CDI Week 2022 Q&A Preview 2: Productivity

As part of the upcoming twelfth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Brian Simpson, MS, RRT, CCDS, CCDS-O, CDIP, CCS, CRC, a CDI specialist at Enjoin, answered these questions. He is a member of the 2022 Furthering Education Committee. For questions about the committee or the Q&A, contact ACDIS Associate Editor Jess Fluegel (jfluegel@acdis.org).

Q: ACDIS receives a high volume of questions about productivity from its members. Why do you think so many people now are looking for broader information on CDI productivity? Why is it important to know where your CDI department stands compared to national averages?

A: In my first few years as a CDI specialist, productivity was measured by the number of reviews done per day. Typically, we would review eight to 10 new cases and 10–15 follow-up reviews. I think that as most CDI departments have transitioned to remote work, productivity issues and standards have become more important. Perhaps this not only reflects accountability, but also areas that demonstrate the need for education and improvement. I think that managers and department leaders find it necessary to know where their staff compare when it comes to productivity and statistics. Not only is this information often requested by hospital administration, but it helps the staff to evaluate their own performance when compared nationally.

Q: Most respondents (61.37%) said they review an average of six to 10 new records per day, and roughly the same amount (56.24%) said management expects them to perform six to 10 new reviews per day. Given that these percentages are similar, do you think these ranges for new reviews per day are good standards for the CDI industry to hold? Are there risks with having set standards for productivity for the CDI industry as a whole?

A: I do agree that that six to 10 new reviews per day is a realistic productivity standard. I think that risks are more a factor if the facility has query requirements. This could lead to improper and noncompliant queries being issued. I think that often it is not unreasonable to have a 30%–40% query rate, but it could be impacted by the case type or service line reviewed. In my experience, there may be a higher query rate for an adult intensive care unit than a general pediatric medical-surgical floor, for example.

Q: Do you feel it is important to have a set range of expected chart reviews per day for staff? Why (or why not)? Should this range be the same for everyone in a facility, or does it need to be customized for each CDI specialist?

A: I think that it is important to have a set range of daily review expectations. This can help staff stay focused on their workload, maintaining productivity and accountability. This can also keep staff well versed in multiple service lines. If one service line has a light workload, that staff member can assist in review cases from a busier service line. The complexity of cases can vary as well. This can be seen in surgical cases that may have complex operative reports and require complex PCS coding.

Q: According to 68.21% of respondents, the most common consequence for a CDI professional not meeting productivity expectations is that the CDI manager or leader would meet with them for a one-on-one discussion. If a CDI specialist is not meeting productivity expectations in your facility, what next steps are taken? In your opinion, what is the best way to handle a situation when a CDI specialist is not meeting productivity expectations?

A: I think the best way to address inadequate productivity is by individual meetings with a staff educator or manager. Perhaps additional education on a certain disease process or pathology is needed. Also, I think that quality audits should be nonpunitive and should have an educational purpose.

Q: Only 3.05% of respondents noted remote work due to COVID-19 decreased their productivity, down from 6% of respondents who said so in 2021. Has your CDI program returned to a pre-pandemic “normal” now? What changes did your organization implement related to CDI during the outbreak that it intends to maintain going forward (if any)?

A: Prior to the pandemic, my fellow CDI specialists worked 100% on-site. The transition to remote work happened rather quickly but was quite seamless. Our productivity actually increased after the transition. Our physician response rate increased as well. As a result of this increased productivity, the entire CDI staff will remain completely remote on a permanent basis.

Q: More experienced CDI staff are more productive, according to 2022 CDI Week Industry Survey respondents, 63.59% of whom noted that the experience of the reviewer had the largest effect on CDI productivity. What steps can a CDI professional take to increase their experience and therefore improve their productivity? How long do you think it should take for a new CDI specialist to become proficient in their role? In your opinion, can one-on-one staff mentoring, or CDI/coding collaboration, improve a CDI specialist’s record review capabilities?

A: I think that furthering your education in CDI can greatly aid in improving experience of the reviewer, job performance, and productivity. This can be done by reviewing CDI and coding aids, such as training manuals, the Pocket Guide, coding guidelines, and Coding Clinic. In my opinion, 12–18 months is a realistic time period to become a proficient CDI reviewer. When I began in CDI, I was mentored by a great CDI specialist. For several weeks, she did all of my reviews with me, answering questions and offering guidance. In addition to the CDI assistance, I had a very strong working relationship with the coding staff. The feedback I received from experienced coders was very important and helpful in applying coding guidelines to my existing knowledge of pathophysiology and disease processes, which made me a better and more confident CDI specialist.

Editor’s note: These questions were answered from a member of the Furthering Education Committee and serve as a preview of the 2022 CDI Week Q&As, which will be released throughout CDI Week, September 12–16, 2022.