Productivity Standards

robert.hodges2

I know there was a survey on this in the past, but I'm wondering if any of you have productivity standards as a job expectation as to the number of cases chat should be reviewed and re-reviewed each day? If you can let me know some numbers I would appreciate it.

Thanks all and have a great weekend!

Robert

Robert S. Hodges, BSN, MSN, RN
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

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

catladyrn

We don't have a daily rate, but we are supposed to complete reviews >80% per month. That allows for weekend short-term admissions not being done. We have been given strict instructions not to do retro reviews. If they're gone, we don't touch them.

Our IP DRG-payor admission rate is wildly inconsistent, probably because we have a large Medicaid/self-pay population. Some days we each get 20+ new admits and other days we might have seven apiece.

Given that our system is 100% EMR, I always do my followups first and then my new patients. New charts usually don't have enough information to come up with a query that is fair (e.g., missing H/P, pending consults, etc.). Hospital day 3 is where I start seeing my happy hunting ground...

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

robert.hodges2

Thanks Renee. I have a metric of over 80% of all admissions reviewed, but again since I'm a one man shop the only time I don't hit that metric is when I take time off. I don't do retrospectives either.

Robert

Robert S. Hodges, BSN, MSN, RN
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
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

dbutler

We (after a couple of years) became comfortable (with caveats) about the consultants standard of 1900/yr or 158/mo or 8/biz day (full time CDS, no other duties, round fractions up to help account for time off and additional duties). One of the confounding factors is units that tend to net transfer out.....the work is done by the first party but not the 'credit' as far as the # discharges. Also a factor are the complexity & LOS.

Metrics we use internally (for annual eval 5 level scale; one of many factors toward eval):
meets -- 115/month; exceeds -- 130; substantially exceeds -- >150

I do have a couple of folks who are routinely covering 175 discharges a month. Range is 130 to 180.

We don't have a good, reliable way to keep track of # re-reviews, but expectation is essentially a ratio of AT LEAST 1:1 and scaled up to 1:2 for higher performers (estimated due to data constraints, ratio is initial to re-reviews).

Works out to be around 20+ total reviews a day

Don

catladyrn

Don, I'd be curious how those numbers match up against the potential reviews your team could do. What I mean is, is a CDS only doing say, 150, because that's all they've been assigned. It would stink for someone to lose points on their evaluation because of census.

I completed 305 new reviews in September, but I expect that number to go down because the other nurse who started with me is now off orientation (I have experience, she doesn't) and has her own full assignment, so the census gets divided 5 ways instead of 4. And they are looking to hire two more folks. But I review 100% of the cases assigned to me.


Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

NormaB

We usually go by the ACDIS guidelines of productivity. This was taught
in the CDI Boot Camp Information so if it's erroneous it needs to be
updated.

Their guidelines say 20 - 25 reviews a day which can be made up of both
admissions and followup reviews.

Our consultant training team said we should be able to complete at least 10
admission reviews a day. With this in mind the rest (10 - 15) would be made
up possibly in followup reviews.

I focus first on my admissions first and make up the day in Query/Followup
reviews.

If I still have time left over at the end of the day I look at other
payers - or on our 3rd assignment which is not covered at this time.

jyeton.mccoy-johnigan

Perfect, thanks and have a great LONG weekend!!

robert.hodges2

This is great. I just went through my Boot Camp book, but can't find this reference. Are you able to point me to the right document?

Thanks in advance and it is a long weekend

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

dbutler

We review about 92% of all targeted patients (inpatient medicare). The missing patients are usually either 1) short stay Sat/Sun discharges or 2) odd locations (inpatient discharged from the Ed, PACU, childrens.....places where it is simply not worth covering at present for

NormaB

It was a cooment made by one of the speakers. That's why I was wondering if it had been added to the information.

robert.hodges2

Cool, thanks.

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

NormaB

Just checking the AHIMA CDI Toolkit and there is a Job description on page 8 under "Responsibilities" it holds 24-48 hours for initial review and followup reviews every 2-3 days.

pfowler

Robert,
I am having a brain freeze. What is the DRG for dehydration? I know the code is 275.6 but I can't find it.



Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432

Unknown

The code is 276.51 and the DRG is 640.

Thank you

pfowler

I have a diagnosis of dehydration. I queried using signs and symptoms query form and on the D/c summary he dictated Dehydration d/t decreased po intake d/t advanced alzheimers. I wasn't sure where to find this one. You said 276.51. Do you use codes or just the DRGs when reporting?

Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432

Unknown

DRGs as we are not coders!

robert.hodges2

Patsy,

The ICD-9 code is 276.51. Note that the code changes if there is documented hyper or hyponatremia, but the DRG doesn't change. DRG is 640-641.

Hope that helps.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

catladyrn

NTB wrote, "Just checking the AHIMA CDI Toolkit and there is a Job description on page 8 under "Responsibilities" it holds 24-48 hours for initial review and followup reviews every 2-3 days."

Just wondering how they can suggest followups every 2-3 days when most patients are pushed out of the hospital as quickly as possible. Some patients obviously don't need a lot by way of followup, but many others are going to go to coding with missed opportunities if the CDS has scheduled a review for 3 days from now and they go home in two.

As always JMNSHO,

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

robert.hodges2

That is a major challenge Renee. Fortunately I'm small enough here I am able to do 100% reviews every day. I just don't look at anyone who I may miss due to vacation or admitted and discharged on a weekend. Not having to do any retrospective reviews does help.

Robert

Robert S. Hodges, BSN, MSN, RN
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
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

dbutler

Suspect that the 2-3 days may represent an average......some cases daily, others every few and some once a week.

Also, doing a quick final review the day after discharge on all cases not reviewed day of discharge might help to lessen the risk while still having many of the benefits of concurrent review (fresh memory for physicians, easier access, etc.)

Don

NormaB

For most patients 2-3 days would be okay. That gives the attending time to assess the patients, bring on consults, start treatment, and see how patient responds to treatment.

For those that stay 3 or less days you won't get al lot of opportunity anyway.

My goal is to see every new admit the next day. For all those who are still "cooking" (abd pains, chest pains,, syncope, gi bleeds) those I keep following daily if I can. I try to do verbals on those. But I don't beat myself up if they leave in a couple of days.

Unknown

Folks, there is value in reviewing the record prior to 2 to 3 days. There is more to clinical documentation improvement than waiting to see how the patient responds to treatment and also seeing what the physician documents. It is referred to as the proactive approach. A recommendation is made to read the MedLearn Matters SE 1027 & 1028 and see where we may apply our clinical documentation improvement skill sets beginning with documentation in the ER.

Thank you

NormaB

I think its a case by case situation. I can review a chart day after admit and find many opportunities to query. Others it doesn't matter how many times I glance at the chart its not going to change the PDx or SDx's.

Some charts there is opportunity to "guide" the diagnosis such as symptom admits. You wait until the patient is assessed before you jump on the case. Tests are ordered, consults, prcedures, and you need towait for those modalities to be completed. Otherwise you risk what I call the "duh" questions: "What is the etiology of the chest pain?" "An AMI." (Duh!) That's a very simplistic example but you can follow my meaning. There is a watch and wait to some cases.

You have to approach each one in a different way. Also it depends on the focus of your CDI program. SOI/ROM or MS- DRG?

catladyrn

NTB wrote: "Some charts there is opportunity to "guide" the diagnosis such as symptom admits. You wait until the patient is assessed before you jump on the case. Tests are ordered, consults, prcedures, and you need towait for those modalities to be completed."

I could not agree more, which is why I don't think fresh admits are very good CDS hunting grounds. We are not here to out-diagnose the physicians or to jump all over the diagnostics to be the first to come up with the diagnosis. We are here to identify the gaps in documentation, and to strengthen the soft documentation (e.g., acute systolic HF vs just CHF). But they have to have written something first. If the patient's creatinine bumps overnight and the physician hasn't been in yet, do I query for ARF and get the credit when they write AKI? I think not. If the attending writes chest pain and orders a cardiology consult, do I query for the MI and get the credit when the cardiologist comes in later and diagnoses the MI? I think not. As NTB says, a "duh" moment.

I resolve never to have a "duh" moment in this job...

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

robert.hodges2

Be cautious of this for those of you without the electronic record that don't have to deal with "copy and paste" yet. I do reviews on all patients and I agree, if a test is pending or an etiology is documented as unknown, I don't query but will patiently wait and follow to see what turns up.

On the other hand, providers are accountable for what they put in their note. So, when one of my doc's imports abnormal lab or test findings into their note but doesn't address them in their assessment and plan, I will query for the significance of those results.

I focus on continuity of care and a complete and accurate medical record. DRG and CC/MCC findings have little significance for my focus.

Robert

Robert S. Hodges, BSN, MSN, RN
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
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

Unknown

Robert, now your thought process is a breath of fresh air. Someone who understands the real value of clinical documentation improvement beyond fertile CDI ground of hunting

catladyrn

Robert wrote:

"DRG and CC/MCC findings have little significance for my focus."

I wish, I wish, I wish......

lspryszak

There are no productivity standards included in the written materials for the CDI boot camp. The topic often comes up when I'm teaching the CDI boot camp and the answer is always "it depends".

How many new reviews and re-reviews are expected depends on:

1) the focus of the program (select payers, all payers, DRG assignment only (moving the DRG, severity/risk of mortality diagnoses, etc)
2) how much experience the reviewers have (the more experience, the more reviews you can do in a day)
3) Unit assignments and the type of charts - ICU charts typically have more progress notes, labs and diagnostic test results than med-surg charts; these charts take longer to review
4) how many reviewers you have in relationship to number of patients on your review census
5) how much of your "role" is covered by HIM - for example, does the concurrent reviewer have to finalize all queries, even those unanswered at discharge or does HIM finalize unanswered queries? Query follow up after discharge is time consuming.
6) Which providers are on which units - some units have a larger number of non-collaborative providers who admit a lot of patients. These charts require more queries, follow-up and face-to-face interactions than those units with the "good" or cooperative providers.
7) what other responsibilities does the CDS have? When the CDS is also the case manager/discharge planner/quality reviewer/CORE measure person, the number of CDI reviews will be much lower, the number of interactions lower, etc.
8) Length of stay - the longer the patient is hospitalized, the more re-reviews are needed.

This is why productivity standards are not included in the boot camp materials. No two programs are structured the same way.

I refer students to the ACDIS surveys covering this topic for additional information and to use as the basis of developing their own internal metrics on productivity.

As a former manager I expected a new reviewer to be able to perform 8-10 reviews per day (new admissions plus re-reviews) for the first few months. By six months they were given a "full" assignment and I expected to see increasing productivity. I did not expect a new hire to be able to meet review and/or query expectations until they had been in the role for at least a year. My focus for new reviewers was first, quality - then, quantity.

---but that was me. As someone who was a full-time CDS prior to becoming a manager, perhaps I had more insight into what goes into the job than managers without CDS experience.

dawn.laroque

Our program is responsible for CDI and concurrent Core Measure data collection. The expectation is to be able to compelte approximately 20 chart reviews per day, to include any Core Measure data collection for those records.