CDI Productivity Standards

butlers1

Hi Everyone,

Does anyone have CDI Productivity Standards established under ICD-10 that they could share,  Or if you are currently working in CDI,  on average how many reviews (Initials and Secondary’s) do you see per day.  We are averaging between 10 and 15 looking at both MS-DRGs and APR-DRGs. 

Thanks for your input.

Stacey Butler, RHIA, CDIP, CCS, CCS-P

dsmith12h@aol.com

We are told to complete 20-25 total reviews daily.   Looking at  MS-DRGs. 

8 initial (new admit) reviews

12-17 secondary reviews.

Debbie Smith, RN, CCDS, CCS

LPeel

agreed and well stated

don.cdi.rn@gmail.com

Christina makes several good comments.   I'm not aware of any updated benchmarks regards to ICD-10.  Do take a look at the last query benchmark survey.  There is also a very hlelpful whitepaper, article and/or blog post discussing further the type of variables that Chistina discusses.

Don

Amy_Stremming_1992

We are expected to complete 15-20 reviews per day. This includes new and concurrent reviews, and we code also. We query for SOI/ROM as well as CC/MCC opportunities. We have a large teaching university medical center, so most patients have multiple consult notes as well as regular daily progress notes. I agree that once you put quantity into the mix, quality may suffer. There are so many variables between services and CDI specialists that should be considered.

tracey.lee

I'm not a fan of the current productivity metrics. I strongly feel there should only be two metrics to measure for quality reviews.  Response rate and provider agree rate. Too many metrics may skewed the data. Focus on what matter. CDI too often has to prove it's worth to an institution. If the hospital just think of us as the other side of the coin called performance improvement. They will have an " ah ha" moment. 

katysuegood@gmail.com

i beleive that no single metric (or handful of metrics) will ever capture a comprehensive CDI program. There are issues with ALL the metrics. But, the reality is that we have to track something. I dont think we can just throw everything out and not track whether reviews are being performed and how many. Or how many queries are being placed and answered. We do need to show that our CDI's are indeed working and that they are impactful. We track a lot. Number of reviews, query rates, response rates, agree rates, 'unable to determine' rates, retro query rates (from coding requests), CMI, CC/MCC capture, O:E, etc. It is important that anyone using this metrics understands that, in isolation, these are meaningless but that they are tools that potentially guide us to identification of successes and areas of opportunity/improvement.

Katy Good

Amy_Stremming_1992

Perhaps the best tool to show CDI value is the financial gain from our queries. We also track that, but it is very labor intensive. You have to go back and see what the payment would have been without the query and then the financial gain (or SOI/ROM if you wanted to track that) the query made.

Response rate from queries may not be a good metric if you do not have physician buy in.

don.cdi.rn@gmail.com

Katy -- very well stated!

Amy -- financial metrics are important, however these are very far less than adequate!! There are large numbers of other items that need to be kept track of to understand program process, outcomes, successes and opportunities.

Don

Amy_Stremming_1992

Don:

I still think if you can show the financial gain that your CDI program has achieved, as well as the increase in SOI/ROM capture, the quality and monetary benefit is hard to ignore. If these areas show clear improvement with the help of CDI, perhaps the mindset of "numbers of reviews" becomes less important. I do not disagree that there are other things that need to be tracked, but to the executives who do not have a clear grasp of just exactly what we do, the quality and financial metrics speak volumes.

Debra.Clark@sanfordhealth.org

I see reference to a whitepaper.  Would someone be able to provide the link for that?  Thank you.

Deb

Debra.Clark@sanfordhealth.org

I did locate a whitepaper by Wendy Clesi, "Cornerstone of CDI success: Build a strong foundation." If there is another that would be helpful, please let me know.  Thank you.

Deb

Amy_Stremming_1992

http://www.hcpro.com/HIM-288355-5707/QA-Measuring-CDI-specialist-productivity.html

http://blogs.hcpro.com/acdis/2011/11/cdi-productivity-benchmarks-a-cdi-talk-topic/

http://journal.ahima.org/2016/03/23/measuring-cdi-productivity/

Amy_Stremming_1992

One more:

http://engage.nuance.com/NuanceSummitBPI

Debra.Clark@sanfordhealth.org

Thank you.

don.cdi.rn@gmail.com

Amy -- I agree with you.  I'd take it a step further and clarify that presenting the financial without quality metrics to the executive leadership is selling short a CDI programs success and benefit to the organization.

Don

lprescott1

crivera0516 said:

Quantity does not gage weather a CDI specialist is doing a meaningful job as it pertains to MD documentation, revenue cycle, quality initiatives or physician education. I think productivity " standards" can be detrimental to a CDI program if the CDI leadership is not taking into account their specific facilities CDI practice i.e. are the CDS on the floor or off? What CDI software is used? Are the queries electronic or still paper, Does the CDS have support from the medical leadership? Is the medical record totally electronic or half and half? Does the CDI and Coding dept. have a collaborative relationship? All these variable and more play a role in a CDI specialist job performance in my opinion.

Christina Rivera, RN,BSN,CCDS

Absolutely agree. 

mmcaplan

Amy_Stremming_1992 said:

We are expected to complete 15-20 reviews per day. This includes new and concurrent reviews, and we code also. We query for SOI/ROM as well as CC/MCC opportunities. We have a large teaching university medical center, so most patients have multiple consult notes as well as regular daily progress notes. I agree that once you put quantity into the mix, quality may suffer. There are so many variables between services and CDI specialists that should be considered.

Hi Amy! I just want to know what's your hospital's bed capacity/census? I work at a large teaching facility as well and we are expected to review 20-24 charts/day....Reading multiple notes from different consultants/residents/fellows. We find it challenging to meet our numbers (at times) because of this.

Amy_Stremming_1992

We have about 900 on our daily census. There are 23 CDS nurses, so that is an average of 39 patients for each. Of course the numbers on their worklists vary from day to day and season to season depending on the service. Our true goal is 18 reviews/day, but most struggle to reach that number. I was just moved to an auditor position and we hired another new auditor. She comes from a teaching facility also, and their magic number was 20-24/day. She has realized that our CDS are expected to code so much more than at her facility, so I think this is the reason for the huge number gap. Our executives are very focused on quality initiatives, so this has forced us to code much like a coder. We are expected to capture so many codes in order to see what affects SOI/ROM. Per our auditor, she would not have worried with all of those codes at her prior facility. We are slowly trying to change the mindset on this so that our CDS can spend the bulk of their time searching for query opportunities rather than coding.

cari.merlina@uchealth.org

Any thoughts on how to measure SOI/ROM impact without CDS software available?  We (CDI) do not entirely code the chart, so it is difficult to determine which/what ICD 10 code made the impact, esp related to APR DRGs.  Any thoughts?  Thanks. Cari

evanspx@sutterhealth.org

2 thoughts.

1. You really can't measure the SOI/ROM w/o software - it is simply not possible or feasible to do so unless one at least 'rough codes' the major conditions charted...the formulas are complex.

2. We, too, review for ROM/SOI, HAC, PSI, MS-DRG at sites w/ teaching facilities.   I personally feel a number of 24/25 per day is too high in such an environment, and of course, the more coding rules and conventions you are asked to apply, the less will be your 'productivity'.  (Coding is 'hard")  I do not 'sweat' the small stuff, and ask my staff to review for limited factors, such as POA, confirmation or identification of major diseases, that one may expect to reasonably impact an important metric.

Paul Evans, RHIA, CCDS

jackietouch@aol.com

Amen, Paul! Well said and obviously spoken like someone who has been through the trenches!!

Cari ~ Our CDI software is MS-DRG based, yet we are reimbursed on APR-DRGs (children's hospital). The only way I can see if impact will be or has been made is to use the encoder in conjunction with our CDI software or see the impact on reconciliation. I am told we will be upgrading to software that includes APRs/SOI/ROM at some point...hoping it is as easy to use as the encoder.

Jackie Touch, MSN, RN, CCM

evanspx@sutterhealth.org

  The APR/DRG grouper is easy to use as the ROM/SOI are computed as you add diagnoses and procedures...generating SOI/ROM scores ranging from 1 to 4.   All the work is done in the background for you.  We have dual groupers and generate APR and MS DRGs as we audit.

Amy_Stremming_1992

We use the 3M encoder which calculates APR/MS DRG as diagnoses are added. If you do not have access to an encoder, you could use the UHC Expected Mortality risk factors. We have a list of most common diagnoses per service based on this UHC expected mortality calculation that one of our physicians on the quality side compiled. Just try to google UHC mortality risk factors and see what you can find.