CDI Metric

hillsandovals@email.chop.eduhillsandovals@email.chop.edu
in CDI Management

Hi fellow CDI members, my director is looking for me to adjust our Metric. She wants me to make sure that we are in line with other CDI programs.

Could you let me know what your target are for the items below. Here are mine…..

 

Physician Agreement rate goal 90%

Physician response goal 75%

Query rate goal 20%

# of daily charts review per CDIS goal 20

Thanks in advance for your help,

 

Stephanie Hill- Sandoval MSN RN

Clinical Documentation Improvement Specialist  Team lead

215 590 1844

hillsandovals@email.chop.edu

 

Comments

  • butlers1butlers1

    Hi Stephanie, 

    Our metrics are very similar to yours except we do not place a goal on our Query rate, we only provide an average for those.   We feel it can be borderline unethical to place a goal on Query’s when reimbursement is effected by them. We also track our coverage rate.

    •  Physician Agreement rate goal 90%
    • Physician response goal 90%
    • Query rate Average 11% - 20%
    • # of daily charts review per CDIS goal 20
    • Coverage Rate goal 80%

     

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


  • sbuchanan@svhs.orgsbuchanan@svhs.org

    Stacey,

    Your productivity metric . . . is that 20 new charts/day or 20 new and re-reviews combined?  Thank you.

  • chasho1chasho1

    Stephanie and Stacey,

    Are your programs 100% EHR?    Our Network is going to a complete new EHR implementation on 10/1/16 and I too am looking at what our new Metrics should be.  Also, are your programs taking on more Quality Initiatives and how do you add those into your CDI Metrics?

  • kwbourque57@comcast.netkwbourque57@comcast.net
    Stacey,
    How are you doing meeting your coverage rate of 80%?  How many CDIs to you have?
    Reviewed discharges/month?  
  • catarrina@gmail.comcatarrina@gmail.com
    Hi Stephanie- Metrics are great, but I also think it's important for your supervisor to understand that a chart is not a chart is not a chart any more than one patient is the same as the next. This is healthcare, not assembly line work, and the quality of reviews are more impacting and important than charts and graphs, no matter how much they impress people in the C suite.

    I agree with Stacey that there should not be a query goal- you query when you find the need to query. If you have done a good job educating your physicians, you may spend a whole day and find nothing to query for, and that should be a tribute to your team and not viewed as a negative/non-productive staff.

    The only metric that is of value in my opinion is the Physician Response Rate. They will not answer "bad" queries, and they won't answer if they haven't been properly educated. The rest of the metrics are often Garbage In, Garbage Out. A 4 day stay takes longer to review than a new admit, and a medical patient takes longer than an elective ortho admit, and if you find something to query on, well, that case takes longer than one that you don't find anything, and so on.

    The best and most effective way to monitor staff and program success is to have an experienced person taking the time to review and validate CDS work for missed opportunity, quality and compliance of queries, and results over a time period. Rotating assignments can help to point out those who may need some help to get up to speed, but it's really more complex than that. Do nurse managers on the floor track how many pills each nurse is giving? Or how quickly they can assess lung sounds?

    As the field evolves, my hope is that all of the "numbers" that consultants sold hospitals on for creating or revamping CDI Programs will go the route of nursing caps, and that we can be respected as valued professionals rather than viewed as gerbils on a wheel.

    Hope this helps you a bit!
    Cathy Farraher, RN, BSN, MBA, CCM, CCDS

  • christinear17@msn.comchristinear17@msn.com
    Cathy has some good points, however when has any hospital department gotten away without some sort of measurement? Not likely. I work for a large hospital system. Our benchmarks are:
    Total inpatient reviews: >85%
    Total Medicare reviews: >95%
    Physician Query rate: 25-40%
    Physician response rate: >90%
    Physician agreement rate: >85%
    Coder query rate: 10-20%
    Physician response to coder: >90%
    Physician agreement to coder: >85%

    CDS productivity goals/guidance

    Initial reviews: 12-15 new per day

    Ongoing reviews: 13-15

    Total daily review: 25-30 cases (new & ongoing)

    Query: >25% 

     

    Many of our less mature programs and newer CDS are not able to meet the CDS productivity goals. An experienced CDS has no problem coming up with >25% queries.


  • 2116597121165971
    Cathy, thank you for your comments above on CDI consulting companies creating arbitrary KPIs to measure the supposed success of CDI programs. In reality, these ill conceived nonsensical KPIs are created and promoted by CDI consulting companies to measure the success of their efforts at hoodwinking CFOs into believing he/she is receiving value for the millions of dollars being made by these same consulting companies. It reminds me of the military paying $2,000 for toilet seats. CFOs are basically forking over $millions of dollars for a useless overpriced worn out  and tired bill of goods, masking as "CDI." The ultimate measure of CDI effectiveness in affecting positive process improvement in documentation is the trend in volume and dollar amount of medical necessity and clinical validation denials. After all these denials are rooted in insufficient documentation, the name of our profession is clinical documentation improvement. 

    What a refreshing feeling to see a CDI specialists professional that understands the business aspect of CDI, recognizing that we are not in the business of manufacturing and widget building. 
  • butlers1butlers1
    edited October 2016

    Stacey,

    Your productivity metric . . . is that 20 new charts/day or 20 new and re-reviews combined?  Thank you.


    It is for both new and re-reviews per day.

    SB

  • butlers1butlers1
    edited October 2016
    chasho1 said:

    Stephanie and Stacey,

    Are your programs 100% EHR?    Our Network is going to a complete new EHR implementation on 10/1/16 and I too am looking at what our new Metrics should be.  Also, are your programs taking on more Quality Initiatives and how do you add those into your CDI Metrics?

    We are about 90% electronic in our inpatient areas: Trauma, Anesthesia, and some Surgery are still on paper.  Yes, we are working on taking on more quality.  We do not have separate metrics for that, but I would be interested to see how others are handing them.

    SB



  • butlers1butlers1
    edited October 2016
    Stacey,
    How are you doing meeting your coverage rate of 80%?  How many CDIs to you have?
    Reviewed discharges/month?  


    Just of note: our coverage rate is based on our Medicaid population only.  We are a Children’s facility and have about 60% Medicaid.  We have been able to maintain an 80% Medicaid coverage rate up until we lost one of our CDI Specialist.  We are working to regain that with our new team member.  We have 3 CDI Specialist total.

    SB



  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    Always worthwhile to look at the ACDIS survey for benchmarking data.
    I think this is the most recent:
    http://www.acdis.org/resources/2013-physician-query-benchmarking-report

    Don

  • hillsandovals@email.chop.eduhillsandovals@email.chop.edu
    Hi Cathy, thanks so much for the feedback. Also our program is 100% Electronic.

    Steph
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