Misleading metrics: Clinician response rate

I continue to be puzzled by the way some CDI programs are holding onto "Physician Response Rate" or "Clinician Response Rate" as a way to measure a clinician's participation in the Clinical Documentation Improvement process.

I suspect that this is a holdover from the days of paper queries and manual tracking of query creation and responses. Pieces of paper were easy to count, so reports were created and used to see how the clinicians measured up.

Just so we're all on the same page, a reminder that "Clinician Response Rate" is a percentage that looks at how many queries that were sent to a clinician were actually answered by that clinician. And in case you're wondering, I keep saying "clinician" so that I can include physicians, nurse practitioners and physician's assistants -- documentation from any of them can be used to support coding and billing.

Just because we can measure something, doesn't mean that we should measure it. For example, I could measure the distance from my house to the hospital in millimeters, but that probably won't help me to navigate there any better in my car. The metrics we choose should be an accurate reflection of our business processes, and help us to improve our performance in a meaningful way.

Let's look at a few scenarios where a simple response rate may not tell the whole story:

● A query is sent to one Clinician, but answered by a different Clinician (who saw the pending query on in the electronic medical record). Should that first Clinician be "penalized" just because they did not answer (but never had a chance to)? As we move to electronic queries, things can paradoxically become less obvious to add up.

● A clinician answers all their queries eventually, but long after the patient has been discharged and a bill has been sent. In this case, their answers are provided too late to impact reimbursement (unless of course the admission is rebilled, which may garner unwanted attention from any of the various auditors who are looking over our shoulders).

● A clinician always answers all their queries and does so promptly, but is continually queried on the same topic. A simple Response Rate or Response Time will not uncover this situation, which is a strong indicator for the need for more education for the clinician.

So, what can we use to assess our clinicians' performance that is better than simple Query Response rates? Well, one major advantage of the move to electronic queries is that it enables us to accurately measure actual Query Response Times -- how long did it take for the clinician to answer the Query? Short response times are needed to support the accelerated timelines of modern revenue cycle management practices, and by all means it is essential to get queries answered before bills get sent out.

If you just can't resist the urge to get fancy, there are some associated metrics that are closely allied with Query Response Times -- for example, how often did the clinician fail to answer before the bill was sent out -- what we refer to as a "lost opportunity". And, the granddaddy of them all -- which patients have been discharged and not yet billed, but still have queries waiting to be answered.

Do not allow your CDI program to be lulled into a false sense of accomplishment just because Clinician Response Rates are high. This does not provide sufficient insight into your processes and is fraught with uncertainties. A combination of Query Response Time and Query Topic analysis provides the necessary insights to keep your CDI program at its best and to keep your clinicians on their toes.

And, by the way, in case you're interested, clinicians who are always on their toes would suffer from what's known as a "toe-walking gait", which most closely maps to ICD-10 Code R26.89 [Other abnormalities of gait and mobility].

Dr. Elion Bio


Elion JohnDr. Jonathan Elion, MD, FACC, is a practicing board-certified cardiologist in Providence, RI and an Associate Professor of Medicine at Brown University. With over 40 years of experience in computing and more than 25 years of experience in medical computing and information standards, Dr. Elion has committed his career to innovations in high value services and healthcare delivery to maximize efficiency and cost effectiveness. Jon is the founder of ChartWise Medical Systems, Inc., a Rhode Island based company that recently introduced ChartWise 2.0. It is the first-to-market interactive software system designed to improve precision in quality clinical documentation and to support revenue assurance through its web-based, comprehensive built-in expertise, electronic queries and robust on-demand reporting.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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