CDI Week 2020 Q&A: Physician engagement

As part of the tenth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Samir Akach MD, MHCM, CPE, CHCQM-PHYSADV, SFHM, FACP, FACHE, the medical director of documentation, medical coding and quality coordination at Geisinger in Pennsylvania, a member of the 2020 CDI Week Committee, answered these questions. Contact him at sakach@geisinger.edu. For more information about outpatient CDI, read the 2020 CDI Week Industry Survey report. 

Q: Can you describe the engagement and collaboration of the medical staff at your organization with CDI?

Akach: I’m fortunate to work with very engaged physicians in my organization. Our physician response rate exceeds 90%, and physician agree rate exceeds 85% in all our hospitals. This came with hard work from our exceptional CDI specialists and a systemwide educational campaign.

We press on the importance of clinical documentation and its effects on revenue and quality ratings early in the provider onboarding process. Providers’ orientation includes a presentation on CDI followed by periodic one-on-one coaching with each new provider to discuss CDI.

CDI team members are present on the hospital floors, round with physicians, and attend interdisciplinary team meetings. They are viewed by physicians as business partners, and the physicians seek their input frequently. Physician champions from different departments periodically review documentation trends and tailor their educational effort to suit their needs.

Q: According to the 2020 CDI Week Industry Survey, the percentage of respondents who reported that their medical staff is “highly engaged” jumped from roughly 13% in 2019 to over 20%. In your opinion, why is physician engagement seemingly increasing year-over-year?

Akach: Physicians are becoming more and more aware of the effects of clinical documentation on revenue and quality ratings. Physicians want to see their organizations succeed, capture all the revenue to which they are entitled, and survive in this competitive market. They want to make sure that their quality ratings reflect the true quality of care that they provide.

Q: Even though more people say their physicians are highly engaged, there’s still 80% who say they aren’t. Why do you think so many CDI programs have trouble engaging the medical staff? What have been your biggest challenges with gaining physician engagement and what have you done to address them?

Akach: I believe the major challenge is engaging private physicians who aren’t directly employed by your organization. They often cover different facilities, and their attention is split between hospitals and clinics. They finish their rounds early in the morning and leave the hospital before they have the opportunity to interact with the CDI staff. The communication with these doctors is less than ideal.

They might speak with CDI staff on the phone, but they soon get distracted with their busy clinic schedule and forget to answer queries on time. At my organization, the hospital chief medical officer calls these physicians on the phone directly if they don’t respond in time to CDI queries, which has helped to encourage their involvement.

Q: According to the Industry Survey, the majority of respondents currently have a physician advisor or champion. Does your department have a physician advisor or champion? If so, what has been the result of that relationship and how much time do they devote to the CDI department?

Akach: At my organization, we have a physician champion in each department in every hospital, some of which are advanced practitioners. They volunteer their time to address query escalation, review documentation trends, and tailor the educational efforts to the group’s needs. I work to make physician champions’ jobs easy and to provide all the educational tools they need to pass along to their colleagues. Without physician advisors, the educational effort might lack focus and miss the specific need of each group.

Q: Do you track physician query response rate at your facility? Why or why not? How have you gone about improving your query response rate?

Akach: We monitor our physician query response rate very closely since it is like checking vital signs on our patients: early detection is key in fixing any problem. Without this practice, we would not know where or how to focus our efforts to improve documentation.

For example, we found that physician response rate was suboptimal in the cardiothoracic (CT) surgery department. After a careful analysis, we realized that the surgeons’ busy schedules in the operating room hinder their abilities to answer queries in time. We also found that advanced practitioners do most of the documentation in CT surgery, and so we assigned advanced practitioner champions, which successfully suited the department’s needs. Once the champions were engaged in the process, we were able to move the needle in the right direction and improve documentation practices in this group.

Q: The largest group of Industry Survey respondents said their physicians have two days to respond to a query. What is this timeline in your facility and why did you choose that timeframe?

Akach: In my opinion, physician engagement should not be measured by the time it takes them to respond to queries; if you caught the physicians’ attention, it should not take two days for a response, unless they are off duty or out of town.

It is important, however, to have a structured policy in place for query response time and an escalation process, especially for instances where physicians are taking extensive time to respond. A policy is needed to address the issue of delayed responses, and I suggest seeking physicians’ input when developing or updating this procedure.

Q: Do you provide formal education to your physicians, one-on-one/informal coaching, or both? How have your physician education/engagement models changed due to the pandemic?

Akach: We use different interventions with our providers, including formal education and one-on-one coaching. We believe that physicians need to hear information repeatedly and receive it in a variety of ways before they learn and incorporate that information into their daily practice. This approach has been a bit challenging to implement during the pandemic since most department meetings were held virtually. This shift has limited the human interaction and lively discussions we previously had during our presentations.

Q: Does your program regularly share CDI data with physicians? Why or why not?

Akach: Transparency is a key factor in our approach with physicians. By sharing data, physicians are more interested in being part of the solution. I believe that information sharing is the most important factor in gaining our physician engagement.