CDI Week 2020 Q&A: CDI and key performance indicators

As part of the tenth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Susan Sweeney BSN, RN, CCS, CCDS, CDIP, a CDI consultant for Covenant HIM Consulting, and a member of the 2020 CDI Week Committee, answered these questions. Contact her at susan.sweeney@emoryhealthcare.org. For more information about KPIs, read the 2020 CDI Week Industry Survey report. 

Q: According to the 2020 CDI Week Industry Survey, respondents noted the number of chart reviews per day and query response rate as important KPIs in their facility. Nearly 34% said they do not monitor hierarchical condition category (HCC) capture at all and only a just over a quarter said denial rates were important; 33% do not monitor denial rates at all. What does your facility monitor for KPIs? Does anything about the survey result surprise you?

A: I think the survey conveys a pretty standard response for the CDI industry with KPIs still being focused on productivity and physician response to queries. We will need to champion chart reviews and queries for denials prevention, quality, and risk stratification for the CDI industry to grow.

Many organizations I work with also echo the survey responses by sticking to these measures: Chart reviews per day, query response rate, query agreement rate, and query percentage rate. Few are reviewing for HCC risk stratification or denials prevention although these are becoming more well known, especially for denials management.

HCCs seem to only be a concentration in the outpatient setting, but we know they’re valuable metrics for inpatient as well. I also think query compliance review is an important metric—are we asking good queries rather than just reaching a quota? Case mix index (CMI) capture is also on the table as a measurable impact.

Q: In the early days of the CDI industry, CMI was one of the major KPIs. Now, however, only about half the survey respondents noted it as an important KPI for their department. Why do you think CMI’s importance has declined?

A: CMI is volatile and it’s based on so many different factors, many of which are outside of CDI’s control. Take the COVID-19 pandemic, for example. We saw a big drop off on acute myocardial infarction patients, which affected the medical CMI due to lack of cardiology patients. Scheduled surgeries were also canceled, which will decrease an organization’s CMI as well. All of this is outside of the CDI staff’s control. Of course, it is good to keep the pulse on CMI, but you have to monitor other organizational trends outside of CDI’s purview that could be impacting the CMI.

Q: Do you think it’s important to track non-financial KPIs as well as financial KPIs? Is one more important than the other, or should they be looked at with equal importance?

A: Yes, I definitely think capturing quality is equally important as financial impact. CDI Is part of the revenue cycle and capturing financial impact for the hospital remains important especially now with the pandemic affecting the hospitals’ bottom lines. The quality of the documentation and getting the DRG to accurately reflect the appropriate quality bucket is also vital and contributes to appropriate length of stay and mortality drivers for quality.

Q: Who do you share KPI data with at your organization? It is all CDI specialists, just managers, the chief financial officer, or others? In your opinion, who needs to know the KPI data and why?

A: KPI data is shared with the C-suite financial officers, CDI physician champions, and the CDI staff. Sharing the information with all these groups is helpful because it ensures we’re all on the same page with performance.

Q: How can leaders leverage KPIs to show CDI program success? How should CDI leaders decide which KPIs to monitor and place the most weight on?

A: I think this can vary from organization to organization. Consider what stage your CDI program is at. If it’s a new program, KPIs may be limited to CC/MCC capture and query agreement rates. More advanced programs need to add in quality KPI measures, including clinical validation for denials prevention. Patient safety indicators and hospital-acquired conditions for quality measures would be another area. And, of course as I already mentioned, monitoring HCC capture can be valuable as well. The KPIs you monitor and report need to be reviewed on an organizational level and adjusted over time with the growth of your CDI program.