CDI Week 2022 Q&A Preview 1: Productivity

As part of the upcoming twelfth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Tina L. Medrano, MSN/MSM, RN, CCDS, the CDI manager at ChristianaCare in Delaware, answered these questions. She is a member of the Central Pennsylvania ACDIS chapter and the 2022 Furthering Education Committee. For questions about the committee or the Q&A, contact ACDIS Associate Editor Jess Fluegel (jfluegel@acdis.org).

Q: ACDIS receives a high volume of questions about productivity from its members. Why do you think so many people now are looking for broader information on CDI productivity?

A: Over the past couple of years, our CDI team has doubled. We went from having seven CDI specialists to 14. Of the 14, I hired experienced CDI professionals to assist with our staff who have an average of two years of experience. Along with this growth, we also started to use computer-assisted coding (CAC) and working DRGs. With the growth and changes, it has prompted me to search for what a reasonable expectation for productivity should look like at this point. It would be necessary to find and compare similar cohorts with regards to number of beds, whether a teaching facility, etc., since not all institutions are the same, nor should we expect all productivity metrics to be the same across the board.

Q: Why is it important to know where your CDI department stands compared to national averages?

A: Data drives determination of where my CDI team and department is excelling and where we may need more work. It is so important to research to see where other CDI departmental averages are so we can compare them to those that are similar in size and workload as our CDI department to gauge if we are where we need to be.

Q: Most respondents (61.37%) said they actually review an average of six to 10 new records per day, and roughly the same amount (56.24%) said management expects them to perform six to 10 new reviews per day. Given that these percentages are similar, do you think these ranges for new reviews per day are good standards for the CDI industry to hold?

A: Reviewing six to 10 new charts per day is a reasonable amount to review given the charts aren’t more than four days old (for instance on a Monday, our team is reviewing charts from Thursday and Friday, and it may take longer). While the scope of CDI specialists is to be proficient in productivity, we must consider other factors besides just numbers of reviews completed, such as the number of retrospective queries and DRG mismatches.

Q: Are there risks with having set standards for productivity for the CDI industry as a whole?

A: Sure, there are risks with most things in life, including setting standards for CDI productivity. To be a meaningful metric, we must be cautious in defining what those standards should be. I don’t think there is a one-size-fits-all answer for productivity standards.

Q: Do you feel it is important to have a set range of expected chart reviews per day for staff? Why (or why not)? Should this range be the same for everyone in a facility, or does it need to be customized for each CDI specialist?

A: I do feel it is important to set a range of expected chart reviews as a tool for measurement to show improvement and growth for a CDI specialist. Factors such as ICU charts and amount of experience could take longer and result in less reviews.

The productivity range should not be the same for all facilities or CDI specialists because patient populations differ in some facilities as much as CDI specialist experience differs. In order to be successful, we need to compare apples to apples and oranges to oranges to avoid setting anyone up for failure rather than allowing them to grow.

Q: According to 68.21% of respondents, the most common consequence for a CDI professional not meeting productivity expectations is that the CDI manager or leader would meet with them for a one-on-one discussion. If a CDI specialist is not meeting productivity expectations in your facility, what next steps are taken? In your opinion, what is the best way to handle a situation when a CDI specialist is not meeting productivity expectations?

A: When a CDI specialist is not meeting productivity expectations, I will meet with them for some fact-finding/feedback. Giving the CDI specialist time to discuss their thoughts and what may help or hinder their productivity will help with planning the next steps. Often, I have found that the CDI specialist needs some more one-on-one time to see others conduct chart reviews and to answer questions I would never have thought they had.

Q: One outcome of not meeting productivity standards could be for those working remotely (or hybrid) to be asked to come back on-site until they meet expectations consistently, according to 16.58% of survey respondents. Has your organization implemented such contingency plans related to remote/hybrid work and productivity? What benefits has your organization seen related to remote/hybrid CDI efforts? Does your organization help remote/hybrid staff with technology implementation either through reimbursement or stipends to offset costs for equipment or internet infrastructure at home?

A: Historically, we worked two days remotely, and if productivity standards weren’t being met, that CDI specialist would be required to work on-site. Currently we are fully remote and have not had to implement a policy to return on-site. Instead, we meet with the CDI specialist weekly to assist in helping them to reach productivity.

When we first went remote, it was initially easy to see that the productivity increased. As time passed and the CAC and working DRGs were introduced, there was a drop, but it was expected as the CDI specialists were learning new processes.

Our company provides our laptops, dual screens, and docking stations. Currently, there aren’t any other reimbursements, but the money being saved for gas due to being remote is a great incentive.

Q: Generally speaking, do you feel remote CDI has a positive or negative effect on productivity?

A: Overall, I do feel that remote CDI has a positive effect on productivity, but it is of utmost importance to keep the CDI team fully engaged. We do this with our daily huddle Teams^® meetings, which allow time for sharing topics that we all can learn from; however, we don’t stop there. We try to implement fun things such as sharing staff pictures, playing music, sharing feedback, and so on.

Q: Only 3.08% of respondents noted that remote work due to COVID-19 decreased their productivity, down from 6% of respondents who said so in 2021. What effects, if any, did your CDI program see in terms of productivity related to the pandemic?

A: As a result of COVID-19, our organization went from being remote two days a week to being remote full time. I don’t think being remote in and of itself caused a decrease in productivity. If anything, it was the opposite. Currently, we intend to remain primarily remote and have hired experienced CDI specialists from throughout the country who are completely remote.

Provider engagement must be maintained. It is very important for us to reach out to the providers via attending rounds occasionally, having set meetings, and being available for any questions or feedback they may have.

Q: More experienced CDI staff are more productive, according to 2022 CDI Week Industry Survey respondents, 63.59% of whom noted that the experience of the reviewer had the largest effect on CDI productivity. What steps can a CDI professional take to increase their experience and therefore improve their productivity? How long do you think it should take a new CDI specialist to become proficient in their role?

A: More experience does create better productivity; however, it is so important to provide an effective training plan for new CDI specialists. Spending time with experienced CDI specialists helps a new CDI specialist gain more knowledge and is priceless in the long run. Investing more time and support upfront in growing a new CDI specialist means that new staff member will likely become more proficient and confident in their new role. In my experience, the amount of time for a new CDI specialist to become proficient has varied anywhere from a few months to a year.

Q: In your opinion, can one-on-one staff mentoring, or CDI/coding collaboration, improve a CDI specialist’s record review capabilities?

A: Absolutely, all of the above will improve a CDI specialist’s record review capability. One-to-one staffing is something I strongly advocate for when training new CDI specialists, as well as an open relationship with coding. Without these, how will a CDI specialist learn the several facets of how their work impacts the organization as a whole?

Q: What factors do you feel are the greatest obstacles for CDI productivity, generally? Should factors outside of work (i.e., family life, etc.) be taken into account when setting productivity expectations? Why or why not?

A: Initially I would say one of the greatest obstacles for me as a newer CDI specialist was overcoming the shift in focus. It was a very different scenario than being at the bedside and took a bit to adjust to a different way of thinking and viewing the tasks at hand. One moment I was at the bedside and didn’t have to think twice about how to do something, and the next I felt clueless. That is to be expected in a new role and can be frustrating as well.

In order to provide a safe, successful, growing department, it is important to understand what your staff needs and how to support them. Considering what family or life factors may impact productivity is not something to be put by the wayside, particularly after the past few years of learning how to live and work in a pandemic.

Editor’s note: These questions were answered from a member of the Furthering Education Committee and serve as a preview of the 2022 CDI Week Q&As, which will be released throughout CDI Week, September 12–16, 2022.