

    Total Costs: $509.5k

    Revenue:
    High: 4 Person CDI team = $1.2million x 3 and $600k x 1 (for the manager reviewing charts half-time) = $4.2 million potential (looks low as other organizations say a 250 bed hospital can do $5 million/year with a great CDI program).
    Average: same size team = $2.8 million

    Return on investment (ROI) using the equation ROI=(payback - investment/investment) with "going rate" of salary + other costs as detailed above

    High Performing Team ROI = ($4.2M-$509.5k)/$509.5k = 7.24,
    Average Performing Team ROI = 4.49

    So, don't you think we easily justify our existence from a financial standpoint? A CDI team represents at least a 4.5 to 1 Return on Investment!

    We should consider adding 10% to the salaries to make CDI in better standing in competitiveness and attracting and keeping staff.

    Costs: Specialists $83k x 3 + Manager $100k = $349k + 30% (overhead) = $454k; add $60k (software) + $40k (adviser) = $554k
    ROI - High: 6.58; Average: 4.05

    How many other departments in the hospital show an ROI as good as this?

    My main point of this is that most of us CDI Practitioners have advanced training and we are in a very competetive and fast-growing career field, thus, by presenting the value we bring in financial terms, we should be able to justify our higher pay to the administration in relation to our nurse and HIM colleagues.

    With Kindest Regards,

    Mark



    ______________________________________________________________


    I forgot to touch on the ACDIS/CCDS issue. In the job description, ours states that you must attain your CCDS within 2 years of hire. They do not pay for the exam but do provide an paid education day to take it (we have to drive 6 hrs round trip to take it). It is treated just as any other certification at our hospital so we get the equivalent raise as you would if you achieved your CCRN or something similar. Its only $0.75/hr BUT at least it is being valued just as other certifications. I was the first to attain certification at our hospital and I had to advocate for this to be considered. One of the things I included in my spiel about why it should qualify for the certification raise was that it is now recognized for Magnet status. If your hospital is currently working on or considering trying to attempt attaining Magnet status, this is an important factor that may make them see it as being more valuable.

    Just a thought
  • Mark,
    Thanks for laying it out for us!! I completely agree. I was recently tasked with providing rationale for hiring additional staff and I kept repeating the same message. We are revenue-generating. Very few other staff members outside of MD's in a hospital can say this. It is important to push this message.

    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


  • edited May 2016
    Mark,
    I definitely agree 100%. Now I just have to try to convince the
    financial people to compensate us according to our worth (a harder task,
    but I think it's achievable).

    Thanks for the breakdown, it feels good to know that my effort and
    contribution actually reaps very nice financial benefits for the
    hospital, especially since I love what I do and all the learning
    opportunities CDI world has to offer.

    Nieke Oglesby, RN, BSN
    Baptist Health, Jacksonville
    Nieke.oglesby@bmcjax.com
  • Thank you Mark for your helpful synopsis.
    Lisa



    Lisa Romanello,RN,BSN,FNS,CCDS
    Manager, Clinical Documenatation Improvement Specialist
    CJW Medical Center
    Quality and Compliance
    804-228-6527



  • BINGO Mark!!

    Your model covers the major costs (salary and consulting costs are the
    real drivers), so for pragmatic purposes, don't need to include
    everything else when discussing the general case.

    The advisory board is a great reference. In looking at the
    benchmarking data that is similar between that report and the ACDIS
    Query survey, there is reasonable agreement, which supports the strength
    of what Advisory board suggests with regards to ROI.

    Since I've calculated and presented a net financial ROI for several
    years, I'll go ahead and share.
    Cost = total department costs (salaries, consultant, software,
    education, paper, ... etc.)

    FY12 CDI Net ROI = 683%

    Net ROI is one of the figures that I think is essential for every CDI
    program to present.
    AND right next to it -- impact on SOI/ROM or O/E (specifically the
    expected) mortality ratios (whatever you have).

    Don

  • An easy (sort of) calculation to perform when requesting additional FTE's --

    know what your chart value is ($ financial impact / total charts reviewed).

    forecast how many additional cases could be reviewed (AFTER >6 months experience) with the additional FTE(s).

    chart value x additional charts reviewed = possible financial return of adding CDS FTE

    Has been helpful for me.

    Harder to quantify is the need (financial and otherwise) as we gear up for ICD-10. Don't have particularly easy answer to that one.

    Don

  • A quick range, based on Mark's Advisory board numbers:

    High performing chart value:
    $1.2 mil / 1900 cases per year = $631
    Average CDI
    $0.75 mil / 1900 = $395

    Of course, the assumption is that there will be roughly the same number of cases reviewed by both a high and average CDS. The survey data, consultants & Advisory board all do support an annual case load for a full time dedicated CDS of around 1900.

    Don

  • Don and Mark,
    Thank you for the detailed processes. I have needed a good formula to generate data and since I am no mathematician; it does not come natural to me. Both of your suggestions will help me immensely!
    Mark, are you presenting on this at ACDIS? I can't recall your topic.
    Thanks again.

    Jane Hoyt, BSN, RN, CCDS, CPC-H
    Manager, Clinical Documentation Integrity
    Denver Health and Hospital Authority
    Pavilion A, 5th floor, Room 505 ~ Phone: 303-602-3830 ~ Mailcode 1801~ jane.hoyt@dhha.org
  • Hello Jane and fellow CDI-Talkers,

    My presentation at ACDIS will be practical suggestions and proposed best practices for CDI in a brand-new EHR installation.

    I think a presentation on program metrics, benchmarks, financials, etc would be a good topic for a presentation. Maybe I can convince Don to co-present this topic at the next conference? (or if there is a cancellation, is there a possibility to substitute in this one instead of blank space/time?).

    Don has written a great ACDIS blog topic on this - and he has provided invaluable information here about metrics, benchmarks and reports.

    I think the model I sent today would be a good blog posting - not too long, not too much information at one time - so most would not feel "overwhelmed". I will write Melissa about that possibility.

    Look forward to seeing you at the conference!

    Mark

    __________________________________________


    Don and Mark,

    Thank you for the detailed processes. I have needed a good formula to generate data and since I am no mathematician; it does not come natural to me. Both of your suggestions will help me immensely!

    Mark, are you presenting on this at ACDIS? I can't recall your topic.

    Thanks again.



    Jane Hoyt, BSN, RN, CCDS, CPC-H

    Manager, Clinical Documentation Integrity Denver Health and Hospital Authority Pavilion A, 5th floor, Room 505 ~ Phone: 303-602-3830 ~ Mailcode 1801~ jane.hoyt@dhha.org



    _______________________________________


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdomine2@jhmi.edu


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  • I've applied to speak the last couple of years. One of the proposed topics I've suggested has been about metrics. There have been several other great presentations on the topic.

    IIRC, when there are (like this year) 130+ applications for 30 or so slots ... it is VERY competitive and the Conference Committee has a difficult job in shaping a conference agenda with fresh ideas & content along with stimulating speakers that fall into several themes. The speakers every year have been wonderful & varied.

    No convincing needed, I'd be happy to co-present!

    Don

  • edited May 2016
    Good information below. One piece that is overlooked is the costs of defending denials from third party payers where the CDIS has queried the physician and the clinical validity of the additional diagnosis is questioned. The hospital must spend monies to appeal the denial of the daignosis with the resulting DRG change. According to the AHA, the costs involved in appealing a case through the 5 designated levels of Medicare appeals is about $2,000. This costs should be incorporated in the equation of net return on investment for CDI.

    Just some food for thought.

    Thanks


  • I completely agree ... with the concept (and the theoretical value) ...
    my problem is how to we (CDI) measure this impact? how do we know which
    cases or how many cases we've ensured have the appropriate needed
    documentation so that a specific case was not targeted by a third party
    payer?

    Don

  • edited May 2016
    Glenn, and Don (Especially Glenn)

    I most certainly agree that all costs should be built in for any possible RAC defense of a single CC or MCC that was added to the record but the RAC determines that there was not sufficient additional clinical information in the chart to support the diagnosis.

    This is hard to quantify, as there are many RAC appeals and they do not necessarily tell you all the time specifically if it was the diagnosis the CDI queried for, and then, it is still difficult to break out.

    That being said, The truly correct figures for "net payback" for each CDI is $1.4million for high performing teams and $700k for average teams (I verified it with the Advisory Board presentation and updated the figures for a potential blog posting I sent to Melissa). I believe with all of the research the Advisory Board conducted on this matter, that they took all matters into account, especially the possible RAC defense.

    Thanks and Kindest Regards,

    Mark
  • As another (real but difficult to measure) ROI for CDI programs is when the CDI is able to do one of the following:

    1--guide the physician to strengthen documentation (clinical indicators, treatment, etc.; risks and clinical status to support inpatient status, etc.) that would deter a third party reviewer challenge.
    2--successfully add a strongly supported and documented additional secondary dx (cc or mcc), which changes the case from a sole cc/mcc to a case with 2 (or more) cc/mcc and thus deters the third party reviewer from either looking at the case in the first place, or being able to change the DRG by removal of a dx.
    3--also the case where the CDS guides documentation away from an initially documented diagnosis that is NOT clinically supported (even though that might mean the loss of a cc/mcc & lower initial revenue -- such as where the clinical indicators for sepsis are not present, the respiratory status is not significantly compromised or where the Cr only shifts 0.1).

    All of the above are appropriate CDI activities.
    All of the above will preserve revenue &/or decrease the costs of third party processing & defense.

    Don

  • edited May 2016
    Wonderful examples, Don! I too, often query for clinical support, and more often I query for the additional CC or MCC
    to strengthen the DRG.

    But I titled the model :


    "A Simple Return on Investment model for CDI"


    and we are now going into territory which makes it not such a "simple" model anymore!

    I would definitely be prepared to defend with the items we are discussing now, but, I do not believe we should start out with a broad approach. My experience is that the money people want the "meat" or the "juice" and the model provides reference and adequately provides for the figures presented (and hopefully doesn't lose their interest)

    Thanks so much for the input!

    Mark

  • I do tend to get way to carried away with analysis :)
    The simple model outlined is certainly MORE than effective!

    Don

  • edited May 2016
    I agree with Glenn, Don, and Mark. You do need that simple model to speak to CFOs,cetc.
    But we all know that the more complex areas that CDI touches are difficult to quantify. I suppose time will tell in decreased denials and increased SOI/ROM for improved mortality scoring and VPB adjustment. I now have as part of my spreadsheet a column for 2nd cc/mcc. I applaud that 2nd or 3rd co-morbid condition far more than that lone MCC hanging out there. If it is not well-supported by documentation, we yank it. I have come to fear and loath the lone MCC.
    I may start counting that 2nd MCC as part of our numbers.
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