Switching to program monitoring, 45.5% of respondents indicate that they report to HIM/coding, followed by case management(23.5%) and finance/revenue cycle (17.9%). “I think that we’re starting to see a shift—shifting CDI out of HIM and into revenue cycle,” says LeBlanc, whose department reports to finance. “There is so much impact that coded data has. ”LeBlanc says the fact that 23.5% of CDI departments still fall under case management worries him. “I’ve never seen a fit between case management and CDI. They’re too opposite. Case managementis patient-centered, and CDI is documentation-centered, so if push comes to shove, you’ll focus on the patient first and the documentation second. I think quality and CDI fit better.” A large majority (66.3%) of respondents audit for query accuracyand compliance, and 56% of respondents indicate that their hospital administration finds query response rate the most compelling metric for evaluating the success of their CDI department.“Of those four choices, query response rate is probably the best,” LeBlanc says. “You want to look at response rate, but also agree rate—if your response rate is up, but your agree rate is down, you want to make sure you are putting out valid queries. A poor agree rate can be a sign of bad queries/query fatigue.”
“Regarding monitoring your doctors; you might hear “We love that doctor, because he always answers our queries!” But what if he always needs to be queried on CHF? This is not revealed simply by looking at physician response rate. If you always query the same physician about the same topic, he may need targeted education on how to document that disorder better. Monitoring your response rate to queries is not enough, you need to monitor by topic. “ —Jonathan Elion, MD, founder of ChartWise Medical Systems, Inc.
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