2010 CDI Salary Survey

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1 2010 CDI Salary Survey A supplement to CDI Journal

2 Survey shows CDI salaries stagnant Participants say profession is not compensated appropriately CDI specialists increasingly feel their salaries inappropriately reflect the value they bring to their organizations. Over and over, respondents to the third annual CDI Salary Survey lamented the pay cuts, increased hours and workloads, lack of raises, and decreases in benefits. (Read respondents comments on p. 13.) In 2008, 132 individuals completed the survey. In 2009, responses doubled to roughly 300. This year, nearly 900 people responded. In general, the results mirror those from previous years. Seventy-seven percent earn between $50,000 and $89,000, with the bulk (31%) earning in the $60,000 $69,000 range (see Figure 1). In 2009, 32% reported earning between $60,000 and $69,000, and 3 indicated that they earned that amount in In 2009, 61% of respondents indicated that they felt fairly compensated for the work they personally perform. This year that number decreased to 53%. Also, this year only 47% of respondents indicated that the CDI profession as a whole receives appropriate compensation (see Figures 2 and 3). Some blame the ongoing sluggish economy. There have been freezes on salaries and benefits due to the economy. This was done throughout the organization I work for, one CDI specialist wrote. This was done to prevent job losses. I am grateful there weren t layoffs. Other respondents express a lack of patience with the poor economy argument. While the general U.S. economy may be struggling in some areas, wrote one respondent, the economy of CDI is booming. We are responsible for millions of dollars of revenue for the hospital, and the salaries have not kept pace. Others lament that CDI staff earn less in their current role than they did during their previous nursing careers. I took a huge pay cut when I left bedside nursing to come Figure 1: Annual salary 35% 3 25% 2 15% 5% $20,000 $29,999 $30,000 $39,999 $40,000 $49,999 $50,000 $59,999 $60,000 $69,999 $70,000 $79,999 $80,000 $89,999 $90,000 $99,999 $100,000 $109,999 $110,000 $119,999 $120,000 $129,999 $130,000 $139,999 $140,000 $149,999 $150,000 $159,999 $160,000 or more CDI Salary Survey

3 to CDI (which at our facility is part of case management). It was a $5 an hour pay cut, and that was 10 years ago, wrote one survey responder. Some say they feel unappreciated, indicating that the CDI role benefits physicians, coders, quality measures, casemix index (CMI) reporting, and overall financial health for their facilities while staff members themselves see no monetary return from their efforts. We are a highly specialized, educated group of professionals who bring in new dollars and influence the appropriate capture of our facility CMI data. I think we are grossly underpaid for those of us who are effective in this role, one CDI specialist wrote. Practicing the principal purpose of CDI to obtain the most accurate medical record, I believe if the specialist is successful (and ethical) in his/her role and the hospital benefits a pay-for-performance salary structure or bonus seems reasonable, another wrote. Most (95%) CDI professionals work hours per week (see Figure 4) and most (75%) either do not work continued on p. 4 Figure 2: Do you believe that you are fairly compensated for the work you do? Yes No Figure 3: Do you think that, overall, CDI specialists are sufficiently compensated for their work? Figure 4: On average, how many hours per week do you work? 6 Yes No Fewer than 24 hours hours hours hours More than 50 hours January

4 CDI salaries continued from p. 3 overtime or do not get paid for any overtime work they perform (see Figure 5). Comments suggest that some CDI specialists have forgone raises for multiple years, and the survey results illustrate that 6% have not had a raise in more than three years (see Figure 6). CDI was added to my workload while I was a quality analyst, wrote one respondent. What started as three full-time positions are now all mine with no increase in salary. The only raises given out in my facility in the past three years were 2% across the board for all employees. Seventy percent said they received a salary increase in the past 12 months (see Figure 7). The majority (73%) indicated a raise of between of 2% 3% (see Figure 8). In 2008, 66% reported that they received a 3% 6% increase, compared to 64% in 2009 and 43% in 2010 (see Figure 9). Fifty-nine percent indicated their salary and benefits have not kept up with the cost of living (see Figure 10) and many Figure 5: How are you compensated for overtime? I receive twice my regular pay rate: I receive one and a half times my regular pay rate: 14% I receive my regular pay rate for overtime: 2% I receive time off in lieu of additional pay: 3% Other (Please specify): 5% I do not work overtime: 23% I don't get paid for overtime: 53% continued on p. 6 Figure 6: If you did not receive a raise in the past 12 months, when was the last time you received a raise? 35% 3 25% 2 15% 5% months ago months ago 2 3 years ago More than 3 years ago I have never received a raise Other CDI Salary Survey

5 Figure 7: Have you received a raise in the past 12 months? Figure 8: If you received a raise in the past 12 months, what was the increase? No: 3 8%: 7%: 1% 6%: 1% 5%: 2% 4%: 9%: : 1% More than : 1% 1% or less: 12% Yes: 7 3%: 3 2%: 43% Figure 9: Rate of 3% 6% salary increases over time Figure 10: Do you believe that your salary, benefits, bonus, and job perks have kept up with the cost of living? 10 Yes No 2008: 66% : 43% 2009: 64% Editor s note: Results of previous years reports are available in the CDI Journal archives. January

6 CDI salaries continued from p. 4 report cutbacks in other benefits, such as travel (35%), health coverage (36%), and retirement/pension plans (36%) (see Figure 11). CDI credentials The majority of CDI specialists come from a nursing background: 75% indicated that they have the RN credential. Little more than 2 of respondents hail from coding/ HIM backgrounds with CPC, CCS, RHIT, or RHIA credentials (see Figure 12). The expectations for coders right now are really high, says Robin R. Holmes, RN, MSN, director of case management at DCH Health System in Tuscaloosa, AL. The HIM department in general has additional responsibilities associated with the transition to ICD-10 and electronic records implementation, Holmes says. These professionals already have a lot on their plate without adding documentation improvement efforts to it. The number of individuals who have obtained their certified clinical documentation specialist (CCDS) credential rose slightly from 15% in 2009 to 18% in The CCDS credential is going to have an impact as it gains momentum in the industry, says Holmes. It is the next step, professionally speaking, to become a CCDS, agrees Colleen Stukenberg, MSN, RN, CMSRN, CCDS, clinical documentation management professional at FHN Memorial Hospital in Freeport, IL. CDI experience and education Most CDI programs are relatively young between one and four years old, according to the 2010 CDI Program Benchmarking Survey. So it may not be surprising that most salary survey respondents (67%) reported having one to five years of CDI-specific experience. Less than 1% have more than 15 years of experience (see Figure 13). Figure 11: Have you experienced a reduction in any of the following in the past 12 months? 45% % % % % Hours Salary Health coverage Retirement plan match Pension plan Travel budget Tuition reimbursement Continuing education budget Meals and entertainment (e.g., holiday parties, department lunches) Other (Please provide additional comments.) CDI Salary Survey

7 All respondents indicated having at least some collegelevel education, the majority (74%) having obtained either an associate s or bachelor s degree (see Figure 14). But Stukenberg cautions that most CDI professions do not come to the role directly from school. Chances are these professionals have been in healthcare for 20 years or more, she says. New nurses do not have the know-how and experience to be a successful CDI specialist, at least not right out of college. The number of individuals who earn $70,000 with a bachelor s degree was 5% more than those with an associate s degree. Only half of Holmes staff members have their bachelor s degree. Of those who earn $80,000, indicated that they have an associate s degree, 11% their bachelor s degree, and approximately 2 possess a master s degree (see Figure 15). I have 25 years experience and a master s degree, one respondent wrote. I do not feel I am compensated for those things as they are not a requirement for the job. continued on p. 8 Figure 12: Credentials ACM CCDS CCM CCS CPC CPHQ LPN MD RHIA RHIT RN None, I have no credentials Other Figure 13: CDI experience Salary by years of CDI experience Years of CDI experience 4 35% 3 $20,000 $29,999 $30,000 $39,999 $40,000 $49,999 $50,000 $59,999 $60,000 $69,999 $70,000 $79,999 $80,000 $89,999 $90,000 $99,999 $100,000 $109,999 $110,000 $119,999 $120,000 $129,999 $130,000 $139,999 $140,000 $149,999 $150,000 $159,999 $160,000 or more years: 3% 6 10 years: 16% Less than 1 year: 14% Greater than 15 years: 25% years: 37% 1 2 years: 3 15% 5% Less than 1 year 1 2 years 3 5 years 6 10 years years January

8 Figure 14: Education Some graduate work: 8% Doctorate: 1% Master s degree: 13% Bachelor s degree: 41% Some college: 5% Associate s degree: 33% CDI salaries continued from p. 7 Of the 269 people (the greatest number of respondents) who reported earning between $60,000 and $69,999, 10 said they have some college education, 88 have an associate s degree, 117 have a bachelor s, 23 completed some graduate work, and 31 earned their master s degree. None had their doctorate. Obtaining additional levels of education isn t necessary to be a good CDI specialist, Holmes says. However, those who wish to become a manager of a CDI department or director of a program should consider it, she advises. For example, if I hadn t had my master s degree when I applied for my current position, I probably wouldn t have been hired. But I also had 20 years of experience to add to that degree, so I d say it is not one thing over another. Both education level and experience matter. Figure 15: Salary according to education level 4 35% $20,000 $29,999 $30,000 $39,999 $40,000 $49,999 $50,000 $59,999 $60,000 $69,999 $70,000 $79,999 $80,000 $89,999 $90,000 $99,999 $100,000 $109,999 $110,000 $119,999 $120,000 $129,999 $130,000 $139,999 $140,000 $149,999 $150,000 $159,999 $160,000 or more 3 25% 2 15% 5% Some college Associate s degree Bachelor s degree Some graduate work Master s degree Doctorate What is the highest level of education you ve achieved? CDI Salary Survey

9 CDI demographics CDI specialists are primarily women (96%) between the ages of (78%) (see Figures 16 and 17). They work in acute care hospitals (97%) with between 100 and 400 beds (61%) in either the Southeastern or North Central regions of the United States (see Figures 18, 19, and 20). Of the 253 CDI specialists working in the North Central United States, 39% earn $60,000 $69,999, 12% earn $70,000 $99,999, and five earn more than $100,000. Of the 211 respondents working in the Southeast, 27% earn $60,000 $69,999, 13% earn $70,000 $99,999, and one person indicated that they earn more than $100,000. The highest-paid region appears to be along the Pacific coast, with 25 of 73 respondents earning more than $100,000 and 38 respondents who reported earnings of $70,000 $99,999. As in years previous, the division between classifications of municipalities rural, urban, suburban was less pronounced, with 22% of respondents indicating that they work in rural communities, 38% in suburban, and 4 in urban areas (see Figure 21). continued on p. 10 Figure 16: Gender Figure 18: Setting Female: 96% Male: 4% Figure 17: Age Home healthcare facility: Inpatient rehab hospital: Long-term care hospital: 1% 60 69: 20 29: 2% 30 39: Critical access hospital: 1% Ambulatory surgery center: Other: 1% 50 59: 46% 40 49: 32% Acute care hospital: 97% January

10 CDI salaries continued from p. 9 Of the 273 people who earn $60,000 $69,999, 34.5% say they work in rural areas, 3 say they work in suburban settings, and 28% indicate working in urban settings. Of the 65 people who earn more than $100,000, 2% work in rural settings, 8% work in suburban settings, and 9% work in urban areas (see Figure 22). n Figure 19: Number of beds 25 or fewer I don t work in beds: 1% a hospital: 1% beds: 1% 500 or more beds: 18% beds: 7% Have questions? Contact Associate Director Melissa Varnavas Telephone: 781/ , Ext mvarnavas@hcpro.com beds: beds: 16% beds: 23% beds: 23% Figure 20: Region Figure 21: Type of municipality Northeast (CT, MA, ME, NH, NY, RI, VT): 13% South Central (AR, KS, LA, MO, OK, TX): 14% Southeast (AL, FL, GA, KY, MS, NC, SC, TN, VA, WV): 24% North Central central (IA, IL, IN, MI, MN, ND, NE, ND, NE, OH, SD, SD, WI): WI) 71% 29% Middle Atlantic (DE, MD, NJ, PA, DC): 7% Urban 4 Rural 22% Suburban 38% West (AZ, CO, ID, MT, NM, NV, UT, WY): 5% Pacific (AK, CA, HI, OR, WA): 8% CDI Salary Survey

11 Figure 22: Municipality type influence on salary 35% What is your current annual salary? $19,999 or less $20,000 $29,999 $30,000 $39,999 $40,000 $49,999 $50,000 $59,999 $60,000 $69,999 $70,000 $79,999 $80,000 $89,999 $90,000 $99,999 $100,000 $109,999 $110,000 $119,999 $120,000 $129,999 $130,000 $139,999 $140,000 $149,999 $150,000 $159,999 $160,000 or more 3 25% 2 15% 5% Rural Suburban Urban What is the location of the facility or office where you work? Responses indicate additional compensation sought for CDI efforts In the 2010 CDI Salary Survey, respondents were encouraged to provide additional feedback regarding their compensation. Here is a sampling of their responses: Our inner-city hospital has been struggling for the past three years, so there have been no raises. We hope to get a 2% raise in I received a raise when I took the CDI specialist position, otherwise raises have been on hold for three years. Cost of insurance has increased at this facility and the vacation hours are less. We had to give up six hours via mandatory time off each week due to a drop in census. This has been ongoing since March So the raise we received was essentially negated by reduced hours. Marketing tools and supplies, lab coats, all extras have been removed. We get very little continuing education compensation. There have been freezes on salaries and benefits due to theeconomy. This was done throughout the organization I work for. This was done to prevent job losses. I am grateful there weren t layoffs. Workload has increased and no new employees have been hired. As continued on p. 12 January

12 Additional compensation continued from p. 11 a salaried employee, this has increased the number of hours I work, but there has been no compensation for the additional hours. The benefits of working a Monday through Friday workweek, along with potentially flexible hours and autonomy in my job, in many ways serve as compensation for me. I am paid less than others with my experience I have 26 years as an RN and MSN. Sometimes, however, flexibility is key. Our pay range is not as high as the staff nurses, and I think it should be. I am currently at the maximum of the range for the CDI specialist at our facility after 10 years of doing this, which I believe isn t fair after 30 years as a nurse in acute care. However, I am not sure our pay scale is compatible to other facilities. I took a huge pay cut when I left bedside nursing to come to CDI (which at our facility is part of case management). It was a $5 an hour pay cut, and that was 10 years ago. At the time, I did not want to work holidays and weekends and so the CDI position appealed to me. I found I really enjoy the job and the hours work for me, which is important to me. We are a very specialized profession but do not receive extra pay and have to use vacation pay for holidays as opposed to getting bonus time. I have reached a salary cap, so I only get a 1% bonus once a year. There is no benefit for me to maintain certifications because my salary is the same with or without them. Practicing the principle purpose of CDI to obtain the most accurate medical record, I believe if the specialist is successful (and ethical) in his/her role and the hospital benefits because of improved documentation and case-mix index, a pay-for-performance salary structure or bonus seems reasonable. I realize this might be a slippery slope. The opportunity for salary advancement as a CDI specialist for my facility is tied to RN pay increases. This limits the maximum pay range for this position, so regardless of how effective the program/ specialist is, the salary is not indicative of the specialized nature of the job. Most of the CDI specialists at our hospital have transitioned from patient care, and the pay is exactly the same. Given the amount of training needed, commitment to the program, clinical knowledge needed, and critical thinking, I believe the CDI specialists should be a pay grade above staff RNs. There is a fairly wide range in salaries between hospitals in the area. I went from one hospital to the other and received a $9,000 increase. Prior to that, I had not received a raise in two years. I feel that salaries should be in line with bedside nurses. The work I do as a CDI specialist requires as much, if not more, critical thinking as a bedside nurse. I also think that there should be more paid educational opportunities. Education would both benefit the hospital and employee. I think your salary reflects the professional level that you and your employee determine the role of a CDI specialist should be. And your own personal professionalism can determine your salary expectations. Some nurses are not business savvy. I see it every time we interview for a new position. I encourage nurses to become more business savvy. My facility has purchased my ACDIS membership, sent me for additional training, and basically is very supportive. The CDI staff are paid thesame rate as case management, which is a pay grade above staff RN. The difference is that both of these jobs are salaried and therefore do not get pay for overtime. But both of these jobs have some flexible hours in the day and few weekends required to work. I feel that I am compensated well, but I don t necessarily feel that others are from other regions and hospitals. I feel that I am fairly compensated for my work, if I am allowed to work my full-time hours. The census drives the productivity, but this fluctuates on a daily basis. As a CDI specialist I do not think that consideration is given to the follow-up aspect of our work. The job requires more than just working up new cases on a daily basis. The patients now need to be followed more closely, even checking discharge summaries at times to CDI Salary Survey

13 make sure the documentation is consistently carried throughout the chart. Economic compensation for the hospital is the main contribution we make to the bottom line; however, we still have no increase in our own compensation. Nor do we have any increased respect for the work that we do in particular, by the medical staff. I believe that with the significant amount of responsibility, this position should be considered more important than it is at times. I feel our institution values what I do and my compensation is fair. However, I don t think every facility understands the revenue that is generated by accurately reflecting the severity of illness through the physician documentation. Administrative kudos really supports our reputation with the doctors. They are more willing to cooperate or at least listen to us when they know administration is watching. I am the only CDI specialist on staff, so I m extremely busy, which is the reason I feel I should be compensated a bit better. It is a growing field and more people should get into the field. We have flexibility in our roles and that goes a long way! n 01/11 This special report is published by HCPro, Inc., 75 Sylvan St., Suite A-101, Danvers, MA Copyright 2011 HCPro, Inc. All rights reserved. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/ Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781/ or fax 781/ Opinions expressed are not necessarily those of the editors. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. January

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