Q&A: Resolving the case load, productivity question

Q: For a newly trained CDI specialist, what is the approximate number of reviews (both concurrent and follow up) one should expect him/her to be able to handle per day? I recall from the CDI Boot Camp that the starting number was about 10, but I can’t remember how many new versus follow-up cases CDI staff should expect to review. I assume that the base number of 10 records increases as the weeks goes on, right?

A: From my experience, a newly hatched CDI specialist working solo should be able to review about 10 cases/day for the first few weeks. I typically give a new person just one unit to cover, which would mean that on Monday she/he would have about 5-10 new admissions from the weekend (depending on the size of the unit –for example, our units were about 20 beds each) plus their re-reviews. Thereafter that person could have two or three new admits per day which would make about 10 or so total reviews.

After a month, I would add a second unit, thereby doubling the reviews from 10 to 20. A full assignment for my reviewers was four units. I tried to give people similar clinical units to cover so there might be some overlap. For example, whoever covered the cardiovascular intensive care unit (CVICU) would also cover the post-coronary artery bypass graft (CABG) units. That way,

if she didn’t get to review the CVICU record that patient would eventually be hers in the CABG unit and she could review the case then.

As the manager I really scrutinized the number of admissions on each unit (from a data perspective) so that everyone’s assignments were about equal and that everyone had similar query-opportunity units. This way the CDI specialist could not only learn different areas and become more professionally versatile for the benefit of the hospital but enable him/her to build additional physician relationships and a broader understanding of conditions based on the range of physician perspective.

At the six-month mark a CDI specialist would assume a full assignment. Again, as a manager, I understood that it would still be a while before he/she was able to identify documentation improvement opportunities with 100% ability. Our program had processes for prioritizing reviews as well as clearly defined query follow-up policies. Our physician response rate goal was 100% and our policies and processes were designed to make that happen.

My team only had documentation responsibilities, however. We did not perform utilization review, case management, or other measures. If these additional tasks are added to a CDI specialist’s to-do list, I would recommend you adjust your program’s expectations accordingly.

If you have utilization review tasks also included in your CDI duties, and find it inhibiting your ability to follow-up on outstanding CDI reviews, track the number of cases that you are unable to review or follow up on for one-to-three months. This ensures you have data to support your position—that the additional role of utilization review hampers your ability to effectively complete CDI reviews of the records.

Your data should also show potential lost opportunities such as reductions in captured severity of illness/risk of mortality scores, DRG change, missed queries, etc. so that you can show how the lack of complete record review negatively affects the facility and patient care.

Editor’s Note: This article first appeared in the February 16 edition of CDI Strategies. Lynne Spryszak, RN, CCDS, CPC, answered this question. At the time of this article's original release, she was an independent HIM consultant based in Roselle, IL. Her areas of experties include CDI and coding compliance, quality improvement, physician education, leadership and program development.