Journal excerpt: Finding the right candidate

A common struggle CDI departments find themselves facing is achieving an open line of communication with providers. “There was a generalized idea that the case management and CDI teams needed a physician champion, someone who could make sure the messages got across to the providers. That was just the tip of the iceberg,” says Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Waukesha, Wisconsin, and vice president of the American College of Physician Advisors.

A physician advisor needs to not only explain the importance of CDI to providers, but also assist CDI staff on clinical questions. While it is an extremely important role, it is made or broken by the person who fills it.

“I can hear something that makes complete sense to the CDI and coding team but is very confusing to me as a clinician who is not a CDI specialist or coder,” Ugarte Hopkins says. “We work together very closely and have a friendly relationship, so it’s easy to work through where the disconnect lies.”

According to Ugarte Hopkins, a successful physician advisor doesn’t need to have an exhaustive grasp of both the clinical side of things as well as the CDI and coding aspects. Rather, a balance of knowledge is important. Physician advisors don’t need to be fluent in ICD-10, but they should have a basic understanding of the concepts and importance of documentation. Importantly, they also must have more than just knowledge.

“This person has to be able to work well with others, is approachable and helpful, and has a lot of patience and understanding,” says Alyssa A. Riley, MD, MEd, FAAP, pediatric nephrologist and CDI physician advisor at Dell Children’s Medical Center in Austin, Texas. “A good physician advisor should be empathetic to the documentation burdens that all healthcare providers face; however, they also need to be diplomatic in terms of explaining how good documentation is helpful, and why people just really need to take care of their queries, discharge summaries, and procedure reports.”

Successful physician advisors, according to Ugarte Hopkins, are also able to remove themselves enough to present the information to providers and reinforce CDI’s messages, knowing that some physicians may push back and lash out at them specifically.

While many CDI programs capitalize on existing physician relationships and engage an advisor from among their medical staff, Ugarte Hopkins suggests that hiring someone from outside your facility may sidestep the fear of pushback that an existing staff member might have. Since an outsider likely doesn’t have existing relationships with the facility’s physicians, that person won’t be afraid to say what needs to be said and potentially lose friendships. Though physicians may push back, they’ll still likely accept the information more readily when it comes from a fellow clinician, Ugarte Hopkins adds.

“I like to refer to this as being the ‘heavy.’ And while I hate this concept, it’s unfortunately very true that physicians best receive information from other physicians,” she says. “I’m able to legitimately empathize with them that none of us went to medical school to think about if we’re appropriately using the right diagnosis term so it can be coded appropriately.”

Editor’s note: Read this full CDI Journal article here.