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CDI programs send too many queries.

You’ve probably heard this complaint before.

Sometimes it’s a frustrated physician.
Sometimes it’s CDI consultants themselves.
Sometimes it’s someone with something to sell.

It’s easy to get defensive.

But sometimes they’re right.

And instead of getting defensive, I’d use it as a moment to pause and reflect on your own program.

Don’t ask yourself if you’re sending too many queries. You’re always going to say no.

Instead, ask yourself more specific questions:

1. Does every query have a specific impact?

I’ve been told by some CDI specialists that their programs encourage them to send a query when documentation would result in a non-specific code even though the more-specific code would have no impact on DRG assignment, CC/MCC capture, risk adjustment, quality measures, etc.

If it won’t have a practical impact, why send it?

Sometimes the response is, “Well we might get denials for that.”

If that’s the case, then the next question is:

2. Are you actually get denials for that?

Query fatigue is real.
Burnout is real… and dangerous.

You should not be sending queries because of theoretical denials which may or may not be occurring. That’s quite the slippery slope.

(Yes, there are some situations where steps can/should be taken to reduce an otherwise high denial risk, but the solution must be reasonable and not overly burdensome)

To avoid that, you need denials data.

And to have that, you need to reach outside of your silo:

3. Do you have regular meetings / feedback with your Revenue Cycle Integrity Department?

Or whatever department handles denials.

Regular meetings to identify trends and create upstream prevention strategies would be ideal…. but if you’re not, do you even know the names of the people to contact in your revenue cycle integrity department?

I’ve talked to CDI leaders at large health systems who’ve admitted siloing is a major problem.

Get out of your silo.
Make connections
(I don’t like the word connections... make friends.)

Even better, get off virtual!
Have coffee or lunch!
Perhaps… go into the office!
I know, I know. Put down the pitchforks. But I can’t tell you how many “Aha” moments that resulted in real change came from random just-stepping-in-your-doorway-to-chat discussions. Those random unstructured in-person discussions is where the magic often happens.

I digress…

So perhaps you are aware of denial trends.
Are queries your only form of upstream prevention?

4. Are you providing multiple forms of impactful education?

No, I don’t mean monthly 5 page PDFs filled with walls of text that no one will ever read (I’ve seen them. I can guarantee you they don’t work).

I mean real in-person regular departmental meetings. If you do, are they concise (less than 10 minutes), single-topic focused, and devoid of CDI lingo?

Education also needs to come in multiple forms. People often have to hear / see things several times for things to stick.
So not only in-person meetings, but perhaps:

• Weekly concise newsletters (Problem —> solution oriented)

• Posters / pocket cards

• System-wide screen savers to disseminate information

• And maybe even videos! (Yes I know that’s uncomfortable but humans clearly love short form videos - See Tiktok, Youtube, Instagram, Twitter(X), etc.).

Abridge transforms clinical conversations into complete, accurate notes, helping physicians spend less time documenting and focus more on patient care. In a recent ROI analysis with partner health systems, clinicians reported spending up to 23% less time documenting, and observed meaningful improvements in RVUs per encounter—driven by more complete and accurate documentation.

5. Are you going to regular departmental meetings but not getting any traction?

If that’s the case are you using too much CDI lingo?

Have you communicated how CDI may benefit them? (Always take this angle when possible).

Have you listened to the providers to understand why they’re not bought in? Perhaps there’s no alignment (i.e. their census is too high and there’s nothing in it for them).

Perhaps the providers are unhappy with hospital administration and they see CDI as part of that. But if that’s the case, can you take that information to executive leadership? You could be a bridge builder - become a voice for both the providers and administration. Solve a problem for the providers and they’ll be your biggest fan. CDI buy-in will be much easier.

If you can’t get into those departmental meetings:

6. What efforts have been made for CDI to have a regular seat at those departmental meetings?

Do you not have executive / administrative support for you to be in those meetings? If that’s the case, does your executive leadership understand the importance? If you have met with them but still do not have their support, could you have done a better job of understanding their motivation / incentives to then know how to communicate the benefits of CDI?

If the departmental meetings are provider only, have you tried lobbying your executive team for a physician advisor position?

Before you go into a meeting with an ask, have you sought to solve one of their issues first (I did this with our cardiologists)?

7. Do you understand documentation workflow and templates?

Perhaps the EMR / tech is problematic and actually hurting CDI / documentation efforts.

If that’s the case, have you worked with EMR / IT to solve some of those issues?

If the tech can’t be fixed, instead of providing generic education, provide actual screenshots of the EMR (as discussed in this newsletter on fractures, the verbiage you’re recommending may not be available if they’re forced to select from drop-down menus. Provide a work-around or, again, work with the EMR to change it)

8. Is your CDI program judged solely on query metrics?

If that’s the case, then you’re incentivized to not do ANY of the above because actively doing those things may result in LESS queries which will look like you’re making LESS of an impact.

We’ve seen this in our program. Upstream efforts have resulted in less financially-impactful queries… but that’s allowed us to focus on quality. Thankfully, we have leadership that understands that importance.

If you are solely query-metric based, then it’s time to have a discussion with your executive leadership to consider other KPIs in an effort to reduce queries with upstream fixes.

I could go on and on, but you get the picture. Keep asking yourself “why?” to each question / accusation. Truly seek to find a root cause.

And yes, all of the above takes someone in CDI who is not doing a substantial amount of day to day chart reviews. You need someone in a position whose role is broader strategic analysis. If you don’t have one, it’s probably time to get one.
It’ll be worth it.

So where does that leave you?

This is how I see it:

• Group 1: Your program is mature, aligned, and data driven. You send the right queries for the right reasons. Keep going.

• Group 2: You are doing your best but you are stuck sending too many queries and you know it. You know your queries are not ideal, but the system forces your hand. You need leadership support, better tools, and clearer alignment. You deserve help and resources.

• Group 3: You have no idea where you stand. Time to use the above as a self audit.

The invitation

This is not blame. It’s an opportunity. Even I need to answer some of the above questions about our own program.

A well run CDI program improves accuracy, strengthens quality performance, reduces denials, supports financial integrity, and builds trust across the clinical enterprise.

Physicians do not necessarily dislike CDI. They dislike unnecessary interruptions and administrative burden with no perceived value. When the work is targeted, relevant, and clearly connected to their world, the relationship changes.

Your next step starts with an honest self audit.
Do not fear the criticism.
Use it as a mirror.
Start fixing problems today, not tomorrow.

That’s all for now.
Cheers,
Robert

Thank you to Laura Samson, RN BSN CCDS for editing this newsletter!

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