Query Rates

Unknown

I would like to know:

1) Does your CDI program use Query Rate as a yearly goal?

2) If you do what is the BENCHMARK Query Rate you are using AND

3) What is the source of that number?

4) Also what is the Size of your facility? AND

5) What is your ACTUAL query rate?

Thanks to all for helping!

dbutler

First, this is one of the elements that is part of the ACDIS work group for benchmarking -- so there will be some good data when that project is completed.

For me:
1--one of the elements that feeds into the goal established with my leadership (but at that level not a specific goal). It is a goal that I have at my departmental level (and share at least through divisional level)

2--for a mature program, I look for an overall average query rate of >12% with up to 20%. Specific clinical areas will range from 8% up to 25%, and I account for that variation when evaluating individual CDSs. Our focus is primarily for impact on DRG assignment, with some additional activity to capture significant additional diagnosis or clarify problematic diagnostic documentation (severity queries).

3--our program experience, networking, consultants (there is not a single solid source that I've found yet, but the ACDIS work group will be a great touch point)

4--860 beds

5--over the past couple of months, 16% case query rate with 95% of potential cases reviewed (acute inpatient medicare).

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com

mannb1

1) Our query rate was set by Corporate, and this has not seemed to have changed in the year our program has been in place
2) Our benchmark query rate is 40%
3) I do not know the source of this benchmark
4) Our facility has 221 certified beds
5) Our actual average query rate for the last year is 25%, with monthly variable rates from 21% to 34%.


Becky Mann, RN, CDS
Clinical Documentation Improvement
Health Information Services
becky.mann@stjoe.org
707-337-3779, ext. 3593

Unknown

1. Yes

2. Target is 40%

3. Navigant Consulting

4. Average daily census 200

5. 2009 YTD query rate 35% 2010 YTD 40% (2 CDS and review Medicare inpt
only)





Kim Beard
Clinical Documentation Specialist

jyeton.mccoy-johnigan

1) Yes, we use our Query rate as a yearly goal
2) 20%---we review all Medicare and BC pts (3 CDMP's)
3) 380 bed hospital
4) we range from 17%-21% (usually average about 18%--just got lucky this month and hit 21%!!)

**we are a seasoned program--6 years***

bea.smith

Are these mostly written queries or how often do you verbally "query"
with a physician?

jyeton.mccoy-johnigan

Ours are mostly written but we have a great working relationship with our Hospitalist doctors and the verbal queries have increased. They are held accountable for answering all queries. We also, as of this month, have the cell numbers to one of our surgical groups in town. We will still write a query to them, but they want to be called, if they for some reason don't see it!

mannb1

~ 98% of these are written queries;

bea.smith

But your verbal queries count in your yearly goal rate, correct?

mannb1

Yes, as they are entered as "regular" queries into our CDI software. Unfortunately we cannot cull them out from the other 98%.

Becky Mann, RN, CDS
Clinical Documentation Improvement
Health Information Services
becky.mann@stjoe.org
707-337-3779, ext. 3593

mannb1

Our docs, too, are responsible to respond to 100% of queries - but our query response rate is ~ 87% for annual average. I'm not confident that our Medical Administration has driven home the 100% expectation rate to all medical staff.

bea.smith

Thanks. What CDI software do you use? I am asking so many questions
because we are trying to start up a CDI program at my hospital so I am
curious how it is done at other facilities.

mannb1

We use the software from Navigant consulting. They trained us ~ 6 weeks of class/on-unit reviews. We have been up for just over 1 year, with 1 full time and

[Deleted User]

Please also take a look at the Benchmarking report ACDIS released regarding physician queries last year. I'm looking for input on what should be included in this year's survey! Thanks!

http://www.hcpro.com/content/232429.pdf

You can find the report on the ACDIS Web site www.cdiassociation.com under Helpful Resources, scroll down until you see WHITE PAPERS in bold. It is near the bottom of the page.

Unknown

Mostly written. We only do verbal queries on rare occasion.

Kim Beard
Clinical Documentation Specialist

dbutler

How do you define the intent of your query at 40%?

for financial/DRG impact only?
primarily impact with ROM/SOI as possible?
focused on ROM/SOI primarily?

Don

dbutler

This concept of physicians being 'held accountable' for answering queries --
where does the impetus / motivation / teeth come from?

I am curious to know what various folks find effective.

Don

Unknown

Where does Navigant Consulting get their benchmark of 40%? What is is
based on?



Virginia Bailey RN CDS

Clinical Documentation Specialist

Morton Plant Northbay Hospital

727-859-4880 or ext 74880 from within system

mannb1

I am not sure that the 40% is Navigant's benchmark, but it may have been some type of recommendation from them, based on their sampling of our medical records. Again, our administration decided on that figure, based on precisely what, I am not certain.

Becky Mann, RN, CDS
Clinical Documentation Improvement
Health Information Services
becky.mann@stjoe.org
707-337-3779, ext. 3593

mannb1

Currently, the intent of our queries is primarily for financial/DRG impact, but also for accuracy/specificity. I know the trend is leaning more towards the ROM/SOI.

mannb1

I don't know how our physicians are held accountable for this. We discuss physician response rate with Admin. Medical staff, and there does not seem to be any true "outliers" for no responses - so, at this point, there have been no actions taken for any physician.

dog

If I queried 40% of our charts, my physicians would have an MI. I also would be 20 pounds lighter from all the running around I'd have to do to get them answered.

testes

Our physician's bylaws include a provision for answering of post d/c
queries which will result in probation and possible removal of admission
and service providing privileges if queries are not are answered. This
is a recent change, within 4-5 years. I don't think we have had to
remove anyone's privileges but we have had plenty on near or on
probation.

Thank you,
Tiffany
So let it be written, So let it be done.

cbarnes

1 yes,we use the query rate as a yearly goal

2 target is 80%

3 JA Thomas

4 300 + beds

5 We average a rate of 79-80 % It isn't hard to reach this goal Sometimes we think we need a 5th FTE or a part-time FTE but it won't happen !! Our program is 10 years old and we just started using software in August 2009

Unknown

Is the 80% your target for actual number of queries or of the percent
that get answered?



Virginia Bailey RN CDS

Clinical Documentation Specialist

Morton Plant Northbay Hospital

727-859-4880 or ext 74880 from within system

dog

Charlene, you are querying 80% of your charts??? That's an astounding number. What kind of queries are you asking?

Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital

cbarnes

Actual number of queries to be done. Recently the number for those answered has been raised to 100 %. No responses are now unacceptable as of last Thursday.

cbarnes

Acute Respiratory Failure Sepsis Chf (whether Acute w/ specificity) Gram Neg Pneumonia BMI's Malnutrition Severe and protein Calorie Acute Renal Failure Acute Blood Loss Anemia, etc. some times its just a severity question other times an mcc Our doc's seem to have a short memory from chart to chart and it would be nice if they showed some initiative We educate, educate and educate and it's the same old same old.

mannb1

How are you going to address the "no responses" with your docs, since that is a new change for you?

Becky Mann

dog

Charlene, you are talking about your response rate, then, not your query rate? Those are most of the same diagnoses I'm asking for, along with clarification of some surgical procedures. I hear you about the docs with the short memory. I have one cardiologist who always, always has to be reminded to write acute systolic, not just CHF, and to specify what he means when he writes ACS.

I'm not allowed to have a "no response" if the query impacts the DRG. If my boss (the HIM director) wants an account finalized and billed, she will let a severity query go unanswered. In fact, she will tell me not to get it answered after the bill is finalized, because she doesn't want to re-bill. But if it impacts the DRG, the chart isn't closed and the bill isn't sent until I get my answer. With surgeons in the OR all day, sometimes it takes a while. She wants me to page them, but I've been a nurse too long to ever consider paging a surgeon out of the OR just to answer a query!

Renee

Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital

cbarnes

We are going to call each of them or text page for starters. We're doing a tip and we're giving them the heads-up one-to-one what to expect. We are getting a Medical Diresctor in June and he is very PRO towards the CDMP. He has been part of our staff of physicians and is moving into that position. Before the summer is over we hope to have electronic capability for notification of a query. We want some of response even if it is a decline as an answer.

cbarnes

Linda, I hear you about paging the surgeons !!

Our query rate will remain @ 80% but on the no response it's been decided we want some kind of response even if they decline. We know some will mark decline just to get us off their backs but some that are ignoring the questions now might read them and answer if we get more assertive. After all else fails our manager is going to handle it and then it will go to the medical director. They're going to start dinging the doc's for unanswered queries.

The coding supervisor here won't hold a chart for anything. Even if it changes the DRG. She wants those charts in and out and billed !! I think she would like us to disappear.

angelisa.romanello

For a new program the query rate should be between 30-40%.
For a seasoned program, the query rate should be 25-35%.
We only use new reviews to measure our query rate.
Hope that helps.
Lisa


Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement
Quality and Compliance
CJW Medical Center
Office phone: 804-228-6527
Cell phone: 804-629-0396
AHIMA Approved ICD-10 CM/PCS Trainer
Angelisa.Romanello@HCAHealthcare.com

aliciasmail@twc.com

I am curious if that is the norm to only count the initial review when determining query rates? our query rate is diluted based on any time we touch a record it counts.

lsipos@monument.health

Keeping in mind our institution currently only reviews Medicare patients with about an average of 70% coverage currently. We have a query rate presently of 45%. I cannot tell you the % for DRG impact but can tell you if I had to guess-timate it would be about 50% for quality and clarity and the other would impact the DRG by changing it to an alternate DRG or by adding cc/MCC.

Juli

angelisa.romanello

Good question.
If we counted all the review we do including Non-Medicare Sepsis and Non-Medicare Wound Care, our numbers would be very much diluted.

We complete approximately 2000+ reviews each month with 400 or so queries. We cover 100% of our Medicare population.
Lisa


Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement
Quality and Compliance
CJW Medical Center
Office phone: 804-228-6527
Cell phone: 804-629-0396
AHIMA Approved ICD-10 CM/PCS Trainer
Angelisa.Romanello@HCAHealthcare.com

carlena.forsha

Lisa,
How do you achieve 100% Medicare coverage? Do you have weekend coverage or are those excluded from the count?
--Carlena

angelisa.romanello

No, we do not have weekend coverage, however every month I receive a report from fiscal with the number of discharges and then I calculate the number of new reviews from our MIDAS documentation system and it is usually 100%. With Friday coverage and Monday, we seem to catch all of our inpatients. We of course do not review observation or outpatients.

katysuegood@gmail.com

We review 100% without weekend coverage. Our patients do not drop off our worklist until we finish our review so If they were only in for the weekend, we will still review them Monday, query if needed, and close out the account.

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

don.cdi.rn@gmail.com

The CDI Week survey has information on query patterns and focus, query rates, response rates, etc. as did the previous year if I remember correctly. Personally, consider this must reading for a CDI professional to get a really good sense of current trends, benchmarking insights, etc. (Though participation in CDI Talk is much more timely!!)
http://blogs.hcpro.com/acdis/wp-content/uploads/2014/09/CDI_Week_survey_2014.pdf

The Physician Query Benchmarking Report (most recent 2013) survey also has information (has been done several times over the years).
http://www.hcpro.com/acdis/details.cfm?topic=WS_ACD_JNL&content_id=294678

Don

don.cdi.rn@gmail.com

Programs calculate both ways (in part I suspect due to the influence of consultants and/or canned software reports).

I prefer to calculate the % of cases with one OR MORE queries (a case query rate) -- what percentage of cases required at least one query? Doesn't matter when in the review process the query is identified (upon initial or subsequent review).

In addition to the total query rate, I also like to know % of cases with at least one query that has a potential financial/DRG impact (which should be a smaller percentage than the total query rate -- should be querying when needed irregardless of potential for financial impact ... also when there is a negative impact).

Don

angelisa.romanello

Don,
I agree with you. Not all of our queries will move the DRG or provide financial impact however if we can provide "accurate documentation" with a query, we feel this is important. When I report my monthly numbers, I report my query responses as both financial impact and/or documentation improvement. I also monitor query response for movement of SOI/ROM.
Lisa