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* 1. Does your CDI program employ a physician advisor(s)?

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* 2. What is your CDI program's reporting structure?

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* 3. What is your role in the CDI program at your facility?

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* 4. If you are the physician advisor at your facility which of the following best represents you?

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* 5. If you are the physician advisor at your facility which of the following best represents your area of clinical concentration?

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* 6. If you are the physician advisor at your facility which of the following best represents any additional professional roles you play?

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* 7. If you are the physician advisor for your CDI program please list any additional committee or reporting obligations you may have.

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* 8. If you are the physician advisor for your CDI program please indicate any other relevant degrees or certifications you hold.

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* 9. How long has your CDI program had a physician advisor involved/employed?

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* 10. How many physician advisors does your facility employ?

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* 11. Please rate the effectiveness of your physician advisor(s).

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* 12. What criteria does your facility use to evaluate its physician advisor(s) effectiveness?

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* 13. How many hours per week is your physician advisor dedicated to CDI related efforts?

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* 14. Does your physician advisor also serve as physician advisor to any of the following additional departments? (Check all that apply.)

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* 15. How is your physician advisor compensated?

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* 16. If salaried, what is the salary range of your physician advisor(s)?

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* 17. Did your physician advisor receive CDI specific training?

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* 18. Did your physician advisor receive specific coding training?

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* 19.

Is your physician advisor currently:


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* 20. What are your physician advisor’s responsibilities? (Check all that apply.)

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* 21. What is the average referral rate of cases to your CDI physician advisor for review (% of total reviews)?

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* 22. Does your CDI program have an escalation policy in place?

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* 23. If your CDI program has an escalation policy in place, what role does your physician advisor play?

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* 24. Is your physician advisor a member of ACDIS?

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* 25. Please complete your contact information if you would like to be entered into a contest to win a seat at the 2016 Physician Advisor's Role in CDI Boot Camp (ACDIS Pre-Conference) May 22–23, 2016 (8:00 a.m. to 5:00 p.m. each day).

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