Why Physician Engagement And Education In CDI Is Crucial Now More Than Ever
Physician engagement has long been recognized as a pain point in CDI for many facilities. Organizations have struggled with not only getting buy-in from physicians, but also with being able to articulate the “why” for physicians in a manner that appeals to them. There are many reasons for why this is the case, and they range from lack of trust in executive leadership to the differences in billing requirements between facility and professional reimbursement.
In a previous article, we discussed the top reasons why physicians are not engaged in CDI. Faced with numerous challenges, many health systems have chosen not to invest in a solid plan or strategy to actively engage and provide education for their physicians in CDI; a choice that will inevitably prove to have negative consequences in the long run.
The Status Quo
If you follow my posts, you will be aware that I believe the CDI industry is skewed. More resources have been invested in making the Clinical Documentation Specialist more efficient and astute in generating queries, with little to no resources spent on the actual authors of the clinical documentation – physicians. For optimal results, I believe that there needs to be a balance between the two and the approaches need to work in harmony. Sadly, this is not the case at most hospitals.
Faced with this dilemma, many have chosen to continue working on and developing a query-centric model that strives for high response rates from physicians. While this model may not affect long-term improvement in documentation practices, it does deliver tangible results in terms of DRG accuracy, etc. To a certain degree, this has been successful and may be one of the main reasons that physician engagement and education strategies have taken a back seat in these “status quo” models.
The Problem With Status Quo In CDI
If the model described above – i.e., where physician engagement and education strategies do not play a significant role in your CDI efforts – is considered the “status quo”, then here are a few of the consequences that you may be experiencing:
No change in querying patterns: Theoretically, if physicians are truly engaged and active in education sessions, then we should see the overall query rate per physician on specific diagnoses go down over time. However, what we see instead, even for well-established programs, is that all too often, we submit the same query to the same physician month in and month out. There appears to be no real change in physician documentation behavior.
This is not a good use of the sometimes highly skilled CDS’s time and is not an efficient means to getting results in CDI. Yes, of course; there will be instances where a diagnosis may not be obvious to a physician and further clarification will be needed, especially since patients are seen by so many physicians during a single hospital stay. But over time, you should still see an encouraging shift in querying patterns, including an overall improvement in query response rates.
False representation of true patient severity: Because of poor physician engagement and education, many are satisfied with capturing that one MCC or CC that will shift the DRG and then move on. CDSs, more than anyone, are acutely aware of “query fatigue” amongst physicians, and hence, while there are many opportunities in the chart to more fully capture severity, the ones we place in front of them will be to get the biggest bang for our buck.
It’s no secret that there is great competition for a physician’s time, and with poor engagement to begin with, the CDI program does not want to be responsible for valid queries that may seem insignificant to the physician due to poor education. When you take SOI, ROM, and RAF scores into consideration, it appears that there is significant under-documentation of conditions in our patient mix and that our queries couldn’t possibly help capture all the pertinent diagnoses. This results in a false representation of under-reporting of the true severity of your patient population.
Lost querying opportunities: We are all aware that our programs can only compliantly query for more clarification of diagnoses based on information already provided in the chart on those diagnoses. It stands to reason, then, that there will be lost opportunities to query a physician if no information is provided, especially on chronic conditions. This results in further under-reporting of patient severity, which will play a significant role as we transition to value under pay-for-performance reimbursement models.
How Engagement And Education Helps
I see these two issues, not as separate entities, but rather, as being co-dependent. Good education efforts will breed strong engagement, and strong engagement will result in active participation in educational efforts. A robust CDI education strategy is crucial, since the nuances of coding and documentation, as they exist in the billing world, are not something that physicians are routinely exposed to in medical school.
As many physicians typically view documentation as a necessary evil, the engaged physician, who develops true competency, can be a source of competitive advantage in the increasingly value-based healthcare environment. More documentation is not always better, and high-quality documentation does not necessarily equate to more time spent documenting. To achieve optimal results, our efforts need to prioritize both CDSs AND physicians.
Providing education on what, when, and where to document is crucial, not only in a value-based healthcare system, but also for physicians, by allowing them to buy back their time in the long run and represent their patient mix severity more accurately.
“To win in the marketplace, you must first win in the workplace.”