ACDIS tip: Educational efforts for clinical validation rollout

By Cheryl Ericson, RN, MS, CCDS, CDIP, and Cathy Farraher, RN, MBA, CCM, CCDS

The rollout of the clinical validation process should include an educational timeline complete with a roadshow of sorts in which the physician advisor, CDI administrator, and CDI staff explain the expanded review and query focus. Education sessions may use time already scheduled between the physician advisor and members of the hospitalist team, include specific one-on-one appointments between the physician advisor and medical specialty chiefs, and/or include group educational efforts, among other items.

Physicians, as a group, tend to have similar personality traits, according to Robert S. Gold, MD, in his 2008 ACDIS conference presentation, “Building Physician Relationships.” For example, physicians are:

• Educated, so give them definitions
• Scientists, so give them data
• Proud, so illustrate how they rate against their peers
• Results oriented, so give them a goal

Each individual organization should come to an agreement with not only the physician advisor but also the treating physician teams to offer a clinical validation query process that is fully agreeable to all members involved. Many argue that the best form of physician education is physician involvement. The earlier physicians get involved in CDI development, the greater their investment becomes.

As was the case during the CDI program’s inception, medical staff leadership or the facility’s chief medical officer (CMO) should join the CDI steering committee to set overall goals for the clinical validation program and expectations for physician response, involvement, and training—particularly if those elements of the program were not previously established. If they were previously established, the steering committee may wish to reassess the terms and flow of the program in relation to the additional considerations (i.e., medical decision-making) that clinical validation efforts require. Physician investment in CDI at the highest levels trickles down through the physician ranks and encourages the involvement of the entire medical staff in day-to-day documentation improvement activities.

Organizations may decide that it is better to deal with clinical validation queries in a group setting to allow for education of additional members of clinical teams. This could be done by  daily (such as during medical rounds), bi-weekly, or weekly appointment. The longer the delay between physician advisor meetings with the treating clinician, the greater the potential negative effect unanswered clinical validation queries may have on the revenue cycle management, so more frequent meetings are encouraged.

Editor’s note: This article is an excerpt from Ericson and Farraher’s new book, Clinical Validation Reviews for CDI Professionals. To listen to a webinar with the authors on the topic of clinical validation, click here.