Q&A: Identifying metrics for physician advisor success
Q: We have a physician advisor (PA) principally based in utilization review (UR) department, with additional duties at the bedside. Our CDI needs are sporadic and unpredictable. For example, query escalations and peer-to-peer discussions can be on the fly. We may need him five hours one week and not at all the next. So, perhaps understandably, it has been difficult to determine how to distribute blocks of time for our PA on a weekly or monthly basis for CDI. Does anyone have a solution for this?
A: Begin by establishing a set of roles and responsibilities for the PA position within CDI. For example, the PA might spend a set time each week reviewing CDI queries and cases to identify any query improvement, CDI education, or physician education opportunities. Their responsibilities might include, as indicated within the question, interceding on the CDI team’s behalf on unanswered queries or where query escalation from a clinical perspective might be necessary. The PA might be involved in ongoing review of CDI metrics to identify targeted physician, CDI, or coding educational opportunities and work across departments as a clinical ambassador to CDI efforts. (A sample CDI physician advisor job description provided by Mary E. Bourland, MD, vice president of medical documentation, medical director of compliance, and a cardiovascular surgeon at Sisters of Mercy Health System, is available in the Resource section of the ACDIS website.)
Establishing set duties, far from generating “busy work” for your PA, can help programs begin to develop metrics and performance benchmarks related to PA efforts. For example, if the task is reviewing cases and identifying query improvement opportunities, then the PA and CDI manger can determine how many cases should he/she be looking at weekly and how many cases over a month or quarterly period have shown such opportunities. The team can then assess how much time the PA spends developing educational materials for CDI staff or other teams, as well as gauge improvements related to such activities afterwards.
According to the ACDIS 2021 CDI Week Industry Survey, 65% of respondents have an advisor in some capacity (31.89% have a full-time advisor, and 33.67% have a part-time advisor). Only 12.22% of respondents said they do not have a physician advisor and do not plan to hire one in the future. Sharing a PA remains common practice, too, according to the survey.
At Essentia Health, CDI and UR share a PA as well. The PA supporting the team fits in what is needed by the CDI team and keeps a log of time spent, explains Tracy Boldt, RN, CCDS, CDIP, CCDS-O, manager of revenue services there. While Boldt’s team continues to work toward establishing PA program with dedicated time for CDI, the sharing works provided everyone understands shared needs.
Editor’s Note: This Q&A was answered by the ACDIS editorial staff.