what is a review?

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Management
Sounds like a silly question but we have varying opinions on this in our team.

We calculate query rate as queries:reviews so what constitutes a review is a rather important issue. So if you calculate your query rate similarly do you only count documentation evaluation as a part of the concurrent process as 'reviews'?
What about other scenarios:

1. Monitoring of a query (just entering the record to look for responses)

2. DRG reconciliation with coding

3. Placement of a retro query (requested by coding)

4. Etc....


I am of the mindset that it's only a 'review' if you are reviewing new documentation as part of the concurrent process (through review of the DCS).

Thoughts?

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Hi, Katy

    I can't provide any insight as our approach is different But, just want to say that we calculate this metric based on # of CDI reviews/number of eligible admissions (accounts)

    I find this much simpler. We also tabulate our productivity in the same fashion...: How many accounts does our team review per year. We don't count the number of reviews, but the number of eligible accounts (cases) per year.

    Most sources I can find state that 1 FTEE should be able to review about 2,000 accounts per year, including all factors. I know there are advantages/disadvantages either way, but I am really trying to keep this as simple as possible for ME.

    PE

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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I agree Paul, this is how we used to calculate it. Our data analytics recently changed which is complicating things. But also We are trying to assess our staffing levels/productivity and I am trying to assess how many 'reviews' are done per person and finding that different CDI's are assessing this differently.

    In estimating of how many accounts should be reviewed per CDI, how do you account for longer LOS? We review based on geographic locations (CDI's are responsible for assigned units) that change quarterly. ICU CDI's would cover fewer accounts than our major joint unit, for example... It would probably balance out somewhat with our rotation but I am not sure.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Hi, Katy


    In truth, I am not trying to adjust for the different complexities of our reviews ascribed to location. We review for all manner of Pay4 Performance Metrics, Mortality, ROM, and DRG all payers. We have only 5 staff for about 30,000 discharges at 7 sites across California, so my motto is that sampling is a wonderful concept. We know our methodology is crude, but we have found we can average about 2,000 FTEE yearly. I don't really have significant analytic tools or support to be any more sophisticated.


    Best to you,

    Paul

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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Gotcha! Thanks Paul!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • sbourquesbourque
    edited May 2016
    Katy,
    I have the same question you do...we are on a hybrid record. I know that my CDIs are counting checking to see if a query is answered as a review. If it's answered I would agree with counting it as a review since they will have to key in this info and it may impact the DRG. If it's not answered, they don't have to go into 3m 360, they can simply open the hard copy chart, check for answered query. If it's not answered I don't think it should be counted as a review...my opinion only...I have not made this change yet.

    Suzonne Bourque, RHIA, CCS, CCDS


  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    Would it be fair to say this averages about 7-9 new cases a day= 2000 cases per FTE...do you assume time off for vacations? I've heard consultants say12-17 new per day...depending whether vacations (4 weeks est) accounted for...their supposed quota seems like it would average
    2880-4080(48 week)
    3120-4420 (52 weeks)
    12-17/reviews per day

    These proposed recommendations to upper level.



  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    I can't understand why ALL reviews shouldn't count. We don't JUST look for an answer we review the documentation for clarity. We follow till discharge as often a subsequent note causes further need for clarification...

    Maybe one case takes 2-5 minutes but many can consume hours of time. It averages out. Why say when it's simple it doesn't count and when it's very complex...tough luck!
    Especially relevant in areas where quotas are the same despite being on specialized units (we don't rotate)- I think medically complex units are at a disadvantage as to required charts vs time required to weed through multiple providers.


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Various CDI publications have stated the total # accounting for all factors ‘should be’ about 2,000 FTEE. Of course, the actual number depends greatly upon Scope of Work, but this is the number I have found cited most often. I have heard that some Consultants state that 40 per day is achievable? This seems too high unless one is performing a very basic CC/MCC review, only, and not reviewing for any quality factors.

    Paul

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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • sbourquesbourque
    edited May 2016
    When the CDI is checking to see if a query is answered it may take 5 seconds. They open a chart to the query form to see if it’s answered. This is now counted as a subsequent review. They are not reviewing the chart; only the query. Now if they spend time in the chart and do review additional information, then this should be counted as a review.


  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    I guess this is where different focus comes in. It seems you would look at all notes for clarity and conflict that might effect pdx or a cc or mcc. If you operate only on revenue still seems like these things would favor in... Probably the type of case/query?? Simple surgery looking for cc...

    I think things are getting too clouded by consultant recommendations. There are SOOO many variables effecting the number of cases completed. I feel Cdi is morphing into justifying metrics because consultants state things to upper level who don't know anything about what factors in to reviews. Not to mention what an individual facility REQUIRES to be written down.
    Normal values not pertinent to a particular patient. Daily entry for every provider EACH day. It becomes VERY time consuming.

    A facility leadership can require info written down. A consultant comes and follows you and tells you to LEAN UP the notes...then you get told you didn't write something on your daily note.

    There's a lot of disparity especially when the recommended metrics come from one source and the daily work flow from another.

    I find it so fascinating how differently programs vary!




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