Q&A: Determining factors for query rate increases

Q: I have heard that some facilities have seen their number of generated queries actually increasing rather than decreasing over time. Generally, we hope that by improving the documentation concurrently, we would decrease the need to ask the questions retrospectively. If we’ve been diligent and consistent in our query efforts, shouldn’t the number of our concurrent queries go down also?

A: That is everyone’s overriding goal, certainly, but the realistic picture is that we don’t see it happening. An increase in your facility query rate could be due to physicians’ lack of participation or understanding of your CDI program efforts, or it could represent the fact that physicians have just fallen back into bad old habits. Watch when a physician does dictation. You can almost see him mentally re-envision his initial encounter with the patient; you can see him going head to toe in terms of his assessment and documenting that interaction. When that happens  the physician likely is not thinking about the last query you or your CDI team members left for  him nor is he thinking about the last in-service your team provided on coding differences between ureosepsis and septic shock.  He is simply documenting the care he provided true to same-old habits. For example, the bad habit would be to document CHF, not acute-on-chronic diastolic heart failure.

I do agree with the premise that if we educate and train physicians to document completely and accurately (the way we would like them to), the query rate should go down.

CDI programs also need to remember that coding changes take place every year and what you may have thought you addressed previously can soon require additional training. Don’t forget about the slew of regulatory changes in the works or the need for greater specificity in the medical record documentation associated with the impending implementation of ICD-10. All these changes will most likely increase your query rates.

Like every other metric you use to measure your CDI program success, the query rate needs to be examined within the context of the program, the facility, and the larger changes in healthcare.

Editor’s Note: Fran Jurcak, RN, MSN, CCDS, answered this question during the January 27 audio conference “Clinical Documentation Improvement: Strengthen your program and protect against denials.” At the time of this article's original release, Jurcak was Director at Huron Healthcare