Q&A: Criteria for CDI productivity

Q: What criteria are you using to measure your CDI specialists’ productivity? Are you using the number of new reviews, concurrent rereviews, total number of reviews? Is your team’s review process based on a priority point system?

Response #1: Each team member tracks their own productivity with hospital account numbers on an Excel sheet which they submit weekly. In addition, we are able to pull EPIC reports for both productivity and a monthly effectiveness. EPIC recently had an update that allows each individual to see “my work today,” which lists the number of initial reviews, follow up reviews, and queries sent with pending response. However, I realized those numbers weren’t accurate, so we sent that back to EPIC for review. 

Our team has two work queues they work from, a Medicare work queue and a commercial work queue. The team works from the same queue and does reviews on oldest cases first. Mondays are troublesome days, since no one works on the weekends, but by the end of week, things are moving much faster. When the cases in the Medicare queue get down to our specified level, the team will move over to the commercial one and work on those cases.

Response #2: This is a challenge as our software reporting only goes back 48 hours. We try to keep our total number of reviews per day between 20-25; this includes new cases, rereviews, and discharge cases.

Response #3: We do a combination of new and rereviews (concurrent) for a daily average of 15 reviews/day based on productive hours/day. Our CDI staff is hourly, so we use productive hours, meaning we take out breaks and lunch as well as any in-service time and exclude PTO hours. We pull from our software to assist with the calculation. We have a team of dedicated analytic consultants for our coding/CDI department; they have access to our data via our dashboard. We do not use the priority point system in the CDI software because we found it inaccurate.

Response #4: Our expectation is that CDI specialists will review between 1,200 and 1,500 cases annually. We do use prioritization; however, our needs are not strictly aligned with the prioritization features in the tool, so the CDI specialist often has to use their own judgment.

Response #5: We use daily productivity averages for the month to measure our frontline productivity: new case reviews (nine minimum), concurrent case reviews (12 minimum), retrospective case reviews (eight minimum), and total per day (29 minimum) case reviews. We also have an overall query rate (20% minimum), an physician response rate (90%) and agreement rates (80%). If a CDI specialist is below these goals for a couple months, this would prompt educational coaching to help identify issues and/or review trends of concern (e.g., query topics, resistant providers, etc.).

Response #6: We have set expectations around the number of reviews and query rates: we expect 220 initial reviews per month per 1.0 FTE; a minimum of at least one rereview on every chart at discharge with additional rereviews throughout stay depending on the length of stay and the CDI specialist’s discretion; as well as a 25% encounter query rate. We track and share more data than these metrics, but those are the main productivity specific expectations. We use software which does “rank” each encounter to provide some guidance for priority utilization with artificial intelligence (AI).

Response #7: We measure CDI productivity based on:

• Total reviews per day (including new and re-reviews): Our target is 20 or more reviews per day
• The review rate of prioritized cases: Our goal is >90% of assigned prioritized cases
  
  • We utilize an AI CDI tool that prioritizes reviews
    • Unique query rate (number of accounts with at least one query): Our target is >30%
    • Query response rate: Our goal is >95%
    • Query agreement rate: Our goal is >85%

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council. For the purposes of this article, all Council member answers have been deidentified.