Dividing CDS Workload
How does your facility divide the case load? Currently we have a division by units for a staff of four but we are hiring and will have a staff of five. Our current breakdown is a CDS per unit for the med surg and telemetry units. Then we have a CDS for the grouping of Onc/Ortho/Stroke Unit, and one for the critical care patients in CCU/ICU/SCU. Do you give a different workload to the CDS for critical care or are the case loads divided equally by numbers. Do you find that the critical care patients require additional time and clarification? We are working to make sure that the workload is as evenly divided as it can possibly be, so any input is appreciated.
Kelley G. Huff, RN, BSN, CCM
Clinical Documentation Specialist
West Jefferson Medical Center
Phone # (504) 349-1874 or (504) 349-2596
E-mail: Kelley.Huff@wjmc.org
Kelley G. Huff, RN, BSN, CCM
Clinical Documentation Specialist
West Jefferson Medical Center
Phone # (504) 349-1874 or (504) 349-2596
E-mail: Kelley.Huff@wjmc.org
Comments
LOS and less admission, ICU, CCU. It all evens out and we all shift our units to support each other.
I have noticed that some people on here are designated as "lead CDI". What special duties do you have?
THANKS!
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
I find that in the critical care / ICU environment the records are usually better documented and there are fewer CDS opportunities. However, on the Med/Surg and sometimes tele units there are more opportunities and "sleeper" cases to be worked through. Extended LOS and low acuity. Just why are they here??? I usually concentrate my time on those units.
Kim
Kim Digardi, RN
Clinical Documentation Specialist
St. Helena Hospital
10 Woodland Road
St. Helena, CA 94574
Phone: 707.967.5936
Email: digardsk@ah.org
numbers and severity. One floor we split between two of us. Every three
months we rotate so that everyone gets used to the different types of
cases and it also allows for us to be seen by many physicians.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Waterbury Hospital
203 573 7647
As "Lead" CDI - I am responsible for running the morning reports, and other reports that show program effectiveness, etc. Also, as I am the full time RN, I have more time to do those types of things. I work from 7-3:30, while the 0.5 RN works from 2-7 pm. We do find, though, that by the time she rounds, some of the patients to have been reviewed may have been discharged, so we may be missing some opportunities for review - unless the chart is still on the unit, and can be reviewed before it goes to medical records. If that is the case, she may place a query, but @ that point, it is to let the coders know about a possible retro query opportunity, as it would truly not be concurrent.
interest/experience/strengths/weaknesses lie. Sometimes these are not
apparent for awhile. We started by giving each person the same # of
beds. We foundd some can handle a big load - some csn't. Some need
drama units and others need a quiet spot. We did the same thing as you
for critical care but gave it to a fast typist and thinker who keeps up
with the charts enough that they don't get overwhelming. That has
worked well. We also have 2 floors of cardiac - one with caths. I've
given that floor to someone who knows CV-R so he can see if they are
doing anything special for their patient so he can query for an mcc. He
also has ortho/surgery. I've tried several people on those units but it
is like drawing blood from a stone for them. I have one person on the
cardiac unit because we look for core measures there so they must be
fast, able to talk to doctors, and thorough. I have one person on
med/renal and neuro and one on pulmonary and med-surg. I've tried
various combinations. Right now, my fast, nose to the grindstone nurse
works on the core measure unit in the early am. Then goes to the CC
units. The other core measure CDS comes in at 10 and then can roam the
building looking for untouched charts. Our computer system tells us
where those charts are. This has probably been the best approach.
Stagger the time on your one or two promising units and then make at
least one a rover.
are
doing all the other associated tasks or is your dept a total of 5.
May I ask what is your bed count and do you see only MCare or all payor?
Thank you for your valuable information.
fill in sometimes, etc. We have about 388 operational beds. We look at
all drg payor's, which is just about all our pt's. We also look at core
measures of chf, mi for ALL payors.
We have 2 FTE here. We divide the case load by floors at this point. We
each take two. We look at
all drg payor's, which is just about all our pt's. We also look at core
measures of chf, mi for ALL payors.
Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
We divided by number of beds/location/same service, but will probably be looking at reassigments in the future. Our facility is currently in a building program and we anticipate adding more rooms.
I follow Medical Floor, Ortho/Neuro and Medical ICU - I don't find many opportunites for a CDS in Medical ICU because most are severly ill and there are many MCC's and CC's documented. Medical Unit has a garden variety of GI, Nephro (we provide dialysis), a little pulmonary overflow. Ortho/Neuro has a small census. I am also currently in a pilot program to review all queries from our department for compliance.
Another Assignment - Surg Unit, Pulmonary/SDU, & Surgical ICU - Pulmonary is busy this time of year but we get quite a few "campers" in SDU. So not as many admissions to that unit. SICU you have to be a good procedure coder - Brain & Spine and Major Trauma. Surgical is up and down in census but you need to know your procedure coding there as well.
We also have a Cardiac Assignment which follows all Thoracic Surgery (Lung/Heart) in CVICU, Chest pain/Cardiac Caths, Pacemaker/Difibs, and Heart Failure. This is a pretty "happening assignment" because of the CP Unit - lot of turnover.
We don't have a Lead at this time. We report to our Coding Sup. (who has also performed CDI).
We would like to open up our assignments to all payors - but definately add Blue Cross (DRG) and Tricare (Military/DRG)
If we do this we will need more FTE's.
This is the way we broke out assignments when I worked in UM. We also rotated assignments for a while then decided that it was best to stay put. Rotating does make you more "well-rounded" in your knowledge but we also found gaining a rapport with certain physicians and staff worked in our best interests. They could put a name and face together with a Unit. However, I'm open to working any assignment. When I was an Inpatient Coder I coded whatever came across my desk.
We have 4 FTE's, follow medicare and all version 27 payors. Initially we
had designated units. This had positives and negatives. It was helpful to
have RN's in one "area" to become familiar with the staff and the
providers and the documentation needs, but it also left the CDS's without
a broad base of knowledge. What we have found helpful is to rotate units
quarterly
Thank you,
Susan Tiffany RN, CDS
Supervisor
Clinical Documentation Program
Robert Packer Hospital & Corning Hospital
Our assignments are unit based. We currently review about 311 beds. There are 3 CDS. We do not review Psych, OB, Women's Health Unit or NICU. We do perform post discharge queries on all but the Psych units for those we do not review concurrently. We only do CDI.
I review the Cardiac floor including Surgicial CCU and Medical CCU plus a MICU unit and transplant/oncology.
One CDI reviews the surgical floor (includes ortho), SICU and 2 MICUs, Medical Floor and CVA/Neuro unit.
One CDI reviews Medical Floors, Surgical Stepdown, Medical stepdown.
We try to evenly divide our bed assignments. I am the lead - my assignment is slightly less. We do not rotate floors - we cover if someone is out sick or off.
While many of the patients in the ICU/CCU have CC/MCC I find queries are still needed for respiratory failure clarification, ARF, ACS vs MI, Sepsis vs bacteremia or urosepsis.
I am the lead - responsible for reports, policies and procedures, training, tracking assignments, physician orientations - develop and presenting, post d/c queries for Women's health and OB, represent CDI needs at several meetings - we are transitioning to an EMR, developing query forms.
We have requested an additional .5 FTE.
I forgot to mention that we review trad'l medicare and a Medicare HMO - we are looking to add some Blue Cross lines of business.
looking for a 4th so we can expand where we go. We divide our zones
equally amongst the 3 of us and rotate every two weeks. At present, we
only go to 2 of the 5 ICUs, and will do all when we get a 4th person.
We are also going to add the ED when that happens.
Stacey Forgensi, RN, CCRN, CCDS
Clinical Documentation Specialist
Pager 642-1011
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
Deanne Wilk, BSN,RN,CCS
AHIMA approved ICD-10-CM/PCS Trainer
Related question: Most consulting firms suggest a total number of accounts/cases average about 1,600 to 1,800 per fulltime CDI staff. Is this number reflective of actual practice across a number of spectrums?
Many, many variable. I'd prefer to use an annual number of accounts per reviewer as a goal, and wonder how the numbers cited compare to other institutions?
Thanks,
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
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
How many charts does an average CDI specialist (one full-time staff member) in your facility review per day?
New charts: 13.4 Re-reviews: 13.8
What percentage of your chart reviews result in a query?
22.3%
What is your percentage of physician response to queries?
Response: 77.7% Agree: 74%
Paul -- I've heard similar numbers (1900 a year = 158 month = 36.5 weekly = 12 daily). The team average was actually 1916 cases per CDI in FY13 (with a team that at that time probably averaged 5 years or more of CDI experience).
Don
It is striking that the ranges and averages seem to be consistent.
Our team has a lot of experience and all of us are either an RHIA, or an RN, and all also hold either the CCDS or the CDIP credential.
We find that we can review about 1,600 - 1,900 per year. Our average query rate for cases we review is about 20% and our average MD response rate is 80%.
I have been performing some PCS coding in preparation for ICD-10, and I can only say I expect measured 'productivity' for CDI to drop. The Diagnostic portion of ICD-10 is intuitive and the transition should not be that difficult; the coding of procedures accurately in PCS will impact CDI output.
It is always good to get a perspective from others.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
I've seen the question about case productivity asked in a couple of ways .... as best as I can tell given the different ways the questions have been asked, the answers are fairly consistent over time. Total number of cases (both new and re-reviews) does seem to stick to that 20 (perhaps up to 25) range for an average. Seems to me that is a fairly reliable benchmark to look toward.
I really liked the other comment that someone had about how they determined frequency of re-reviews:
"Our concurrent or re reviews are to be done every 48-72hrs until a SOI/ROM is reached of 4/4 then every week. This is the recommendation of our 3M consultants "
Seems like a really nice, structured way to approach, with straight forward expectations.
Of course, all of this conversation is contingent on the variables of the expected scope of the CDI reviewer -- thorough documentation, ROM/SOI, DRG management, quality, etc. The larger the scope, the smaller the reasonably expected case volume.
Don
I have had the expectation of doing 15 to 25 cases a day, and been told an “experienced CDI can do 34â€. I personally think 20 is the best number. There are days I can do more but when I feel like I have to get 25 it’s often a challenge and I would not say they are all done with the same thoroughness. I think also it helps to have a very clear goal…if you are REALLY querying for quality and completeness of record… I think that is a challenge exceeding 20.
Just my opinion and sorry but I can’t talk in system averages but more from the person doing the reviews.
Ann
Paul Evans, RHIA, CCS, CCS-P, CCDS
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
I wonder if the initial respondent on that point is expected to review every 2 days, even with a case that is a stale, long stay?
Is there a secondary decision point to transition re-reviews to weekly I wonder (when 4/4 seems unlikely)?
When my charts 'get stale' and remain at a 2/2 or 3/3, I tend to mark them as complete - it is not always feasible to review each and every chart until the final point of discharge. I prefer to spend my time reviewing Cardiovascular Surgery, Telemetry, ICU Cases, et al, given the opportunity often afforded in such cases. When I see the patient is stable and that the Case Mgr is making plans for discharge 'soon', I sign off on such cases. Our time is limited, and I prefer to spend my limited time reviewing cases w/ probable greater need for a query impacting a quality metric or proper reimbursement.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org