Q&A: Query rates for clinics

Q: We are in the process of placing personal goals for clinic CDI specialists (i.e., CDI specialists who are reviewing clinic notes). One of our goals is to establish an appropriate query rate. In your experience, what is a good query rate for the clinic?

Response #1: Generally, at our organization, 35%-45% of the clinic chart reviews will have queries.

Response #2: We use a percentage determined by the number of queries divided by the number of reviews.

If that number is low (50%-74%), my team is likely missing something or only reviewing records with minimal opportunities.

Personally, I like to see this percentage in the 75%–90% range to show we are actually identifying areas for providers at the point of care. This is more about making sure we surface relevant clinical indicators and not just diagnoses via a robust review of each record. The other thing we consider is that there are generally multiple queries per review: In my view, the more clinical indicators my team can find, the more support we can provide primary care physicians (PCP).

About 45%–60% of our reviews generate queries for our PCP practices. We use AI to help identify which reviews should be given priority.

Response #3: I think that setting an expected query rate can be troublesome, and there are other elements that you need to consider when setting expectations. Today, providers are so busy that you do not want to add to provider burnout by creating query fatigue just so that you can make a query quota.

Newer programs tend to have a higher query rate as CDI specialists and providers are in the learning phase. As the program matures and providers become more educated, the query rate should decrease.

Having a CDI educator meet with providers, especially one on one, can also have a positive impact. This can show your CDI program's effectiveness and lower the query rate. A high query rate expectation can result in provider/CDI burnout as well as poor query generation.

Editor’s note: This question was previously answered by members of the ACDIS CDI Leadership Council, and originally appeared in the CDI Leadership Insider, the exclusive eNewsletter for members of the ACDIS CDI Leadership Council. For the purposes of this article, all Council member answers have been deidentified.