Standard Caseload

teresa.russoteresa.russo
edited May 2016 in CDI Talk Archive
Good Morning,
Our program is growing and as we add on new CDI folks the question came up as to what is the Metric or the Standard Caseload a CDI Specialist should carry.
We are a large teaching hospital/Level 1 Trauma facility with a daily census around 400. In April we will be opening up a new hospital tower which will double our current census.
Right now we review all patients but are assigned by service. Our role will be expanding to assisting with core measures. We currently have 6 CDI and will be adding 4 additional positions.
I would appreciate any and all information you are willing to share.
Best Regards,
Teresa

Teresa Russo RN,CCM,CCDS
Documentation Improvement Coordinator
University Health System
4502 Medical Drive
San Antonio, Texas 78229
ph:210-358-8608 fax: 210-358-4632
teresa.russo@uhs-sa.com


Comments

  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    Hi,
    I don't have help just a question.

    So your census will be 800? and now 400? reviewing all payors- making each cdi responsible for 65ish patients and that will increase?

    So what is the focus of your program? revenue, soi/rom?
    number of reviews per day- new/rereview
    Query rate?
    response rate?

  • teresa.russoteresa.russo
    edited May 2016
    The focus of our program has fluctuated.
    Right now we are focused on raising our CMI-Currently it is 1.72 and our goal is 2.0. So everything hinges on that. After the CMI we focus on SOI/ROM, then CC/MCC's.
    Our query rate right now is around 24% with our goal to be 35%.
    Out of the 6 positions we are operating on 4-One is out on Maternity Leave and we have a vacant position.


    Teresa Russo RN,CCM,CCDS
    Documentation Improvement Coordinator
    University Health System
    4502 Medical Drive
    San Antonio, Texas 78229
    ph:210-358-8608 fax: 210-358-4632
    teresa.russo@uhs-sa.com


  • wendy.clesiwendy.clesi
    There are multiple variables that impact the CMI. CDI contribution to the CMI is typically focusing on CC/MCC capture and alternate PDX as they do not have any impact on volume fluctuations.

    In a facility this size and average daily census of 400 with CDI focusing on cc capture and SOI/ROM for all payors, approximately 8 CDS would be needed to provide adequate coverage (approx. 50 beds per CDS. Please note that this does not factor is any responsibilities related to Core Measures.

    I have seen CDI programs be pulled into many other areas like UM/UR; Case Management; Quality. It is my opinion that each of these functions are separate and require specific knowledge and expertise. Additional responsibilities require additional staffing as this will impact CDI productivity. Of greater concern is that many hospital have tried to do this in the past and have failed. The program will result in a team of individuals that are "jacks of all trades and masters of none". Ultimately, CDI should grow their programs to focus on complete and accurate documentation and the rest will follow (reimbursement; medical necessity, quality, denial prevention, etc.).
  • teresa.russoteresa.russo
    edited May 2016
    Thanks
    I appreciate your thoughts. Up until now we have been focused solely on CDI functions.
    It will be interesting as we move forward.

    Teresa Russo RN,CCM,CCDS
    Documentation Improvement Coordinator
    University Health System
    4502 Medical Drive
    San Antonio, Texas 78229
    ph:210-358-8608 fax: 210-358-4632
    teresa.russo@uhs-sa.com


  • laura.reurink@avera.orglaura.reurink@avera.org
    edited May 2016
    At this time, we too are re-evaluating our program focus.
    Give me 30-60 days and reach out to me again?
    Wishing you well on your journey.
    Laura

  • angelisa.romanelloangelisa.romanello
    edited May 2016
    Hello Teresa,
    Our current workload for our CDIs is a minimum of 25 cases per day .
    That can be any mix of new cases and re-reviews.

    Since I average this out over the month, it allows for days when the CDIs are able to either pick up additional cases or fall short of the metric.

    This number will also vary according to the number of queries a CDI needs to place each day.

    We are in the process of moving to an entirely electronic system so the CDIs do not have to make as many visits to the units for chart reviews as before. The electronic documentation allows for easier reading and interpretation. ( however more risk of a CDI DVT )

    That being said, the CDIs focus totally on reviews and queries, most of the other activities are my responsible. Since I have a fairly new team, 3 with less than one year of experience, I have them focusing on reviews and learning what documentation is necessary to have a complete patient record. I feel they need to be proficient in ICD-9 so we can move on to ICD-10.

    We also use the encoder to code the charts.

    Variables to consider:

    * As we move into ICD-10, I am sure our metrics will need to be tweaked.

    * This program has been in place for 6 years now and our population of physicians has stayed fairly constant, therefore they know what documentation is essential.

    * We very seldom have to query our surgeons for acute blood loss anemia or our cardiologist for CHF specificity.

    Good Luck as you move forward and as I tell my team, CDI is a work in progress.
    Lisa


    Lisa Romanello, RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement
    Quality and Compliance
    CJW Medical Center
    804-228-6527
    Angelisa.Romanello@HCAHealthcare.com




  • teresa.russoteresa.russo
    edited May 2016
    Thanks Lisa,
    I appreciate all your input. There are a lot of variables.
    Currently my team consists of only 2 senior CDI Staff. At this point none of the 3 newest team members have any formal training.
    We use 3M as well and the encoder and we are working towards training from 3M either in March or April.
    Best Regards,
    Teresa

    Teresa Russo RN,CCM,CCDS
    Documentation Improvement Coordinator
    University Health System
    4502 Medical Drive
    San Antonio, Texas 78229
    ph:210-358-8608 fax: 210-358-4632
    teresa.russo@uhs-sa.com


  • angelisa.romanelloangelisa.romanello
    edited May 2016
    Good Luck Teresa.

    In the six years, I have been here, the program has changed and evolved and that is such a nice road to travel.

    Seeing your address made me a little melancholy. I graduated from Incarnate Word College in 1994 and we had to move away from San Antonio in 1996. I miss it so much.

    Best

    Lisa

  • teresa.russoteresa.russo
    edited May 2016
    Thanks Lisa,
    Go Cardinals! :)
    You wouldn't recognize San Antonio now...it has really grown and expanded.
    In April, University Hospital will be opening a huge new tower- the Sky Tower.
    It will be interesting but exciting times.
    Take Care,
    Teresa

    Teresa Russo RN,CCM,CCDS
    Documentation Improvement Coordinator
    University Health System
    4502 Medical Drive
    San Antonio, Texas 78229
    ph:210-358-8608 fax: 210-358-4632
    teresa.russo@uhs-sa.com


  • teresa.russoteresa.russo
    edited May 2016
    Thank You Laura

    Teresa Russo RN,CCM,CCDS
    Documentation Improvement Coordinator
    University Health System
    4502 Medical Drive
    San Antonio, Texas 78229
    ph:210-358-8608 fax: 210-358-4632
    teresa.russo@uhs-sa.com


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