Reassess CDI metrics to ensure program progress

Just because you can measure something doesn’t mean should measure it, Jon Elion, MD, founder and CEO, ChartWise Medical Systems, told ICD-10 Monitor’s Talk Ten Tuesday back in February of 2016. Specifically, he pondered why CDI programs hold onto legacy targets such as physician response rates as a measurement of program success. Instead, measures need to change as the CDI program itself matures and grows.

As CDI programs begin, managers need to track:

• physician query rates (how many queries per record reviewed)
• Physician response rates (how many of those queries receive a response either positive or negative)
• physician agree rates (how many query responses align with the intent of the CDI specialist)

Such measures help CDI programs assess the competency of its staff as well as the engagement of its physicians with program goals. Yet any assessment tool needs to be analyzed itself and the reason behind the data interrogated, Elion indicated.

For example, if the CDI team sends a query to one physician but a different physician responds should that response count towards the first or second physician’s data? What about the physician who responds to all queries, just not in a timely way? What about the physician who answers all their queries but always needs to be queried on the specificity of his or her patient’s heart failure?

Theoretically, as a CDI program matures its physician engagement and response rates should increase throughout the first year and stabilize in the second or third years. While programs may not expect 100% consistent physician response rates they should expect it to hover in the mid-90% range.

Elion doesn’t mean that CDI managers should toss out those traditional measurements altogether but to use them instead to identify potential trouble spots, educational opportunities, and to nip any provider support concerns in the bud early.

Such measures should not be used to penalize physicians, however. “Clinicians who are always on their toes would suffer from a toe walking gait which most closely maps to ICD-10 code R26.89,” he said.

What types of metrics does your CDI program measure and what items to you think should be retired?