During a heated debate among members of a CDI committee about what the targeted physician response rate should be, one of the more reserved members of the newly formed group (an IT analyst) asked the question, "What would happen if the physicians decided their own response rate?" It was an academic medical center. There were 12 people on this committee. Half of the members did not hear the question and the other half pretended not to hear it. But then, the CFO, who was in attendance that day asked the IT analyst to repeat his question. This time, everyone listened.
It seemed like such a novel idea at the time. And, who knows if the response may have been different if the CFO was not in attendance. But, on that day, CDI History was made at XYZ Medical Center. Instead of having a decision about their behavior pushed or thrust upon them in the form of an expected response rate, physicians were pulled into the decision making process. Here's how it worked:
The CFO met with the CMO to discuss the CDI response rate "project", as it was called. They decided it would be best to work through all of the department chairs. The CMO met with the chairs in groups and individually to explain CDI, the response rate, and what it meant to the hospital. He also explained what it meant to each department.
The CFO had decided that he would tie some departmental bonus to the CDI response rate. As long as the response was at a minimum of 60 percent the department was eligible for the bonus which would be put into capital equipment or other department specific dollars. Response rates higher than 60 percent were eligible for higher bonus dollars. The rule was this: The Department had to set their own response rate and, while they could be eligible for a higher bonus if they set a higher than 60 percent rate, they would not be receive a bonus unless they met the response rate that they set for themselves.
Furthermore, the chairperson was instructed to meet with his physicians and arrive at an agreed upon rate - among all or most of the members of the department. While rates would be calculated for each physician indivudally, they of course each had an impact on the overall department response rate. Within a month, all of the response rates were set - and they varied from 60 percent to 95 percent.
Each month, response rates were caculated and shared within and among departments. At the end of the year, all but one department met the response rate that they had set for themselves.
Besides masterful management on the part of the CFO, what happened here was physician engagement due to their invovlement in the decision making process. And, more importantly, in order to make a meaningful decision, the physicians had to be educated and to educate themselves on what CDI was all about.
While it may or may not have been the CFO's plan on the day he asked the IT analyst to repeat his question, that one simple question that became a decision supported by senior management and presented in a positive, but challenging way to the department chairs and their physicians resulted in the most successful CDI response rates I have ever seen in my 20 years of consulting......last I checked it was 8 years and running......
