What parameters do you use for the financial impact of CDI? Just from queries or from queries and reconcilliation with coding to code higher weighted DRG?
We recognize two types of impact. One is from the query to a physician which results in a DRG/SOI/ROM increase. The other we call a coder query, where our input on a chart causes the coder to revise her original coding. We write it up as a regular query, but it goes to "Dr. None". That way it can be tracked and evaluated.
To be honest, there are months where the coder queries have more financial impact than the physician ones!
We don't track our direct query impact on a financial level, we only track query rates, responses, CC/MCC capture, etc. There are various reasons we have decided not to do this (requires post-coding review, low volume because of low single CC/MCC rate, etc) but of course it is a valid way to track real financial impact. We do track CMI. CMI is also imperfect because it is impacted by many factors but does allow some capture of overall impact of education and changing documentation trends. We do track DRG reconciliation as well, both positive and negative revenue.
ultimately, where the industry is currently, it is difficult to capture true financial impact of a CDI program because there is a lot of indirect financial impact (denial prevention, quality-related penalties, etc) and because many programs are reviewing multiple/all payer making tracking of real financial impact complicated and time-consuming. I think it is important to track several metrics while acknowledging that none of them likely capture true impact.
We do the same as Laura. We also track reimbursement impact for 'No Responses'. We look at 'trends' for the financial impacts as we realize as Katy says there are so many factors that influence what the final reimbursement actually is.
Comments
We recognize two types of impact. One is from the query to a physician which results in a DRG/SOI/ROM increase. The other we call a coder query, where our input on a chart causes the coder to revise her original coding. We write it up as a regular query, but it goes to "Dr. None". That way it can be tracked and evaluated.
To be honest, there are months where the coder queries have more financial impact than the physician ones!
Laura
We don't track our direct query impact on a financial level, we only track query rates, responses, CC/MCC capture, etc. There are various reasons we have decided not to do this (requires post-coding review, low volume because of low single CC/MCC rate, etc) but of course it is a valid way to track real financial impact. We do track CMI. CMI is also imperfect because it is impacted by many factors but does allow some capture of overall impact of education and changing documentation trends. We do track DRG reconciliation as well, both positive and negative revenue.
ultimately, where the industry is currently, it is difficult to capture true financial impact of a CDI program because there is a lot of indirect financial impact (denial prevention, quality-related penalties, etc) and because many programs are reviewing multiple/all payer making tracking of real financial impact complicated and time-consuming. I think it is important to track several metrics while acknowledging that none of them likely capture true impact.
Katy