Question regarding CDS Census...

paxnerospaxneros
in CDI Talk Archive
We are heading into Summer which for our hospital is typically lower in census. (House-wide) Managers have been asked to staff according to census.

For example, if the Inpatient Coding Team comes in -(there are 4) and there were only 50 charts discharged and scanned for them to work on - two would probably be sent home, or they would all work half a day and then go home.

In CDI we have a hard time achieving this goal. We may only have 15 New Admissions which seems very low. But that could be due to our House-wide census being full. In other words if a Unit can only hold 42 patients and they have 40 - only two can be admitted unless someone is discharged. This would apply to every unit.

So based on new admissions it looks like someone should go home - but based on the house-wide census we could really be working on our continued stays more.

Does anyone else have to look at Census/Staffing for CDI?

I would appreciate hearing any ideas or seeing procedures any of you have in place to address this issue.

Thank you in advance,

Norma T. Brunson, RHIA,CDIP,CCS,CCDS

Comments

  • Unknown
    edited May 2016
    Our program is not fully staffed so it does not matter what the census is. The work is full time plus.


    Charlene
  • wrightnawrightna
    edited May 2016
    Our program is not fully staffed either so this is not in the cards for us.....interesting though with ICD 10 on the horizon it seems there would still be other things staff could be doing (new tip cards, query sheets incorporating ICD 10 concepts, etc.) Rechecks is where we fall short so we always have more than enough to do......full-time plus is also our gig here!


    Nancy Wright, RN, BHA, MBA, CCDS
    Certified Clinical Documentation Specialist
    Health Information Management
    Saint Mary's Health Care
    200 Jefferson SE
    Grand Rapids, MI 49503
    PH: 616.685.6687
    FX: 616.685.3014
    wrightna@trinity-health.org
    www.smhealthcare.org
  • paxnerospaxneros
    edited May 2016
    Thank you for bringing that up Charlie! That is another issue I will add into the mix - we were originally staffed for 4 personnel and only have 3 CDS. So we are not working with a full staff either.

    However, this happened one day when I was out - our department was sent home because of "low-census" throughout the Hospital. "Unnecessary" personnel were sent home. That day we only had 2 CDS working.

    Any suggestions of how do effectivly communicate that issue?

    N.Brunson, RHIA,CDIP,CCS,CCDS
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    We have 2.9 FTE for 3 campuses - our situation is the same as Charlene's, we will never review even 75% of our eligible cases and we can only sample our cases. I suppose we should be grateful in that we have plenty of work. So, not an issue for us.

    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
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Do you review all patients regardless of payer? If so, could state a review of all cases may support overall O/E ratio?

    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
  • kmckaigkmckaig
    edited May 2016
    We are in the Case Management/Discharge Planning Dept and yes, we are asked to work according to census. Sometimes we've been asked to flex so many hours across the board and other times the CDS' have been told to flex more hours than Case Management or the Social Workers and still other times, we've gone alphabetically to flex. Not alot of consistency.....and yes, it does affect Queries, Case Mix, Physician Education, capture rate etc.
    There has been discussion with leadership in the past about making us a "fixed" department which would prevent us from flexing with low census but that never was done.

    Hope this helps,
    Karen

    Karen McKaig, BSN, RN, CCM, CPUR, CCDS
    Case Manager
    Clinical Documentation Specialist
    Baxter Regional Medical Center
    Mountain Home, AR 72653
    870-508-1499
    kmckaig@baxterregional.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    This (Nancy's Comment) is what I was thinking. Our department all just became salaried (I always have been) so there would be no incentive for them to downsize us. However, I am really surprised that they would have you do this unless you are covering all patients and are totally prepared for ICD-10. It seems like there is ALWAYS something to do. Education (of the CDI's), internal audits, education materials development (for MD's), etc, etc, etc....

    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
  • paxnerospaxneros
    Agree! Our work is never completed - most days we get our priorities done and we leave work undone. In the past, we could fall back on this other work to keep us busy. A day to get caught up. But seems they would rather send folks home than find them work to do.

    Thanks all!

    NTB
  • Unknown
    edited May 2016
    It all depends upon how you define working on continued stays. If you are reviewing the record for opportunities to improve the completeness and accuracy of the record beyond just chasing down CCs/MCCs, then there is justification for all CDIs. Otherwise, continued stay reviews may not be justified.
  • paxnerospaxneros
    edited May 2016
    We are beyond that issue at this point. Making sure your facility is credited for quality care through quality documentation is the goal. But make no mistake- we exist in a for-profit world and this means capturing revenue which can be reinvested in our facilities to provide better care to our communities.

    We just need the added time to do this- and that can't be based on the census. Reviewing records and capturing documentation takes time, Speaking with other disciplines and educating physicians on the floor- takes time.

    Thank you all for your input.

    Norma T Brunson,RHIA,CDIP,CCS,CCDS
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