Engaging physicians in clinical documentation improvement

While most hospitals and health systems are working hard to improve the precision of their clinical documentation, these efforts can be futile unless physicians are invested in the process and understand the value to the patient, the organization, and themselves.

Jill Barber, director of managed care and payer strategy at Southwest General Health Center in Middleburg Heights, Ohio, says that although the hospital has had a CDI program in place for years, its case mix index was in decline while length of stay and complications were on the rise.

"CDI and the idea of case mix index erosion really started becoming front and center as an issue for us" in 2012, Barber says, noting that Southwest General added clinical documentation specialists to its finance team to help deal with the concern.

"They were all seasoned CDI nurses, but our physicians were able to ignore them. … We had physicians who would take the stairs to go around the CDI nurses. It really was not a good relationship."

As a result of the lack of cooperation from physicians, the query response rate for clinical documentation-related questions was less than 20% for the hospital, and a lot of money was being left on the table, Barber says.

In the fourth quarter of 2012, Southwest General piloted a query process program with the 13 physicians who are part of its cardiovascular service line's co-management company. Queries were sent via email through the electronic medical record's message center. For the first time, physicians were able to respond easily, and the impact was clear. For these 13 physicians, the query response rate rose from 23% to 75%, and there was a significant decline in duplication of queries.

"The physicians were really getting it, and also, we noticed we weren't querying them for the stupid stuff anymore. … We really hardwired the process, and basically what happened was we were seeing such significant results we said this was no longer a pilot, and we began to hardwire the whole process across all physicians."

The impact on revenue was substantial, Barber adds. "For us, in one short year, it was $1.4 million in additional revenue for our cardiovascular service line. To put that into perspective, that is over 3% of that service line."

Additionally, the organization-wide case mix index has increased by 7.6% because physicians are now capturing a more complete and accurate picture of their patients' severity of illness. Along with benefiting the hospital's revenue cycle, the higher CMI means patients' medical records are more precise—which can help improve quality—and physicians receive acknowledgment for treating sicker patients.

A key to the program was engaging physicians in a way that matters to them, Barber says. "I think this speaks to them on a more real level than just the idea that the hospital wants more money. You are telling them to get credit for the sick patient that they are really taking care of. I am saying, 'Let me tell your story through the codes you put on the bill about the high-quality doc that you really are.' The main takeaway is pretty evident. We were not able to really be successful in a CDI program until we engaged the physicians," Barber says.

Southwest General is now focusing on engaging physicians outside of the cardiovascular service line to expand the positive impact of the CDI program, she says. "The query response rate for all physicians is still only 46%, and our goal is to get over 80% for the organization."

Editor's Note: This article originally published by HealthLeaders Media.