Q&A: How many cases should CDI review each day?

Q: Is there an industry standard metric goal for CDI specialist reviews of Medicare cases? Should a CDI team strive to review, for example, 80% of all Medicare discharges in a given month?

A: As most CDI programs operate on a Monday through Friday basis, we cannot review 100% of Medicare admissions concurrently. Some patients may come and go without a review. If your organization has a high number of admissions that are short stays (two to three days or less), even if they arrive on a week day, the CDI team may not actually have time for a review prior to discharge.

Many organizations have begun to expand CDI reviews to seven days a week, and also have CDI specialists perform retrospective reviews for short-stay admissions. If a facility wants to cover more admissions by adding retrospective reviews, they must consider whether the time spent performing retrospective reviews will remove staff from their concurrent review efforts and whether that will negatively affect those expectations.

The second concern that affects your ability to review a specific percentage of Medicare records is staffing. Do you have enough support to cover a specific percentage of records? If your facility has a high patient turnover each day, you will be asked to review a higher volume of admissions. The larger the population, the more difficult it will be to review, for example, 90% of the admissions. If you are a one-person-shop, you cannot possibly review a specific percentage of patients, as your population will wax and wane throughout the year.

Lastly, the mission of your CDI department, or the identified purpose of your reviews, might also affect your productivity or the number of reviews you can realistically complete. If you review records primarily for CC/MCC capture, your reviews may be quicker, and therefore your target number of reviews can be higher. However, reviews to capture SOI/ROM or other quality metrics may require more time and detail, and therefore your goal would have to be a bit lower.

In short, when it comes to productivity expectations there is no right answer, just as there is no one prototype of what a CDI program or department is. Each organization defines the responsibilities of their CDI specialists differently, depending upon their culture and needs. Some programs focus on patient safety indicators (PSIs) and quality, some focus on medical necessity, and others focus on reimbursement—the number of cases reviewed will be different for each organization, each focus type. Take into consideration the patient population to compute an expected number, or percentage of reviews.

If you are an ACDIS member, you may wish to ask this question to the CDI Talk networking group and see what other facilities require for an expected number of reviews each day—just be sure to preface the question with a description of your CDI specialists’ responsibilities and your CDI department’s mission. CDI specialists from other organizations may be able to weigh in and help you set a realistic standard for your facility.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Specialist at HCPro in Danvers, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.