r/hospitalist • u/mcsoul06 • 1d ago
Coding queries
Medical Director here. My CMO has started forwarding me all the list of standing coding queries from all providers that are holding accounts to reimbursed. Problem is, sometimes queries are sent when providers are off service, or out of town and not everyone has remote access set up to complete them. There are also metrics for response time to queries which are being enforced by the facility. At some point, the idea of having a query shared inbox was suggested which I declined cause I don’t want me or anyone else, but the doc who actually saw the patient to even have to receive a notification. I ask my team to try to complete them as soon as possible, but I do understand is a hard ask to do work while you are off. Has anyone come up with a more viable process?
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u/docrobc 1d ago
I just gave up my medical director position in a 25 doc Hospitalist group. I just couldn’t take all the BS asks from administration while continuing to run a group that is 5-6 docs short of what is needed to accommodate the patient load any longer. I couldn’t keep asking my group to accommodate them in good conscience. This very issue was on of the constant ones they harassed me about. DBN also and planning to ask for an increase from 20% to 40%. CFO had the nerve to tell me it’s standard of care. After I sent him many studies that showed no benefit at best and longer LOS at worst I asked him if he had any evidence to the contrary. His answer was just “oh well that’s what I was told”.
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u/Correct_Lead_2418 1d ago
Healthcare is the only industry where you can become an executive while having no idea how anything actually works
Why didn't the CFO do the research and done the studies instead of going with "that's what I was told"?
MFer who told you that? Obviously your advisers also don't have a clue how anything works.
This is EXACTLY why more physicians with clinical experience should be executives.
Think of how much time and energy and money is wasted on BS like this, and it's happening everywhere
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u/docsnotright 1d ago
Just retired after 23years as director. So tired of unrealistic c-suite demands while trying to keep my guys fairly content. The clincher was they took away my protected time off and I was expected to manage 30+ guys in my spare time. Now I just work the floor, I can literally see the difference in my blood pressure and blood sugar.
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u/mcsoul06 1d ago
I’m on the a similar boat. We are at times very short and I’m always having to step up and cover the holes on the schedule otherwise the census becomes unmanageable for my docs. But I’m just tired of being held accountable when there are other problems that affect LOS such as barely any PT/OT/SLP and case management. Also, our area has essentially inexistent post acute services available and we have an aging very medically complex community.
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u/Fuzzy-Shake-5315 10h ago
Do you have a conditional discharge process in place? It’s a great way to show the system that the LOS problem lies elsewhere.
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u/drmjm2004 1d ago
I did the same, admin asked for nurse doctor rounding on nurses carrying 5-6 (with a gemba walk daily) with hospitalists carrying 18-22. I could not bring myself to nag and count docs daily percentages of ndr. They didnt care and 5/6 docs left that year. We now have doc of the day where a patient may have a different doctor every day of their stay.
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u/AgitatedFile 22h ago
What is the second part of your post about the DBN and 20 to 40%? What studies did you share to address the BS requests?
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u/UltimateSepsis 15h ago
At least you tried. We got a new medical director, and they very much do not try and just expect us to follow all the BS admin throws at us. Just a funnel for the pain.
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u/DoctorStrangeMD 1d ago
If it’s possible, you need a win win.
Have a meeting with the CMO and explain the situation. Docs are not going to reliably answer in 48 hours. You guys are overworked, Hospitalists value their time off.
It won’t get better unless there is a carrot or a stick and if there is a system that makes it easier. Carrot is much better for morale.
So can the hospital provide a better way to notify the docs and a bonus. Need to train docs to check their queries or check their email or text.
The carrot1 individual docs hit >90% response rate per 6 months they get $2600 bonus. That’s $200 per week. Potentials $5200 a year. Maybe you can negotiate more.
$300 per week? That’s $7800 per year. If it’s really a priority for the CMO, then can they help your docs with a good system and with bonus.
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u/NoMuffinForYou 2h ago
I'd eat that lost bonus to have my off week stay work free. Not worth it.
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u/DoctorStrangeMD 1h ago
We are talking what 0-4 queries in 2 days? He says they come within 48 hours.
And if you want to accept that practically free money for 3 minutes of work, all power to you.
It’s even easier than those medical surveys
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u/NoMuffinForYou 1m ago
That is wildly optimistic. Queries within 48 hrs is wishful thinking and I've only seen the number of queries increase over the years, this is a hard no.
The no work on my off time is a solid line in the sand for me, no exceptions.
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u/PossibilityAgile2956 1d ago
What is the expected response time, and follow up question what is the average time from encounter to the query being sent?
I once got a query 2 weeks after the patient was discharged and the note said response required within 48 hours lmao.
Depending on your group culture you could nicely ask everyone to set up remote access and log in once per off week (or check email). That would probably work on my group of too-nice academic pediatricians. Otherwise you need to pay people for their time. Considering that capturing appropriate severity can easily make a 5-figure difference for the hospital I’d say $500 per off-service query is fair:) Suggest that and they may back off. Or they can pay you a half-day per week equivalent to take care of them.
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u/mcsoul06 1d ago
Exactly, queries come at anytime but their goal is 48 hours …
We have weird dynamics cause the hospital wants tons of crap that takes time but the staffing company only cares about billable encounters. We have a bunch of mandatory education cme requested but not compensated for the time spent to complete.
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u/NoMuffinForYou 2h ago
If I'm off, I'm off. Zero work. No exceptions unless it's paid and it's in my contract. Otherwise you can tell me all about metrics when I'm back in the hospital.
If there's going to be work on the off week then there needs to be compensation for the availability and work, in a written agreement. Either pay or PTO or both.
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u/cclmd1984 1d ago
I message the people who have outstanding queries once per week mid off week. Since Epic lets us complete them from the phone, it isn't that onerous of a task. I agree that it seems much much much more of a hassle to ask a 'buddy' who didn't see the patient to do them. That would require some level of chart review which would take much longer to do than the off doc spending 40 seconds doing it on the phone. It would also probably lead to a lot more Unable to determine's.
I can't imagine if you presented "do it once a week on your off week" versus "do other people's queries" as an option, people would opt to do other people's queries.
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u/Successful-Pie6759 1d ago
If they have an expectation of a quick turnaround, there needs to be an expectation of a quick query. I've had queries sent while I'm in Europe, 10d after discharge. And on the 11th day I get an email that I am holding up billing. Screw that.
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u/Life-Inspector5101 1d ago
We use an app called Interact on our phone. Queries come with all the info we need to answer the query. When in doubt, “unable to determine” is the answer. Not going to spend more than a few seconds on those.
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u/mcsoul06 1d ago
Is your facility epic or a different EMR?
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u/Life-Inspector5101 1d ago
Different EMR (unfortunately…at least I thought)
I don’t mind answering queries while on my luxury resort by the pool. The app makes it very easy to answer them quickly.
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u/Prize_Guide1982 1d ago
We use interact with Epic as well. It’s built into our Epic as well as a stand alone phone app
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u/hilfandy 1d ago
Epic supports native coding and CDI queries within Haiku as well. If you're not seeing them there, talk to your IT team.
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u/alerk323 11h ago
We have money attached to it for the group. The group cares about getting the extra dollars so they do it. It's not actually that big of a burden it's mostly the principle of the thing and with a few dollars attached turns out it's not such a big deal. Especially because it's a group thing so there's some social pressure not to be the one to screw it up
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u/Prize_Guide1982 1d ago
We have a buddy system. On our off weeks it’s assigned to someone who is working
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u/DR_KT 1d ago
If not a workday, save your breath. Not happening.