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The goal should be a 100 percent response rate.

On a recent onsite, one of the clinical documentation integrity specialists (CDISs) asked me my opinion on how assiduous a clinical documentation integrity (CDI) professional should be to get a query answered. My response may surprise some of you.

I must preface my answer with the assertion that the goal should be to have a 100 percent response rate. I cannot understand the concept of a provider being asked a question in the clinical setting and refusing to answer. I also don’t get not making the effort to comprehend the question being posed so that one could make an informed decision.

Aiming for an 85 percent response rate means you are willing to leave 15 percent of your queries unanswered. Are you really willing to leave 15 percent of your queries unanswered? Then why did you compose them? If they were worthy of generation, they deserve to be answered and closed.

When I worked as a physician advisor in a large multi-hospital system, one of the smaller community hospitals had a large-volume admitter who elicited the lion’s share of queries. The CDIS had a standing appointment with his office for Friday afternoon and the provider would passive-aggressively make her wait in his waiting room for an inordinate amount of time before he would deign to meet with her. Sometimes she would wait, and he would ghost her. For those of you who do not know anyone in the dating world right now, ghosting means someone just doesn’t show up. They don’t text or call to cancel, they just don’t show.

That was his system. CDISs used to have to phone or text some providers and fax queries to others. They would email and send multiple reminder emails. They would track the providers down in the hallways. When we obtained an electronic CDI query system, some of them would use that.

I’d ask the CDISs why they had so many different processes, and their answer was, “Whatever it takes!”

Admirable, but unacceptable.

My surprising response is that the organization should develop a standard system for queries that fits into the providers’ workflow and stick with it. You can’t establish the procedure without practitioner input, but I oppose setting up differing systems for individual providers. The solution to a provider who doesn’t utilize the hospital email system or the inbox of the electronic health record (EHR) is to mandate utilization of the hospital email system or the inbox of the EHR. The medical administration needs to hold the providers accountable.

Most institutions have a medical records completion policy which includes repercussions like suspension for failure to comply in a timely fashion, say within 14 or 30 days. Queries are part of the medical record.

What we in CDI do is important and valuable to the provider and the system. Providers are not doing us a favor by answering our queries; we are, in essence, doing them a favor by sifting through their suboptimal documentation, finding opportunities, and presenting them for improvement, so that they get credit for taking care of as sick and complex patients as they do. The administration needs to facilitate the process and encourage cooperation. The provider and hospital’s quality metrics and financial viability may very well depend on it.

Program Note:

Listen to Dr. Erica Remer report this subject live today on Talk Ten Tuesdays, 10-10:30 a.m. EST.

 
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Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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