Staffing for blended programs.

wfreemanwfreeman
in CDI Talk Archive
My staff and I currently do a CDI review and the UR for 100% of our Medicare patients. In addition, we do CDI only reviews on our managed Medicare patients. Does anyone else have a similar program, and what are your staffing levels? How many new patients/reviews are done by each CDS/Case Manager per day (average). Any insight would be appreciated.

Comments

  • mannb1mannb1
    edited May 2016
    Our CDS dept is made up of 1 and 1/2 time RN; we do 1) Medicare, 2) CDC pts (we have a large population of Calif. Corrections pts from local prisons) 3) Non Medicare DRG payors, and 4) Long LOS pts that aren't in the above categories. The consultants figures that 1 FTE should be able to do 15 new reviews/day, and 8-10 f/u, but that is sometimes tough to do! I won't say we do 100% of our Medicare admits, as we run our reports 48 hrs after admit, and sometimes patients have already been discharged.


  • sbeattysbeatty
    edited May 2016
    We have 2.0 FTE RN CDS. We do Medicare, Medicaid, all DRG-reimbursed
    payers not in the previous 2 groups, which currently is only CVOR cases.
    We do CDI only, no UR. We are preparing to go to all payers, hopefully
    by FY 2011 (Oct 1). We think we can gain enough efficiency with a new
    software product (CDIS) to do that, but that remains to be seen. We are
    licensed for 225 beds, but average census is about 130. We generally
    have 15-20 new MC/MCD admits from a list generated 24 hours after
    admission. Our re-reviews are usually 10-15 daily. We split down the
    middle on admits and go to all units. (15-25 reviews/daily each). When
    one of us is on vacation, the other does it all-what fun that is! When
    census is up we may have 30-40 reviews total each. Our consultants said
    we needed 1.5 FTEs for our average census. We review not for just CC/MCC
    capture, but all secondary diagnoses to get accurate SOI/ROM. Our
    consultant focus was on CC/MCC capture only when they recommended 1.5
    FTE. That was 8 years ago. We have tailored our program to meet our own
    standards over the past 8 years.

    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org

    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More


  • dogdog
    Don't you just love the consultants, Sandy? Our consultants said we only needed 1.0 FTE, but they only count my Medicare census. The rest of our patients are invisible to them. I review all DRG payors, so my census is at least twice what the consultants think it is. But of course the hospital follows the recommendations, so I am alone.

    I think the OP was asking about CDS who do CDS and UR simultaneously, and I don't do that, so I'll skip that part of the discussion. Other than to say I hope I don't ever get asked to do that because I think UR and CDS together might constitute a conflict of interest.

    Renee

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