Points To Consider For CDI Data And Metrics
Organizational CDI metrics have been a hot topic of late, as many realize that looking at CMI alone, especially in the short term, can be misleading. It does not tell the full story about how complete documentation impacts HCC scores, quality metric risk adjustment, SOI, etc. (CMI & CDI: To Link Or Not To Link).
While there seems to be some standardization of metrics across the CDI industry, many organizations use different metrics to measure performance, effectiveness, and the sustainability of improvements in their programs. Here are some points to consider regarding metrics around CDI:
Is It The Right Metric For Your Organization?
Not all metrics are created equal, and depending on the culture of your facility, not all may be embraced equally. When choosing metrics to measure your efforts, one of the key points to consider is the ability for the metric to align and accurately reflect the progress being made towards the overall goal of your program.
If the goal of your program is to increase the overall quality of clinical documentation at your facility, then how well does each of your chosen metrics measure it and contribute to achieving this goal? Even accurate metrics that align with program goals are of limited use if the people that actually do the work in the organization do not embrace them.
Do your physicians feel comfortable with their “query response rates” being on an executive dashboard, and do your CDSs feel comfortable with their performance being measured by “query rates”? Do the metrics make sense to physicians?
Many physicians are not familiar with CMI and MCC/CC capture rates, and while these metrics can be used as a true outcomes metric, do they feel that these metrics can be used to evaluate their documentation performance? In addition, it’s clear that leadership must view these metrics as valid and aligned with organizational goals.
The Source Of Truth For Data
Repeatedly, I see programs with conflicting information depending on who pulled the data, the source, and how the metric is calculated. Credibility of your metrics and data will be crucial, not only to achieve the desired results, but also to instill confidence in your physicians that the metrics have relevance to their documentation performance.
The same applies to CDSs, especially when their productivity and performance is frequently being measured by metrics where the source of truth comes into play. This is an issue that should only be experienced a handful of times before you put systems in place to efficiently and reliably report the metrics.
The source of data should be transparent, and you should have designated individuals who are responsible for collecting, cleaning, and publishing data. The verification and validation of data cannot be overstated.
Too Many Metrics
Be cautious of adopting and implementing metrics because the industry uses them and they are deemed to be “best practices”. I would argue that you should rather focus on a small balanced set of metrics that are aligned with organizational goals, reliable, and cost-effective to maintain or produce. Discard metrics that are redundant and that may take away from overall performance.
As mentioned above, key metrics should have leadership and stakeholder input to agree upon relevance and significance. In our current environment, we are drowning in data, so be careful not to add to the chaos with too many metrics.
People Versus Process
Many metrics in CDI are implemented to measure and assess employee performance. This leaves the door open for manipulation of data, over-reporting, under-reporting, and even incorrect reporting. In some cases, it may have the effect of encouraging behavior that optimizes the metrics, but does not necessarily contribute to documentation quality (e.g., querying early in the hospitalization for a diagnosis that physicians would likely document anyway).
Core metrics for CDI should focus on outcomes and program performance, since this will lead to wider participation within your facility from everyone involved in the integrity of clinical documentation.
Consistency Of Metrics
Choose the standard metric to measure performance of the program at your facility and then stick with it. The ability to spot trends and measure performance against previous time periods is very powerful and can assist with program buy-in. Standard metrics also allow you to leverage these metrics as part of an executive dashboard, which is a common and effective strategy to monitor overall performance.
There is no magic bullet for CDI, so data and metrics that just sit on a shelf, without action, will not get you the results you desire. The struggle is real and the rewards are great, but only if you put in the work. Advanced analytics and metrics provide us with a competitive advantage to improve overall performance, but only if we choose to act.
This should not be limited to the members of the CDI program only, as has been the case historically, but should also include action plans with physicians in mind. Physicians need feedback, education, and performance monitoring to be most effective at the bedside and in the patient chart.
We live in exciting times, where we can learn from the massive amounts of data we have access to. It is crucial that we play this game with the right mindset and skillset, and not just go along with the way we’ve always done things.
Data and metrics have their challenges, but if you want to have a competitive advantage, you should address these challenges head on and aim for continuous improvement.
“A useful metric is both accurate (in that it measures what it says it measures) and aligned with your goals…Don’t measure anything unless the data helps you make a better decision or change your actions.”