Could This Be Worse Than Poor Physician Engagement?
When considering what could be detrimental to a CDI program achieving its goals, there are not many factors that I believe can be worse than having poor buy-in or engagement from physicians. Of course, there are many factors that could sabotage the efforts of your program, ranging from inadequate staffing to poor workflow processes.
All of them, though, are overshadowed by poor physician engagement, without which even the most efficient program with the best technology will be brought to its knees. Having physicians who are engaged and contributing in a positive way to your CDI efforts is crucial to achieving results that are sustainable.
There is one other factor, though, which comes up all too frequently and, in my mind, is worse than poor physician engagement: Poor physician advisor (PA) or medical leadership engagement. Here’s why I believe that…
If you have poor physician advisor or medical leadership engagement, your chance of shifting the “physician engagement needle” even a smidge becomes greatly reduced. Engaged clinical leadership will work tirelessly to ensure that physicians at the bedside “get it”, as they appreciate the value of accurate, compliant documentation and what the impact of its absence can be.
I have wondered (as I am sure you have too, probably) how and why PAs would not be engaged and function in that manner. Is that not part of a key element of the PA job description? You would be correct in assuming that that should be the case, however, we still encounter CDI programs struggling with physician advisors almost as much as they do with the physicians themselves.
Why Would A Physician Advisor Not Be Engaged In The Program?
Before we take a closer look at why your PA is not “engaged” in your program, let’s ensure that we are not interpreting the PA’s behavior as poor engagement when it really isn’t. Remember, part of the role of the PA is to ensure that the clinicians have a voice or a seat at the CDI table, if you wish. You may frequently experience resistance and push back from your PA on certain issues.
These issues may range from clinical to query-related matters, where the PA may not necessarily take the expected stance on a topic. If a PA is truly performing their duties well, these scenarios will not be rare, as they have to ensure safeguards for the docs from being overwhelmed and frustrated, which could backfire and hurt your efforts.
The scenario above must be clearly distinguished from a PA who represents the physicians only and very rarely, if at all, appreciates what the CDI program is trying to achieve. A poorly engaged PA is reluctant to address problem docs, review charts with an open mind, and provide frequent education to physicians at team meetings (to name a few). This can be very challenging, as this scenario only adds to your CDI woes.
I believe that the main reason we encounter poorly engaged PAs is due to a flawed hiring process. A physician advisor should have some formal background, training, and education in all the areas that will make them effective in their role. This includes CDI, case management, keeping up-to-date with the latest regulations, and interacting with disruptive or challenging docs.
Many organizations, in the rush to ensure that they have a PA, have fallen short in testing and confirming that these qualities and skills do exist in a candidate. Instead, they have checked off a box by appointing an individual who has been with the organization for a prolonged period and seems to have a good relationship with their colleagues. This does not mitigate the risk that comes with having a PA without the required background, training, and skills.
Another very valid reason could be the PA’s contract, which includes reimbursement and expectations of the role. Many organizations won’t pay a competent PA what that PA is worth and set high expectations of what they should be able to achieve with limited hours per week, all while still having clinical responsibilities.
This can demotivate your PA and cause them to adopt an unfavorable attitude towards tasks that are not only time consuming, but may also jeopardize their pre-existing relationships with their peers. This is not the way I would structure the role, as it may just not be worth it to the PA that is hired.
A third possible reason behind poor PA engagement could lie in the manner in which the C-Suite (including the Chief Medical Officer) interacts with them. I believe that a physician advisor who meets all the requirements of a competent physician advisor should be treated as a leader and their voice be heard.
PAs should be involved in the decision-making process in all things related to physicians in CDI and case management, as they are very frequently a wealth of unique knowledge that should not be ignored. A PA who is “kept out of the loop” and treated in any way other than a peer will very quickly lose motivation and become less engaged.
To sum up, I firmly believe that a poorly engaged PA can have a significant negative impact on the outcomes of your CDI program. It is important that we hire appropriately, reimburse adequately, set clear expectations, and treat our physician advisors fairly to avoid these common reasons for poor PA engagement.
Your CDI metrics will thank you.
“Employee loyalty begins with employer loyalty. Your employees should know that if they do the job they were hired to do with a reasonable amount of competence and efficiency, you will support them.”
– Harvey Mackay