Avg Query Rate expectation for small hospital

I'd like opinions on what people think would be a reasonable query rate for a very small (<50 beds, usually never more than 40 bed occupancy) community acute inpatient hospital. I am a one man show and at the recent conference my leadership heard 25 -35%. I don't think that is reasonable especially considering what our patient population is. We do no open hearts. Mostly ortho and GI surgeries.

All advice and suggestions welcome.


  • Great topic for discussion. In reviewing previous ACDIS discussion board posts from 2010, query rate goals range anywhere from >12% to 40%. The Advisory Board survey in 2015 cites an average query rate of 28% (https://www.advisory.com/research/financial-leadership-council/at-the-margins/2015/01/cdi-benchmarks). 

    I think that your query rate goal is going to depend on  the mission/goal of your CDI program. Goal will also be dependent on your population and payers: If goal is revenue driven and optimizing MS-DRG, goal may be different  than if revenue driven and optimizing APR-DRG. If goal is quality driven, goal may also be different.

    Many factors to consider and I am looking forward to seeing how others respond.

    Jackie Touch, MSN, RN, CCM
  • Rates would also depend on what else you are tasked to do. Are you just looking @ MS-DRG's or are you also looking @ SOI/ROM, involved in any retrospective process like mortality reviews, or are you responsible for MD education?

    Being solo is hard! I did it for 4 years! Hang in there.

  • Thanks to all. What a great group you are. Yes I do revies for both MS DRG and APR DRG, mortalities, Physician Education and education for case management as I have been requested to do thta. Not to mention producing highly polished reports for senior leadership. They're not as polished yet as I would like them to be but I'll get there.
  • I think it's different for everyone.  It's easy to give a number, apparently Stanford, we've been told has a query rate of 50%.  We're nowhere near that number.  For us in a small community hospital, it's been a delicate balancing act.  How to keep your physicians engaged without giving them additional burdens of answering queries.  We've found that when you query too much you end up chasing the physician away and they never trust or talk to you again, much less answer your queries.  That works fine when your physicians are employees of the hospital like Kaiser, not so much so when they are independent contractors.  We are a relatively new CDI program, we focused on relationship development and building trust among our physicians, then our queries followed suit.  Once they knew who we were and what was being asked of them, they became more receptive with great results. 

    It also depends on the physicians, we found that the more education we put out (we put out a flyer with a documentation tip every week), we have physicians documenting better, necessitating less queries.  It also depends on coding clinic too, now that combo codes such as HTN, CKD and CHF are linked - we have no longer had the need to make the link, the same is true of diabetic complications... but on the flip side, when a new code comes up we find ourselves querying more such as the case with HTN urgency, emergency and crisis because everyone was so used to documenting malignant, accelerated, or benign...

    Also the more you round with physicians, the more conversations you have with physicians, the more impact you will have on their documentation... at least in our facility.  I went from putting out 30-40 queries a month to 5-10, all from talking to doctors and getting them to amend their documentation on the spot.  It's kind of funny but when we were hit with the cyberattack on transcription, having a doc amend a paper note is much easier and user friendly than electronic.  Best of luck to you.


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