Q&A: Staff, KPIs for hospice, mortality cases

Q: Does anyone have dedicated staff for hospice and mortality cases? And if so, do you have metrics or key performance indicators (KPI) for those specialized staff/reviewers? Additionally, does anyone have job profiles for specialized roles such as lead CDI, specialized reviewers, etc.?

Response #1: There are three of us on our CDI team (nine in total) that review mortalities. We have one of the best observed-to-expected mortality ratios in the state, so we make mortality reviews a priority as in other CDI programs. If the patient expires or goes into hospice, we collaborate with the coders in their software to ensure at least four MCCs are documented (if truly appropriate) to accurately reflect the patient’s risk of mortality (ROM). 

Response #2: We do not review any hospice or scattered bed hospice cases, as they are coded differently, and most treatment orders are discontinued depending on the case. Our CDI specialists receive a notification when a patient has expired, and they complete the review if they were assigned to the patient prior to death.

If they weren’t already assigned to the patient, the cases are reviewed by a CDI specialist that specializes in this type of review and is a subject matter expert. We have provided our team with specific education focused on mortality reviews and what they should look for.

Response #3: We have one team member dedicated to retrospective reviews (pre-coding, post-discharge) that were not concurrently reviewed. She prioritizes mortality reviews. We found that many of these patients expired before ever making it to our prioritization list for concurrent review. This team member has the same expectations as a concurrent reviewer at this time.

We also have a team that reviews hospital-acquired conditions, Patient Safety Indicators, and mortality charts post-code, pre-bill. This group looks at mortalities to ensure that their severity and risk are appropriately reflected.

For this team, we complete an annual time study to evaluate how much time they are working each week. We then have them fill out a split fulltime employee (FTE) form to agree that X% of their FTE will be spent reviewing these charts. For example, this year it’s 0.2 FTE on the quality work, so their expectations for concurrent reviews is 80% of the fulltime expectation. We do not currently have specific job descriptions for these roles.

I am in the process of developing them, however, as we are creating a clinical ladder for our team. The proposed clinical ladder and associated job description are currently being escalated through executive leadership for approval.

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council. For the purposes of this article, all Council member answers have been deidentified.