Physician Accountability In CDI
The concept of focusing on people, process, and technology also holds true for CDI. The people category includes focusing on the individuals that make up the CDI program, but all too often, physicians are not included in these efforts. I believe that this is the case either because organizations have tried to include them in the past, but were met with resistance and poor results, or alternatively, have not tried at all since expectations were not high in gaining favor with physicians.
There is some truth to not having high expectations with regards to physician engagement in CDI and receptivity to performance measurement, as it appears that there seems to be a lack of trust in executive leadership by physicians for a myriad of reasons. Knowing this; should we continue to strive to engage physicians in CDI, let alone make them accountable for results?
The business definition of accountability can be summed up as follows: The obligation of an individual or organization to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner.
Based on this definition, and considering that physicians are largely responsible for costs, quality, and hence, value demonstration in healthcare, it is crucial that we not only develop strategies to engage physicians in CDI, but that we also hold them accountable for optimal performance. It is important to also realize that diving into a thoughtless accountability strategy can backfire and result in long-term (sometimes irreparable) damage with physicians.
Points To Consider For Accountability In CDI:
Establishing physician accountability to optimize severity capture through documentation has a better chance of being successful if the organization, as a whole, shows a track record of holding physicians accountable or adhering to standardized care processes. For that to be true, a physician must believe that accountability is in place to improve the overall delivery of care to patients and not just for executive leadership to improve financial performance.
To develop such a culture takes time, coaching, education, communication, and strong leadership. If your organization does not support this kind of culture, making a case for holding physicians accountable in CDI will almost certainly be doomed from the beginning.
In general, physicians are not accustomed to being measured (although this is changing), so this alone can pose its own set of challenges. If metrics are used to hold physicians accountable, then it is important that physicians have a sound knowledge base of the metrics being used, why, and their limitations / validity. The transparency of metrics is important within an organization, as it can spark a physician’s competitive nature because no physician likes to be considered an under-performer.
The transparency and display of metrics in CDI does not necessarily mean that they need to be on display for the world to see, as is the case with publicly reported quality metrics, but at the very least, there should be transparency within the relevant areas of your organization. Sharing data and performance metrics, at least internally, also leverages the Hawthorne Effect, which states that the behavior of subjects in a study is altered due to their awareness of being observed.
Physicians are keen to know how they are performing compared to peers in their specialty. I will take it a step further and say that they prefer to be compared to peers within the same specialty AND the same facility. Comparing a physician to a physician group across the country or based on national averages makes a far less compelling case for any performance differences.
Feedback And Coaching
You want to develop a program where physicians eventually start holding themselves accountable, whether you have an accountability strategy or not. This type of culture is more likely to unfold if physicians get constructive feedback and the means exist for them to improve. True accountability does not stop with placing physicians in a low versus high performing category and then letting it be.
The real goal of accountability should be to instill a sense of ownership and pride that goes along with high-quality documentation, causing a physician to genuinely want to improve their performance. When we do succeed in getting our physicians engaged with the topic and associated metrics, we must ensure that they have the tools and coaching to help them “move the needle”.
As the healthcare environment continues to evolve, engaging physicians and holding them accountable for complete, accurate, and high-quality documentation is fast becoming a necessity rather than a luxury. Adopting a strategy that has proven results will facilitate its implementation in CDI, and even though it may very well be met with resistance, it is an investment worth making.
“Accountability breeds response-ability.”