We started our CDI program here 6 months ago but havent seen a change in the CMI. My question is, how long does it take for the CDI program to affect CMI?
If you look to the CMI, you will be disappointed...Too many other factors involve that number. Look to your query rate and your query response rate. Try to have individual physician encounters and talk about their specialty and what specificity you are looking for. Ask them questions about what you can clarify so they know what you are looking for. Our program is more than 2 years old and still querying daily for CHF specificity!!!
Absolutely, look at other measures to determine if you are being effective.
By the way -- who is driving the focus on CMI changes? external source such as consulting; corporate; local administration?
You should be able to see changes in specific cases immediately, and be able to report that improvement -- BUT be very CONSERVATIVE when claiming any impact on DRG assignment.
However, looking at the CMI overall -- what is the surgical / medicine split?? has that changed?? more or less of the heavier weighted surgical cases? do you have the non-head & neck drgs -- one case can easily influence CMI +/- 1%? how about any changes in specific service lines? what are your top 10 or 20 DRGs (or base DRGs)? is there an increase in some of the lowest DRGs such as chest pain? etc etc etc
Trying to directly claim affect on CMI without being prepared to do a full and detailed analysis is a two-edged sword that can end up very painful.
Better to focus on a complete and accurate medical record.
I completely agree with Don -- there are so many variables that affect the CMI that someone has to REALLY understand what goes into the Case Mix to analyze CDI impact.
I mean, just look at the factors that influence CMI that we can do nothing about:
- Volume of patients admitted with a particular diagnosis - we all experience seasonal variations in pneumonia, AMI, stroke, etc.
- Volume of surgical cases -- I think we're all seeing a shift from inpatient to outpatient surgeries
- Change in physician practices - if an ambulatory surgical center opens we may lose business to them
- Practitioners leaving the facility - if one of your CV surgeons (or group) leaves, we lose those high-relative weight patients
- Lack of provider collaboration - if the medical staff is not engaged, we can educate, follow-up on queries, and talk 'til we're blue in the face; but if they are not held accountable for participating in CDI there's only so much we can do without that level of support
- In short, you have to analyze what else is going on in your organization when you interpret CMI data. Identify a way to measure and report your impact on those other indicators of success: provider engagement, severity of illness, decreased denials, etc.
Comments
Look to your query rate and your query response rate. Try to have individual physician encounters and talk about their specialty and what specificity you are looking for. Ask them questions about what you can clarify so they know what you are looking for.
Our program is more than 2 years old and still querying daily for CHF specificity!!!
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
By the way -- who is driving the focus on CMI changes? external source such as consulting; corporate; local administration?
You should be able to see changes in specific cases immediately, and be able to report that improvement -- BUT be very CONSERVATIVE when claiming any impact on DRG assignment.
However, looking at the CMI overall -- what is the surgical / medicine split?? has that changed?? more or less of the heavier weighted surgical cases? do you have the non-head & neck drgs -- one case can easily influence CMI +/- 1%? how about any changes in specific service lines? what are your top 10 or 20 DRGs (or base DRGs)? is there an increase in some of the lowest DRGs such as chest pain? etc etc etc
Trying to directly claim affect on CMI without being prepared to do a full and detailed analysis is a two-edged sword that can end up very painful.
Better to focus on a complete and accurate medical record.
Don
I mean, just look at the factors that influence CMI that we can do nothing about:
- Volume of patients admitted with a particular diagnosis - we all experience seasonal variations in pneumonia, AMI, stroke, etc.
- Volume of surgical cases -- I think we're all seeing a shift from inpatient to outpatient surgeries
- Change in physician practices - if an ambulatory surgical center opens we may lose business to them
- Practitioners leaving the facility - if one of your CV surgeons (or group) leaves, we lose those high-relative weight patients
- Lack of provider collaboration - if the medical staff is not engaged, we can educate, follow-up on queries, and talk 'til we're blue in the face; but if they are not held accountable for participating in CDI there's only so much we can do without that level of support
- In short, you have to analyze what else is going on in your organization when you interpret CMI data. Identify a way to measure and report your impact on those other indicators of success: provider engagement, severity of illness, decreased denials, etc.
Good luck!