Increasing Queries

As a CDI Manager, I am always looking for opportunities to increase query volume.  Does anyone have any strategies for increasing query volume.  Open to any and all suggestions.

Comments

  • As a manager I am curious why you are looking to increase your volume of queries? Are you trying to meet a benchmark that a consulting firm has given you? Are the coding staff issuing tons of retro queries that could be issued on concurrently?

    Do you query for complication clarification? HAC's? PSI's?

    I think trying to meet a query % defeats the entire purpose of documentation improvement. As an academic med ctr we see our %'s spike in the months after new residents are onboarded and through education we start to see them drop...the same is true when a new attending MD is onboarded, we generally end up querying them more but then it levels off with front end education, tip cards, posters, etc.. not saying this occurs with 100% of them but it definitely does with those who are interested in portraying the actual SOI/ROM and resource consumption of their patients.

    Thanks,

    Jeff

  • I agree w/ Jeff's thoughts.  Not being critical, at all - so please know that.   BUT, I do not 'care' for the idea that a site 'must' have XX% of queries issued as this is a very simplistic approach. 

    We have different campuses, different staff, and different types of patient mix and complexity of care, and each site has its own 'query rate'.   IF a Consulting firm or Executive is mandating you 'must' have a certain query rate, I'd suggest you ask them to explain the rationale?

    Paul Evans.

  • I agree w/ Jeff's thoughts.  Not being critical, at all - so please know that.   BUT, I do not 'care' for the idea that a site 'must' have XX% of queries issued as this is a very simplistic approach. 

    We have different campuses, different staff, and different types of patient mix and complexity of care, and each site has its own 'query rate'.   IF a Consulting firm or Executive is mandating you 'must' have a certain query rate, I'd suggest you ask them to explain the rationale?

    Paul Evans.


    Definitely not being critical either. I have two campuses also and they vary greatly in all metrics especially with one being a Children's Hospital.

    To the original poster--are you reviewing all payers? If you have a large population that are paid on APR-DRG, your query rate will be lower also.

    Jeff

  • agree with above- but would also ask have you noted missed opportunities in query audits that would lead you to think you are "under querying". If you are missing opportunities- education may be needed. The question to ask is WHY are you missing opportunities- is it due to lack of critical thinking by your CDI staff related to a clinical understanding of conditions and their manifestations? Or is a lack of knowledge related to coding practices and the required documentation needs? Or is it an assertiveness issue in that the CDIs do not wish to engage with providers? Sometimes comprehensive education to staff related to these issues can assist you with identifying areas of which you may not be using query effectively.
  • We are a teaching facility that serves as a safety net hospital.  We review our Medicare, Medicaid, commercial, and self pay accounts.  Our average query rate is around 8%, but we do work diligently with the providers to support continued education.  We do audit and find missed query opportunities. In addition, we do not have a discharge review by our CDI staff. (In the process of trying to set this up)

    I am not searching a percentage.  I am just looking for any strategies to help my staff identify missed query opportunities while they are reviewing charts. What tools or tips do you have that keep query opportunities in the forefront of their mind?

  • JMontg01 said:

    We are a teaching facility that serves as a safety net hospital.  We review our Medicare, Medicaid, commercial, and self pay accounts.  Our average query rate is around 8%, but we do work diligently with the providers to support continued education.  We do audit and find missed query opportunities. In addition, we do not have a discharge review by our CDI staff. (In the process of trying to set this up)

    I am not searching a percentage.  I am just looking for any strategies to help my staff identify missed query opportunities while they are reviewing charts. What tools or tips do you have that keep query opportunities in the forefront of their mind?


    Management review for missed opportunities can be presented at staff meetings as case studies...if one person missed the indicators, etc.. the entire staff may benefit from hearing.

    Review retro queries by Coding to determine if any of those could have been sent concurrently and drill down on the reason they weren't. As you already know many queries sent retro are for path results or something that occurred after last CDI review. I would drill down and get the ones that were actually missed opportunities and turn those into educational opportunities for the staff.


  • I appreciate the advise.  I now have a CDI Quality Assurance Auditor that is able to review and audit for missed opportunities.


  • We have been able to identify query opportunity with the help of technology-CDI software.  We do look at our query  rate as a team but we do not have a specific goal.  Before the software our query rate was about 12-15% and now is between 25-40% (facility dependent).  Also we have seen a sharp decline in our retro queries.
Sign In or Register to comment.