Need help from experienced programs

Unknown

I am supervisor of a seasoned CDI program of 8.5 years. We have had a consulting group come to our hospital to evaluate our program. The consultant group has given us a goal of 50% query rate. We are seasonsed and have been working with our physicians for 8.5 years. This query rate seems appropriate for a new program. But for a seasoned program who has been working with the physician for 8.5 years, this seems rather high. At our facility (a large teaching facility), our program is running a 35-38% query rate. The consulting group also states a goal of 100% response rate for all queries. In a teaching facility with residents and attendings, this seems impossible. We have been averaging a response rate of 88-89%. I would like to know what other seasoned programs think about these goals and how your facilities are doing. Thanks for your help.


Juanita B. Seel, RN , CCDS, CDIP

lprescott

We had a consultant come in one year ago and our query rate did increase. The program was five years old. Remember the consultant is being hired to raise revenue and increase SOI so that will require more queries. I found I could not compare query rates from before to after for a number of reasons. We hired a second CDI (100 bed hospital) so we began looking at all payors and about 20% more Medicare than I could handle on my own.

Also their software does not allow me to separate a retro from a concurrent query. We are combined in the same bucket. If I wish to figure these rates I need to do it by hand. You need to ask them how the query rates are being computed- number of queries by number of patients or number of queries by number of reviews.

You also need to question why are you asking queries. Our rate is high but I query for many issues some DRG/coding related, some SOI related, some medical necessity related....etc etc.

The numbers can not be easily compared unless you understand the math. Apples to apples or apple to oranges.I hope this makes sense.

Laurie L. Prescott RN, MSN, CCDS
lprescott@morehead.org

robert.hodges2

Personal opinion I think they are being a bit nuts. My program is only 4 years old, I work with hospitalists only, and I have seen my query rate drop every year as the providers documentation improves. I've gone from around 40% to around 25% and there are queries, such as heart failure and pneumonia, that I rarely send anymore because the providers know I will query every time if it's not specified. I also have a >90 response rate, but unless there is something from administration where providers are held accountable to respond at a 100% rate, I don't see that happening.



I will be interested in seeing how others respond to this.



Robert



Robert S. Hodges, BSN, MSN, RN, CCDS

Clinical Documentation Improvement Specialist

Aleda E. Lutz VAMC



Mail Code 136

1500 Weiss Street

Saginaw MI 48602



P: 989-497-2500 x13101

F: 989-321-4912

E: Robert.Hodges2@va.gov



“Patriotism is easy to understand in America; it means looking out for yourself by looking out for your country" Calvin Coolidge

Linda_Rhodes

Hi Juanita,
We are a seasoned program also and have previously set the benchmark at 35%. We vary anywhere from 25-45% depending upon many factors. Every year in July we see our query rate increase as the new residents come onboard. Then we see a trending downward as they become more familiar with the queries and verbage. Our query response goal is set at 100% (in an ideal world), however we run around 85% and administration is happy with that number.
Recently we have seen an increase as we start to query for ICD-10 specificity. I know that we will have to relook at all of our program benchmarks with ICD-10.
I would be cautious in accepting a consulting companies numbers...they have to justify their cost.
Good luck!
Thanks,
Linda


Linda Rhodes RN, BSN, CCDS
Manager Clinical Documentation Improvement
New Hanover Regional Medical Center
Wilmington, North Carolina
Office # 910-815-5544
Cell " 910-777-8344
e-mail : linda.rhodes@nhrmc.org

don.cdi.rn@gmail.com

Hi Juanita (& Linda),

Agree with Robert's & Laurie's comments also.

I've set our benchmarks related to the work of the Advisory Board & of the ACDIS survey.
Advisory Board high performing programs query rate 25%
ACDIS 18%
Response -- Advisory Board 82 - 93%, ACDIS 87%

These 2 sources are neutral & based on reasonable data samples.

Our FY12 case query rate 27%;
Response 79% (an area of improvement we are focusing on & is rising, target >85%, prefer 90%)

ALWAYS take a consulting companies suggested goals with block of salt ... check other sources.
However, consulting companies are very often excellent opportunity to learn some new things and to improve.

As others indicate, query rate can be calculated in a variety of ways.
I prefer a 'case query rate':
# of cases with 1 (or more) query / # cases reviewed
How is the consulting company calculating their query rate?
what focus of queries ($, all, ICD-10)?

Response rate needs to be defined & needs to be balanced against what are the quality of the responses.

Don

evanspx@sutterhealth.org

I have the same opinion expressed by Robert – the numbers cited by the consulting firm seem difficult to accept. I also believe the % of queries issued ‘should’ decline with maturation of the program. Bear in mind, we should be ‘prudent’ when we chose to issue a query – I ‘could’ probably issue a query for almost every chart reviewed, but I question the value or wisdom of doing so. In particular, a query that is not warranted or does not add true value to the case may harm physician relations, in my opinion, and will be seen as simply irritating?

A 100% response rate seems unsustainable as well.



Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

katysuegood@gmail.com

This was what I was going to say too Paul. I think we have to be careful with these goals as we don’t want to overwhelm MD’s with unnecessary queries. We want to make sure that we are querying when there truly is need but tossing queries out when there is no real impact (and that doesn’t just mean money) could be detrimental. Querying on 50% of all records concurrently seems excessive unless you have some really poor documentation currently.
Also, unless you already have full coverage, it seems you could increase coverage by decreasing the query expectations. You might be able to review a couple extra charts a day in the times you would otherwise be spending on some (possibly unnecessary) queries.

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

evanspx@sutterhealth.org

Good points, Katy – IMO, a need to query for 50% of the cases would indicate some very poor documentation? I would ask the Consulting firm to vet the need for such a high query rate? Is the firm suggesting a query to type/acuity of CHF (needed) or could they be asking a team to query for the type of hyperlipidemia? Can they indicate the topics that should be queried – PNA, CHF, Renal function, Respiratory Status, SIRS, and so on?


Again, I could get to a rate even higher than 50%, but I think this rate would be artificial, at least in my sites? I personally feel a need to step back and justify my queries and ask myself to think thru the value my query may add to each case. We can lose our credibility quickly if simply issue a query for the sake of doing so?

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

robert.hodges2

I fully agree. A query has to have an impact on severity, continuity of care, patient safety, or quality of documentation. I know my emphasis is different since I don’t have to play with CMS and recovery audit contractors, but the goal is still the same, a complete and accurate health record. Many times I don’t query because, well, it doesn’t really impact anything. But when I do query the provider knows why and because verbal is the method of choice here we usually have a good discussion and they understand the rationale. Severity of illness has become a focus here and I’ve done a lot of education on how capture of secondary diagnoses impacts that. I’m just lucky I have great providers to work with who understand this now and support it.



Robert



Robert S. Hodges, BSN, MSN, RN, CCDS

Clinical Documentation Improvement Specialist

Aleda E. Lutz VAMC



Mail Code 136

1500 Weiss Street

Saginaw MI 48602



P: 989-497-2500 x13101

F: 989-321-4912

E: Robert.Hodges2@va.gov



“Patriotism is easy to understand in America; it means looking out for yourself by looking out for your country" Calvin Coolidge

Unknown

Thanks for always contributing Robert, it helps us so much do our jobs
better everyday!

Jamie Dugan RN

Baptist Health System

Jacksonville, Florida

Unknown

Thanks for all the great responses! I agree with all of you. I really just needed to know that my expectations were in line with everyone else who had an experienced program. We recently added 8 CDI's which increased our staff to 14 CDIs. I do expect with the new staff our query rate would increase--hoever, at a 50% expected query rate, I feel that some of the queries would not be necessary. The one thing that concerns me is the impression this may leave with the physicians. I agree 100% that a program should be monitoring, evaluating and working toward the most accurate severity of illness and risk of mortality. I really do thank you for your feedback!

Juanita "Nita" B. Seel, RB, CCDS, CDIP

Unknown

Our facility struggles as well with no accountability with no answered queries. Our medical staff has been reluctant to initiate any formal process to address physicians who do not answer queries. Our main hospital's group is monitored monthly and a report generated for no response queries. I think this does motivate some docs. One thing I have found is that there are a lot of md's offices that do not know what a query is and therefore do not handle it as a priority. I have tried to educate them, as I find out how it impacts the md and have had some successes that way.

kshumpert

All queries that are generated currently by CDI and retrospectively by coding are followed up by CDI. We have added to the job description that any queries that are unanswered by CDI involvement are submitted to the Chief Medical Officer. Our CMO attend the ACDIS conference when she first started her position. Afterward, she requested to meet with me and other RAC team members to go over what she had just learned. It was a whole new world to her. I was so happy to explain that ACDIS was my association, my conference. She has been completely engaged ever since. She had me develop a protocol that went before our credentialing committee. All physicians that have 50 or more admissions per year have to meet with me one-on-one for a documentation session as a requirement for re-credentialing. The physicians are given a discount on their re-credentialing fees for complying. Our CMO meets with me weekly to go over items; she wants to know about any physician issues and planning. She has added me to the UR committee. She keeps me busy, but I am so happy that she is engaged and sees the value behind my role. I have a wonderful physician advisor that helps me with criteria and any reviews that I need as well.

The very best scenario is to try to engage a physician leader. I hope the very best for your program!

Thanks,
Kathy
Kathy Shumpert, RN, CCDS

Interim Director Outcomes Management
Clinical Documentation Improvement Specialist
Community Howard Regional Health
3500 S Lafountain
PO Box 9011
Kokomo, IN 46904
Office 765-864-8754
Cell phone 765-431-0123
Fax 765-453-8447