- Historically CDI has measured query impact primarily through financial metrics, but this has expanded over time to include quality related metrics such as severity of illness, Vizient drivers, and O:E ratio
- While the administrative burden on physicians is real, not submitting a query due to lack of impact can have a variety of negative implications
- A better solution to alleviating administrative fatigue is to focus on creating a consistent, streamlined workflow for physicians to review and respond to queries
Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 9: Should CDI Specialists Query If There’s No Impact to learn more.
Recently Iodine Software hosted a webinar in partnership with ACDIS, and the most frequently asked question was: should CDI specialists submit a query if there won’t be any chart impact? This stems from a concern for physicians, who often complain of administrative burnout, and is an attempt to alleviate administrative fatigue.
Historically, CDI has measured the impact of queries by calculating the financial impact of the query to the DRG, either through movement to a CC/MCC or by changing family (ex. pneumonia to sepsis). Over time, as CDI scope has expanded, they’ve looked to other areas to measure their impact: severity of illness, risk of mortality, elixhauser comorbidities, patient safety indicators and hospital acquired conditions, to name a few.
Fran Jurcak, Iodine’s Chief Clinical Strategist spoke on how there are a few issues with only querying when there’s measurable impact.
First, the end goal of clinical documentation improvement is to accurately represent every patient and their clinical reality, both in the documentation and the final code set, and that cannot be accomplished if CDI specialists aren’t querying consistently and all diagnoses aren’t captured.
Second, picking and choosing when to query sends an inconsistent message to providers, and can actually hurt education efforts. As Fran Jurcak said, “What about on the physician side?…What he’s seeing is, sometimes you query me, sometimes you don’t, I’m just going to sit back and wait for when you need me to, as opposed to when I should.” Inconsistent querying can ultimately undermine CDI’s efforts overall.
Finally, there are cases where at the time of generation a query won’t have impact, but post-discharge it will. As Fran Jurack explains, “In the end, when things are final coded and the final documentation is in, and maybe the physician has ruled out some of the conditions that you thought initially were there, will that query now have a level of impact that you didn’t see on day two of your review, but now happens in the post-discharge space.”
“I think that perception is something we need to think about in the CDI space, because we are trying to capture the appropriate clinical picture for every patient and not pick and choose when something may have meaning or value.”– FRAN JURCAK, CHIEF CLINICAL STRATEGIST
A better strategy for reducing physician administrative burden is by modifying the process and workflow for physicians. Fran Jurcak argues that the burden of documentation is not going away, and in fact may worsen in the future as additional conditions impact quality factors. Some key factors to consider when designing a query response process for physicians include:
- How are physicians finding the query – Where are the queries located? Is it easy for a physician to find that there’s been a question, or does it get lost in a sea of other queries?
- Do the physicians have all the information they need – Do they have the information necessary to quickly and efficiently answer the question? Are the forced to dig through the medical record for additional details?
- Are queries consistent – Are queries standardized so physicians know what to expect and where to look?
- Where is the answer going – Does it become part of the permanent medical record? Does the CDI specialist need to translate the physicians response into another format?
Luckily, technology is well positioned to help in all of the areas listed above and automation of tasks that don’t require clinical knowledge can remove work from over-burdened plates.
Iodine’s Interact leverages templates to both streamline the query authoring process and provide a consistent workflow. Physicians can easily find the information they need to answer a query. Interact’s mobile platform means physicians can review and respond to queries from their phone. All the clinical evidence they need is at their fingertips and their reply gets added to the medical record thanks to EMR integration. This allows health systems and hospitals achieve complete and accurate documentation and coding, capturing the full clinical picture of the patient.
“It’s about workflow, it’s about consistency, it’s about creating efficiency and templates that make this process easy, so it’s less of a burden. The burden is not going to go away…So there are two options for physicians: get it right in their documentation, which is where our educational programs come in, or when you happen to miss it, find a quick and easy way to get that answer into the medical record.”FRAN JURCAK, CHIEF CLINICAL STRATEGIST