At a recent CDI conference, a presenter proudly announced, "Our hospital achieved a 100% physician query response rate in surgery."
The audience of seasoned CDI specialists seemed impressed but skeptical.
Hospital CDI programs rarely achieve high physician query response rates. Physicians find query workflow burdensome and time-consuming. A physician friend summed it up succinctly, "Queries are time away from making people better."
Back in the day, CDI specialists stuck paper queries in the paper chart for physicians to answer the next time they documented on the patient. These queries were not easily tracked, reported or discoverable. Today, some hospitals have replaced paper queries with email-type queries in the EMR, ironically with the same lack of tracking and reporting.
Yet, these email queries in the EMR have not eased the burden on providers. Response rates of 60% or lower are common, leaving significant opportunities for hospitals to achieve full reimbursement and accurate quality scores on the table.
Also, without the ability to easily track and report on provider query activity, hospital CDI programs still cannot effectively manage the process or motivate greater physician response rates. Some CDI specialists argue that paper queries were more successful.
To boost query response rates, CDI specialists and coders allocate significant bandwidth to manual follow-up efforts. A CDI Manager in the audience whispered to me, "Our response rate to queries in the in-basket is 40%, so we resort to verbal querying where we get a 70% response rate, but it's killing us."
The presenter echoed this statement when she detailed the keys to her 100% response rate in surgery. "We employ top-down leadership, physician advisor support and an electronic query process… with follow-up."
How much follow-up, I wondered? I asked her after the presentation, and she described the following CDI query follow-up activities:
- Searching patient charts to determine if physicians have responded to their queries
- Documenting query information and updating the status in multiple systems for tracking and reporting
- Emailing, calling and approaching physicians multiple times with query reminders
- Creating lists of physicians with unanswered queries for the physician advisor to chase-down
Attaining a 100% physician response rate to queries is a clear measure of success for any hospital CDI program. However, poor query workflows force a trade-off. CDI specialists appear to be devoting significant effort to query follow-up activities taking time away from reviewing additional charts and educating providers.