Understanding CDI Metrics

By Tammy Combs

Understanding clinical documentation improvement (CDI) metrics can be confusing, especially when you first start reviewing them.

Let’s dive a little deeper into the topic and take a closer look at some frequently reported CDI metrics and evaluate how these measures can reflect the success of a program and identify any areas where opportunities reside. The metrics we will discuss include case mix index (CMI), review rate, query rate, response rate, response time, and quality/revenue impact.

  • Case Mix Index (CMI): The CMI is the average of all the diagnosis-related groups’ (DRGs) relative weight for a hospital. This basically shows how sick the patients are at that hospital. CMS then uses this to help calculate payments. This is a measure that could be monitored monthly to closely review the impact of the CDI program. To determine a CMI goal, the hospital will need to be compared to a hospital that offers the same types of services. Senior leadership and the CDI team will usually review the CMI report.
  • Review Rate: The review rate is a calculation of the number of records that were reviewed by the CDI team. This is a good quantitative measurement of CDI productivity. As with any metric, make sure the goal is obtainable. To calculate a review rate goal, you must take into consideration the acuity level of the reviews to accurately represent the review time. This could be monitored monthly and broken down by CDI specialist. Senior leadership will usually want a high-level overview. The individual numbers would be for the manager to review and share with the individual staff members. If productivity is not being met, the individual numbers can help build an action plan.
  • Query Rate:The query rate looks at the number of queries sent in relation to the number of reviews done. This gives a snapshot into the query opportunity of an organization. This would be a challenging number to have as a productivity goal. It might be best to use this number to see where you stand in meeting high quality documentation standards. If you have a productivity standard in place, it may put the team at risk of sending inappropriate queries just to reach their goal. An alternative would be to perform monthly audits on the CDI team on records. The audit could include records that have had queries sent and those that had no queries sent. This would give the auditor the ability to look for any missed opportunities and review queries for compliance.
  • Response Rate: The response rate captures how often the provider is responding to the query. This will help measure the engagement of the provider groups. You may want to break the response rate out by provider groups each month to get a more detailed picture. If you see a group with a lower response rate you may want to include the physician advisor to provide additional education to that group. This is an important measurement to take back to senior leadership to help support efforts to promote physician engagement.
  • Response Time: It is important to have timely responses to the queries for prompt coding completion. This metric will let you know how quickly a physician is responding. If you see a group with long response times, that may be an area of opportunity. This may be a metric where it would be appropriate to have a standard goal. When developing the goal, it would be beneficial to reach out to physician leaders to collaborate on a realistic goal for the providers. You may want to break down the response time by the physician groups each month.

  • Quality/Revenue Impact: The quality and revenue impact is one of the most exciting measurements to monitor. This can give you a look at the financial gain or loss by having a CDI program in place. CDI programs should be reviewing for appropriate reimbursement regardless of the positive or negative impact. You can also pull this type of report to look at quality metrics such as PSI, HAC, SOI, ROM, and core measures. You may need to work with your IT department if you do not have a dedicated CDI software program to pull the reports.

When reporting out the CDI metrics, use graphs and charts to give a visual picture to the group. This will help the numbers makes sense. It is important to look at the metrics monthly and then trend throughout the year to see the accomplishments made. Don’t forget to take time and celebrate your achievements. For more information on CDI metrics you can review the CDI Toolkit in AHIMA’s HIM Body of Knowledge online.

Now it’s your turn! What other types of metrics do you track and trend at your facility? Please feel free to comment on this blog. We’d love to hear from you!

Tammy Combs, RN, MSN, CDIP, CCS, CCDS, is director and lead nurse planner of HIM Practice Excellence for AHIMA. She provides professional practice expertise to AHIMA members, the media, and outside organizations on clinical documentation improvement (CDI) practice issues. Combs authors material and provides support for AHIMA’s online CDI education platforms. She also serves as faculty for the AHIMA CDI Academies and CDIP Exam Preps, and is a technical advisor for AHIMA on CDI publications.

Original source:
Combs, Tammy. "Understanding CDI Metrics" (Journal of AHIMA website), February 24, 2016.