Radio Recap: CDI productivity

ACDIS surveyed more than 400 CDI professionals about their facility productivity expectations and published a white paper on the topic in the fall. Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM, director of clinical documentation excellence for Wake Forest Baptist Health in Winston-Salem, North Carolina, and Judy Schade, RN, MSN, CCM, CCDS, clinical documentation specialist for Mayo Clinic Hospital, discussed their experiences, illustrating the same basic findings as paper during the December 28, 2016, episode of ACDIS Radio.

At Wake Forest Baptist Health, CDI review at least 90% of their total daily admissions, Hicks said. At Mayo Clinic, they aim for 100% of all Medicare admissions, Schade said. Both facilities also monitor other aspects of the CDI process, such as query response rates and query agree rates, but there are no set expectations because those numbers vary drastically on a day-to-day, case-by-case basis.

As far as the chart review expectations, Hicks and Schade also had slightly different answers. According to Schade, CDI specialists should review between eight and 10 new reviews per day. After that point, CDI specialists should complete re-reviews every two-to-three days depending on the original review. Hicks expects a total review number between 20 and 25 cases, with five to 10 of those being new reviews. Although Hicks set out more stringent total review expectations, Hicks and Schade agreed that a max of 10 new reviews was a reasonable expectation. According to the white paper study, the average for total reviews is between 16 and 20 per day, in line with Hicks’ and Schade’s comments.

As CDI expectations evolve, CDI programs may have many competing initiatives. The new white paper attempts to “identify a lot of variables” regarding what affects staff productivity rather than provide strict expectations regarding national averages, said Schade.

Nevertheless, some common themes exist. “One major variable is whether the medical record is paper or electronic. Paper charts mean CDI staff have to incorporate travel time to the nursing units into their productivity, while the electronic medical record enable the CDI staff to stay at their desk,” Hicks said.

The goal and focus of the review represents another big variable. “If staff are only looking for CCs and MCCs, they can probably review more records than, say, a CDI specialist who’s reviewing for MS-DRG assignment, hospital-acquired conditions, patient safety indicators, and severity of illness/risk of mortality. That’s going to take them longer,” Hicks said.

Experience and skillset also play a huge determining factor in overall productivity, according to Schade. “ICD-10 presented many, many challenges with diagnoses and procedure codes, so specializing has assisted in accurate and complete document coding and also providing a resource to coding,” Schade explained with regards to the Mayo Clinic’s model. According to the white paper, experience level was the largest variable (54%) to CDI productivity.

Hicks also indicated that other responsibilities influence a CDI specialist’s productivity. Technology, however, has also made it possible for CDI specialists to review files quicker and more efficiently than before. At Mayo Clinic, they combat the effect of other responsibilities by “performing 100% of reconciliation—that’s after coding and before billing—on all the records that were reviewed concurrently,” Schade said. This brings about a “complete and accurate view of the patient” at the end of the day.

With outpatient CDI—a relatively new area—Wake Forest is only reviewing the “raw number of cases reviewed,” Hicks said. Additionally, at the current stage, the process is very manual. Wake Forest hopes to develop technology to both improve efficiency and track the success of the program. Mayo Clinic is in the early stages of developing an outpatient CDI program as well, Schade said. She recommended that other facilities looking to incorporate outpatient CDI programs do some research on the ACDIS website, as that has helped Mayo get things started.

When it comes to CDI productivity standards, “there are so many variables that impact each individual CDI program and that was really reflected in the survey results [in the white paper],” Schade said.