RE: Productivity)

evanspx@sutterhealth.org

Very nice Excel document - thank you to all that replied to my question
on this topic.


Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 15, 2011 11:12 AM
To: Evans, Paul
Subject: RE:[cdi_talk] Productivity)

Here's something I put together to try to account for the time variance
based on EHR, all paper or hybrid records as well as the length of
experience of the reviewer.

It isn't formatted by # discharges/year, but you could certainly
multiply the charts/day over a week, month, etc.

I feel very strongly that the type of record (all-electronic, hybrid,
paper) affects how fast you can do a review, as well as how many things
you have to assess for at each review: documentation, DRG, CORE
measures, AHRQ measures, medical necessity, POA, and on and on.

I'd love to get some feedback to let me know what you think about it.
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catladyrn

Lynne, I'm a little confused by some of the numbers. Are you saying that a reviewer can do more reviews in an all-paper chart system than someone who's 100% electronic? I know that when I had to deal with paper charts (we were hybrid), that the biggest obstacle to getting them done was finding the chart, and then wrestling it out of the physician's hands. Not to mention hours spent deciphering squiggle.

I do think the numbers are extremely low. Especially if you're removing SOI/ROM from the mix, which to me is an integral part of all reviews. But for those folks who are also reviewing for medical necessity, I suspect they might need more than a 5% offset.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

fishdl@shands.ufl.edu

Thank you so much for sharing! I think your numbers are pretty accurate and I'm relieved to see someone else recognizes that it takes longer to review an electronic record than a paper or hybrid record. Maybe it's our EHR (EPIC), but we find it very difficult (and sometimes impossible) to locate all the essential documentation. We went live about six months ago - hopefully it will improve.

sharon.cole

We've been given a quota of 20 new pts daily, then add follow ups.

Sharon Cole, RN, CCDS
Case Management
254.751.4256
srcole@phn-waco.org

lspryszak

Personally, my reviews went a LOT faster when I had an all paper record because I could have 3 charts open at the same time. With an electronic record I could only look at one screen at a time due to the system we had.

The electronic record is quicker for posting the H/P, labs and consult notes, but one issue I never had problems with was "copy, paste, forward".

Now that many facilities are moving toward review of all payers and toward overall documentation specificity (rather than DRG focus) I honestly think that a ration of more than 1:1600 discharges a year is asking too much - especially for those who have to do reviews for more than just code-related specificity.

I'm sure many would disagree with my estimates - on a good day, after years of experience I could review 60+ records - but that was on paper, and without stopping for breaks.

It's all in the type of record, what you have to look for, how many reviews are needed for each record, and so many other variables. I've seen too many programs where consulting firms set up unrealistic benchmarks and the team becomes demoralized and burned out.

dbutler

Paul -- let me first send this out (a summary of some data), and then
comment on our standards.
Great discussion from many!!

Don

CDI Productivity Benchmarks

There are few (if any) true benchmarking resources that I have found
outside of ACDIS. Consultants certainly have their own models, but that
is not the same as an objective “what is being achieved”. All three
of the following are worth reading carefully.
● 2010 Physician Query Benchmarking Report
● 2010 CDI Program Benchmarking Survey
● June 2010 White Paper on CDI Staffing Survey (respondents were
mostly managers or leaders and one response per hospital). Also nicely
summarized discussions by the CDI workgroup about factors that affect
CDI productivity.
● For an annual volume of discharges, the on-line poll (#36, Dec
2008) suggests a median of around 1700 discharges / year / CDS. It
shows an interesting distribution, with a big peak at >2500, and then
the next high point the two elements between 1300 & 1900. There are
other on-line polls that also provide some insight.

Let me briefly summarize some of the ACDIS survey data. I will use the
2010 Physician Query Benchmarking Report, though the other 2 sources
generally agree.

Items that influence productivity:
● Frequency of concurrent review: 58% daily, 24% every other day.
● Majority of queries: 63% written paper based, 20% written
electronic, 3% written, 12% equal mix written & verbal
● Do you query when there is not a financial impact: 43% always,
44% frequently
● Do you use templates for written queries: 31% always, 36%
frequently, 16% sometimes, 13% never.

Direct productivity benchmark measures:
● Do your CDS’s have a set query quota to meet: 56% no, 38% yes
(the median point for that query quota appears almost 25% queries).
● Median query rate about 18%
● Median physician response 87% (with a clear break for >70%
suggesting an absolute minimum)
● Median Physician agreement 88%^ (again, >70%)
● Median new charts per day of 12 (majority between 6 & 25)
● Median repeat reviews per day of 12 (most 6 to 20)

Most sources suggest an average combined total of charts reviewed
around 25 charts. Unfortunately, when extrapolating the daily numbers,
they don’t match up with what is commonly discussed for an annual
productivity model broadly between 1300 & 1900 (ie, 20 to 25 working
days a month x 12 new reviews daily x 12 months gets you to >2400
cases).

dbutler

For my organization, we currently are staffed to 150 discharges per month, or 1800 per year.
We don't do other roles (collect core measure data, validate medical necessity aka UR or CM, etc.).

We are >95% electronic chart, a large tertiary academic center.

With this staffing, the areas of activity & focus that don't get enough attention are PI projects, special studies (why is our stroke / ami / etc population with a low expected mortality in comparison to observed), physician education materials, staff education.

Generally, folks are working flat out to maintain chart review, query & follow up activities and the required direct aspects (data collection for CDI outcomes, collaboration with coding, brief research on specific pt clinical condition and keeping updated on key coding changes).

I think 1800 / year / CDS is rather high without very significant leverage with work flow & process tools, other expectations, degree of physician collaboration, etc.

Don

evanspx@sutterhealth.org

Excellent feedback, Don! Thank you for sharing.

Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739