Performance Review for CDI Professionals€¦ · 18 Performance Appraisal •Objective form to record progress –Accuracy in data –Objective detail of progress to stated goals

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Performance Review for CDI Professionals

Fran Jurcak, RN, MSN, CCDSVice President of Clinical AffairsIodine SoftwareAustin, TX

2019 Copyright, HCPro, a division of Simplify Compliance LLC, and/or session presenter(s). All rights reserved. These materials may not be copied without written permission.

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Learning Objectives

• At the completion of this educational activity, the learner will be able to:– Identify appropriate metrics to include in a performance review – Articulate the role of auditing in the performance review process– Define appropriate requirements for completing a chart audit– Utilize an audit tool to objectively assess staff performance– Develop a targeted plan of action in response to audit results


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It’s that time of year!


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Polling Question #1

• What is your greatest fear regarding your annual performance review?– Fear of the unknown – objectives not stated– Fear of failure – did not meet stated objectives– Fear of feedback – I think I’m doing a good job, but …?– No fears – met the stated objectives– What review? – no formal process established


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Annual Performance Review

• 3 reasons why employees fear performance reviews– Fear of the unknown

• Reduce fear of the unknown through education and communication– Fear of failure

• Nobody likes surprises, so give feedback regularly– Fear of feedback

• Be honest in your self‐assessment

https://www.saba.com/blog/3‐reasons‐why‐employees‐fear‐performance‐reviews


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Communicating Goals

My what?

How are you doing on the

objectives I never told you about?

You know, the You know, the goals for your performance that I’ve

implied but never spoken

aloud.

I’m hitting every one of them.

How are those going?


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Why Have Performance Reviews?

• Johari Window– Identify blind spots in performance– CDI programs not always target for

specific feedback within organizations

• Transparency of operations– Different ways to use data/information

to inform process

• Identify areas for performance improvement– Results in ongoing growth and maturity

of program with greater contribution to the organization’s strategic plan

https://en.wikipedia.org/wiki/Johari_window

Everyone knows this

No one knows this

Things hidden from others

Others know this but hidden from

me


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Job Satisfaction and Goals

• Job satisfaction is a direct result of an employee's perception of how well their job supports an organization’s goals and outcomes

Kampkotter, P. (2017). Performance appraisals and job satisfaction. The International Journal of Human Resource Management, 28(5).

Intrinsic Job Satisfaction Extrinsic Job Satisfaction

Employees consider: Employees consider:

The kind of work they do (daily tasks) The conditions of work (managers, salary, co‐workers, etc.)


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Defining the Importance of Performance Review

• Individual staff engagement– Known expectations– Accountability– Responsibility

• Program success– Teamwork– Organizational outcomes

Mission

Goals

Company objectives

Employee objectives


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Leading Practice Performance Review Process

• Well‐communicated• Realistic expectations• Identification of quality and effort • Decreases noncompliant practice• Identifies knowledge deficits

– Process – Clinical and/or coding


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Keys to a Successful Performance Review Process

• Policies and procedures– Supports accountability

• Identification of criteria for review– Performance review document

• Transparency of the process– Communicate goals, expectations, as well as results

• Accountability of staff– Self‐assessment and ability to comment important to the process


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Performance Review Is a Process

• Metrics• Assessment of quality of work

– Audit• Workflow• Record review

• Peer review• Additional duties/responsibilities

Goal setting

Performance monitoring• Feedback and

coaching

Performance appraisal

Improvement plans and/or rewards


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Setting Goals

• Be specific– When reviewing metrics, communicate benchmarks and rationale

• Align with organizational goals– Individual achievement and job satisfaction are tied to aligning with organizational outcomes

• Set the right number– Too many goals becomes unrealistic, employee not sure of the priority

• Indicates micro‐managing by the manager • Achievable and realistic

– Discourages performance improvement

https://www.thebalancecareers.com/create‐successful‐performance‐appraisal‐goals‐1918840https://www.thebalancecareers.com/how‐to‐set‐and‐achieve‐goals‐1918137


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Feedback and Coaching

• Employees need to have the end in mind but manage own route – Feedback and coaching along the way– Regular one‐on‐one meetings

• Honesty is the best policy– Establishes trust and accountability

• Empowerment goes a long way– Ensures commitment to success– Proven to improve performance

• Focus on what needs to be accomplished – Individual goals that align with the organizational goals


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Performance Appraisal

• Objective form to record progress– Accuracy in data– Objective detail of progress to stated goals

• Include positive comments and strengths • Should include employee self‐assessment and rebuttal (as appropriate)

– 360‐degree feedback

• Details should never be a surprise to the employee• Share form in advance to verbal interview and planned signature• Document goals for future

https://www.thebalancecareers.com/effective‐performance‐review‐tips‐1918842


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Improvement Plan and/or Rewards

• Improvement plan:– A plan for how to improve performance– Usually includes goals, steps, assignments, and deadlines– Identify specific goals for each specific assessed criteria

• Rewards– Examples:

• Remote work once per week• Clinical ladder growth

http://www.njsacc.org/qualityStandards/pdfs/9_Writing‐an‐Action‐Plan.pdf


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The Process


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Gathering Data• Metrics• Number of records reviewed• Number of queries created• Number of queries responded to• Number of provider interactions• Financial impact• Quality scores

Quantitative

• Quality of work• Knowledge base• Work effort/efficiency• Work accuracyQualitative


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Quantitative Data – Examples

FIRST:Metric Alignment

Organizational goals

Program goals

CDIS goals

•Financial gain•Increased monthly cash

•Quality goals• Improvement in TPS

•Financial gain•DRG impact goal

•Quality goals• Increase in PSI queries

•Financial gain•Increase in volume of impact queries

•Quality goals• Increase in volume of PSI queries


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Management of Data

• Utilize real‐time data • Monitor performance of staff and department

– Daily/weekly/monthly

• Reports from CDI tools (examples)– Review rate– Query rate– Response rate– Physician acceptance or agreement rate– Coder agreement rate


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Organizational goals

Program goals

CDIS goals

• Financial gain• Increased monthly cash

• Financial gain• Improvement over last year

• Review rate

• CDIS goal not in alignment with program or organization

• Results in– Poor performance– Decreased job satisfaction

Quantitative Metric Example


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Assessing Quality of Work Through Audits

Audit• Definition

– An official inspection of an individual’s or organization’s accounts, typically by an independent body

• ACDIS White Paper– “… provides oversight for the CDI

program, insight into physician documentation and collaboration, and objective evaluation of the performance and effectiveness of individual CDI staff members as measured against your facility’s policies and procedures.” (D. Butler, 2011)


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Audit Process

• Identify goal of the review– Goal alignment and communication key to

success• Select number and type of records to

review– Realistic– Time‐sensitive

• Review– Be as objective as possible– Utilize an objective template

• Action plan– Leverage identified strengths– Target areas for improvement– Monitor for success

Set the goals

Establish clear

measurement

Provide support

Give continuous feedback

Appraisal interview

Document the process

Create A Process

*thehumanresourcesolution.com


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Qualitative Data: Assessing Quality of Work

• Audit cases for:– Missed opportunity examples:

• Documentation integrity• Coding clarification• Clinical validation

– Appropriate identification of queries– Compliance of query format/content

• Following policies and procedures• Includes relevant clinical information to support the query

– Accuracy of data entry into CDI software


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Audit Template

• Develop criteria prior to review (template)

• Develop objective measurable assessment – Assign points for criteria

• Transparency in process– Include staff in development– Communicate changes

• Communicate expectations• Share results


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Objective Criteria Examples

• Adherence to process– Data entry correct

• Query type• Provider• Impact of query

• Quality of review– Query identified appropriately– Compliant query communicated with provider

• Reconciliation– Final data accuracy– Timeliness of completion


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Qualitative Review

Clinical missed opportunity examples• Clinical indicators present but no query

created• Documentation present but not

supported by clinical evidence• DRG mismatch with coder and no

interaction to discuss– CDS identified conditions that did not code

– Coder identified query opportunity that CDS missed

Accuracy of data examples• ICD‐10 codes and DRGs• Use of clinical indicators

– Appropriate to condition identified• Query sent to appropriate provider• Response of provider• Correct impact identified in CDI tool


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Qualitative Review Example

• Cindy CDS has 2 years of experience in the role. After a recent change in unit assignment, she has a 10% query rate, below the program goal of 30% and significantly lower than the peer average of 28%.

• Plan:– Review 20 reviewed and discharged records– Discharged within last month– No posted query by Cindy– Longer than 2‐day LOS

• Utilize template to identify missed query opportunity.


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Qualitative Review Example

Results of the review Action plan35% missed query opportunity Plan follow‐up audit – 90 days

post‐educationClinical topics identified: • Acute tubular necrosis• Chemotherapy‐induced pancytopenia

Education regarding clinical topics

Identified that verbal queries not entered into database

Reinforce workflow process for data entry

Additional actions by manager:• Ongoing feedback and support• Side‐by‐side checkpoint in 7 days to monitor for accuracy in query entry


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Other Considerations in the Performance Review Process

• Impact of “non‐productive” work– Definition: Non‐productive work in the CDI profession refers to those activities that a CDS may perform that are not an integral part of regular chart review or query process

• Examples include:– Creating and providing education– Attending rounds/meetings– Attendance in non‐CDI education sessions– Communication of working DRG to other departments– Obtaining responses to retrospective coder queries


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Non‐Productive Work Analysis

• Consider:– Responsibility

• Assigned versus self‐created

– Value• Does work bring value to the CDI process/workflow?

– Quality• Objective assessment necessary


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Analyzing Results of the Review Process


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Analyzing Results

People Process TechnologyResults • Knowledge base

• Lack of adherence to established (good) process

• Errors in data fields

• Workflow effectiveness

• Ensure updates occurred

• Evaluate effectiveness

Action plan • Educate

• Performance improvement plan

• Redefine/educateregarding data fields

• Update/refine workflow

• Create efficiencies

• Leverage available technology

• Identify goal of use and re‐establish process/workflow


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Performance Improvement Plans

• Tool to give an employee with performance deficiencies the opportunity to succeed• Used to address failures to meet specific job goals or to ameliorate behavior‐related

concerns• A PIP should be used when there is a commitment to help the employee improve, not

as a way for a frustrated manager to start the termination process• An improvement plan should include:

– Information on what acceptable performance levels are and how the employee's current performance is deficient

– Specifics regarding the unacceptable performance should be given, including dates, data, and detailed explanations

– Attach the job description and any relevant employer policies to further clarify expectations– Specific and measurable objectives that are achievable, relevant, and time‐bound– Guidance on what management will do or provide to assist the employee in achieving these goals– Details on how often the manager and employee will meet to discuss progress– Clearly stated consequences for not meeting the objectives of the plan

https://www.shrm.org/resourcesandtools/tools‐and‐samples/how‐to‐guides/pages/performanceimprovementplan.aspx


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Next Steps

• Communicate results• Communicate action plan• Additional validation

– Timing• Necessary or not?

– Consistency and objectivity

• Communicate results – AGAIN!


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Evaluating the Process

• Discuss issues identified• Did the action plan fit the issue?• Validation of effectiveness of action plan– Review the data

• Allow enough time to pass

– Compare with previous

• Planning for issue re‐review• Plan for the next review

Act

Plan

Do

Check


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Case Study


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Background

• Staffing was adequate but job satisfaction low– Staff verbalized lack of resources and reference materials to support growth– Significant turnover during the past 2 years (50%)

• CDI tool/technology not the issue• Utilized query templates appropriately• Program goals

– Documentation integrity

• Performance review goals– Review rate > 80%– Provider response rate > 75%


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Example

• Manager believed staff was dedicated to being successful and working hard to educate the medical staff regarding documentation integrity

• Most current 2 months data:

• CFO happy with financial results• CDSs not consistently meeting individual performance metrics

– Review rate expectation: > 85% of assigned records– Query rate expectation: > 25% of records reviewed

Review Rate Query RateMD Response

RateMD Acceptance

Rate Financial Benefit CMI

Month 1 80% 17% 78% 88% $227,400 1.453

Month 2 65% 15% 69% 84% $359,000 1.448


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Example

• Targeted audit of 25 charts/CDS– Performed by CDS manager– Greater than 3 day LOS– Medical cases with no CC/MCC– Signs/symptoms final DRGs– With and without CDS posted queries

Results

• Knowledge base needed improvement– Areas identified

• Coding guidelines• Clinical topics• Definitions of data entry fields

– Significant time being spent concurrently coding• Code and DRG assignment accuracy below 50%


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Example Improvement Plan

Goal Result Plan Target Date Re‐assessment

Adequate clinical knowledge for CDI role

Adequate coding knowledge to support identification of working DRG

Missed clinicalindicators for queriesMissed query opportunities (37%)

Inappropriate ICD‐10 codes and DRG assignment

Attend CDI boot camp/academy

Attend CDI boot camp/academySupport certification

8 weeks

1 year

Re‐audit records for each CDS 8 weeks after completion of boot camp/academy

> 90% data entry accuracy

75% accuracy across teamRange of accuracy 62% to 90%

Review/revise data field definitions

Communicate definitions

2 weeks

4 weeks

Review 10 records per CDS for data entry accuracy 4 weeks afterimplementation and communication of definitions


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Re‐Validate


RateMD Acceptance


Month 1 80% 17% 78% 88% $227,400 1.453

Month 2 65% 15% 69% 84% $359,000 1.448


RateMD Acceptance


Month 1 70% 18% 75% 89% $189,750 1.461

Month 2 85% 25% 89% 88% $268,450 1.502

Pre‐assessment data

Post Action Plan data


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Resources

• ACDIS Code of Ethics, 2017• ACDIS Forms and Tools Library, CDS evaluation examples• https://www.thebalancecareers.com/create‐successful‐performance‐appraisal‐goals‐

1918840• https://www.thebalancecareers.com/effective‐performance‐review‐tips‐1918842• https://www.thebalancecareers.com/how‐to‐set‐and‐achieve‐goals‐1918137 • http://www.njsacc.org/qualityStandards/pdfs/9_Writing‐an‐Action‐Plan.pdf• https://www.saba.com/blog/3‐reasons‐why‐employees‐fear‐performance‐reviews • https://www.shrm.org/resourcesandtools/tools‐and‐samples/how‐to‐

guides/pages/performanceimprovementplan.aspx• https://en.wikipedia.org/wiki/Johari_window• Kampkotter, P. (2017). Performance appraisals and job satisfaction. The International

Journal of Human Resource Management, 28(5).• thehumanresourcesolution.com


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Thank you. Questions?

[email protected]

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Documents

Performance Review for CDI Professionals€¦ · 18 Performance Appraisal •Objective form to record progress –Accuracy in data –Objective detail of progress to stated goals