- Each year Iodine conducts multiple cohort studies, focused on productivity improvements and overall impacts to performance experienced by clients throughout their journey with Iodine
- In 2022, 94% of facilities experienced a lift in productivity with Iodine, with the average facility seeing a 136% lift in normalized query volume
- With Iodine, physician response rates either stay steady, or significantly improve in cases where Interact has also been deployed, even in the face of increased queries
- Iodine also measures the impact queries have, including CC and MCC capture volumes, CMI, and GMLOS. The vast majority of facilities experienced an improvement in MCC capture with Iodine, with a median of a 27% increase in the number of cases that have an MCC
- The increase in MCC capture resulted in significant financial impact: an additional $3.5 million in annual reimbursement
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Iodine’s Cohort Studies started as an internal initiative in 2017 in an effort to understand the impact clients saw with AwareCDI and how certain key metrics were trending. Each year Iodine conducts multiple cohort studies, some focus on productivity improvements, others report on overall impacts to performance clients experience throughout their journey with Iodine. Cohort studies are completed by comparing pre-Iodine data as a baseline against the most recent CMS fiscal year’s data with Iodine. Every facility for which there is at least two months of baseline data and two months of measurement data is included in the study. Only like months are compared to account for seasonal variety (i.e. January-March of 2021 is compared to January-March of 2022) and for DRG based cohort studies, only that year’s CMS DRG tables are used.
The intent is to examine: if a CDI team performed at the same level as they did pre-Iodine, what would that performance have been, and what is the difference between that modeled performance and what was actually observed with Iodine.
Iodine examines productivity through two main means, unique case query rate and normalized query volume. Iodine measures both query rate and query volume to provide as complete a picture of CDI performance as possible. Since unique case query rate is an indicator of whether CDI specialists are looking at the right cases, it is possible to have a high query rate by only reviewing those cases that you feel confident you will query, but as a result your query volume will drop. Conversely, you can drive up your query volume by increasing staffing, but that’s not very efficient. Examining both query rate and query volume ensures that Iodine has positive impacts on both and is driving as much value for clients as possible.
Many health systems use query rate as a measure of success of their CDI program, although methods of calculating this metric can vary between organizations. Iodine examines query rate as a measure of the percent of cases that have been reviewed and resulted in a query – from an efficiency perspective it measures if CDI specialists are looking at the right records. In 2022, the average Iodine client more than doubled their query volume, as compared to their performance immediately preceding the adoption of AwareCDI.
Iodine measures normalized query volume as a measure of the overall output from a CDI program, as more queries lead to more accurate documentation which has a variety of downstream affects including accurate reimbursements, quality reporting, and more. Iodine adjusts for changes in CDI staffing over time, and compares the incremental queries sent in the fiscal year 2022 against the baseline period, the year immediately prior to a facility adopting AwareCDI.
With Iodine, 80% of facilities saw an improvement to their unique case query rate, with the median hospital experiencing a 42% lift in query rate. So, if prior to Iodine a CDI program was querying 32% of the cases they reviewed, and they experienced the median impact with Iodine, they’re now querying 45% of review cases.
Higher productivity and more efficient and effective processes enables clients to expand the scope of their programs and accomplish more with their existing staff. One client had a team of 17 CDIS and after implementing Iodine they increased their query rate from 21% to 35% using only half of their staff, enabling the remaining staff to be redeployed to performing retrospective reviews. Other orgs have leveraged the freed up man-hours to increase collaboration with other departments like coding, implement second-level reviews on mortality or PSI cases, and improve job satisfaction as CDI specialists work at top of license.
Administrative burden is already at an all time high for many physicians, which means the prospect of a CDI department suddenly sending twice as many queries, if not more, can be a daunting one for providers. However, Iodine’s cohort studies show that with Iodine physician response rates either stay steady, or significantly improve in cases where Interact has also been deployed.
When reviewing and responding to a query is no longer a burden for physicians, response rates and times can improve, even in the face of additional queries. On average, there is an almost 17 hour savings in response time, with CDI specialists waiting 31 hours or less for a physician to answer a query, meaning CDI specialists don’t have to spend as much time and energy chasing down responses. The average physician spends 60 seconds or less reviewing and responding to a query, and the median physician response rate for an Iodine client with Interact is 94%.
Impact of a Query
In addition to lifts in productivity, Iodine also measures the impact those additional queries have, including CC and MCC capture volumes, CMI, and GMLOS, with the theory that as documentation gets addressed, it more accurately reflects the true acuity of the patient population, and as a result these measures naturally go up. The more the productivity of CDI teams improves, the more one can expect MCC capture to increase, as well as CMI and GMLOS to a certain extent.
In line with our productivity metrics, the vast majority of facilities, 90%, experienced an improvement in MCC capture with Iodine. On average, their MCC capture volume improved by almost seven percentage points, which ultimately resulted in a 27% increase in the number of cases that have an MCC – more than one out of every four cases.
While CMI is a common metric across the industry, especially for CFOs, it’s influenced by a wide variety of factors, many of which are outside CDI’s control. This includes things like changing patient populations, shifts in med/surg volumes, changes to service line volumes and more.
Almost as many facilities experienced a lift in GMLOS as MCC capture (84%). GMLOS is a good indication as to whether or not a hospital is getting credited for how much effort it takes to care for a patient. If a patient is under documented, it will appear that they should have a short hospital stay, and then there can be a gap between expected LOS and actual LOS.
Iodine utilizes two different methods for calculating financial impact, a “bottoms up” approach based on the value of a query, and a “top down” approach based on increase in MCC volumes.
The bottom’s up approach is calculated by examining: what are the number of queries issues by a hospital, how many of those queries are likely to have a financial impact, what was that impact measured in CMI MS-DRG relative weight points. Using this approach, a fictional hospital with 10,000 discharges, a 30/70 med/surg split and a $6,000 base rate would see an additional $2.4 million in appropriate reimburse.
Using the top down approach, looking across our entire cohort (which includes everything from hospitals that have been with Iodine for just the minimum two months to hospitals who have been an Iodine client for seven years) the average is $3.5 million in annual additional reimbursements based on improved MCC volumes.