The Critical Role of Physician Engagement in CDI Success
Quality clinical documentation is vital to achieving optimal patient outcomes and accurate reimbursement. It is also essential for maintaining regulatory compliance around quality reporting initiatives. When developing a clinical documentation integrity program, many organizations overlook the importance of involving their physicians. They may be dealing with a physician shortage or think already overworked physicians may not have the time or interest to be involved. However, this mindset can cause an organization to miss out on the value that only physicians can bring to the table.
Physicians can help CDI teams by providing a level of clinical acumen that CDI specialists may not possess. Their deep understanding of the connection between diagnoses, condition severity, comorbidities, care plans, and outcomes is invaluable for optimal CDI. Through proactive collaboration, physicians and CDI specialists can develop a more effective documentation process that reduces the need for retrospective queries and minimizes workflow disruptions.
Aligning Incentives and Education
While physicians have the best understanding of the connection between the clinical elements of a patient’s health journey, they may not understand the importance of documentation integrity on quality metrics or the revenue cycle. That’s why ongoing CDI education is so essential. Continuous learning enhances physician documentation skills and CDI awareness and helps ensure they’re current on ever-evolving payer and regulatory requirements. An effective CDI education program for physicians should include the following elements:
It is essential to provide ongoing opportunities for physicians and CDI specialists to review actual documentation cases in order to understand the rationale behind CDI initiatives. The Association of Clinical Documentation Improvement Specialists (ACDIS) recommends that the information reviewed be relevant to the individual physicians’ specialty area, which can help them better engage in the conversation.1 These meetings should be nonjudgmental and allow both physicians and the CDI team to ask questions and share their perspectives.
A successful CDI program requires a framework of open communication and regular feedback. This can foster an environment of trust rather than confrontation among physicians and CDI specialists. Physicians who understand their impact on quality outcomes and patient satisfaction are more likely to refine their documentation habits for long-term CDI success.
Physicians must understand how their documentation quality and CDI compliance impact the organization’s quality metrics and patient satisfaction scores. Therefore, it is essential for physicians to regularly review the organization’s metrics, especially metrics around diagnostic-related groups (DRGs), severity levels, upcoding and downloading, case mix index, query response times and agreement rates, documentation completeness and specificity, and outcomes.2, 3 Physician groups should also include revenue cycle metrics, including clean claims rates, denials related to documentation errors, and denial-related write-offs. For hospital-employed physicians, revenue cycle metrics should still be provided, but care must be taken in how they are positioned since hospital revenues can be a contentious topic for them. Regardless of the environment, CDI software is an invaluable tool to help in tracking metrics.
Developing an incentive structure for physicians that includes rewards and recognition around their CDI involvement and results can go a long way in encouraging their ongoing participation.
Driving More Effective CDI
While the adoption of electronic medical records has caused increased administrative burdens for clinicians, they have also created an opportunity for vastly improved clinical outcomes, lower costs, and enhanced patient satisfaction. However, achieving these improvements all hinges on the quality of the physician’s clinical documentation within these systems, which is why organizations must engage their physicians in CDI initiatives. For many organizations, creating a program that actively engages physicians can be challenging, especially when challenged with staffing shortages. Partnering with CDI specialists can help and Conifer Health is an excellent choice.
Conifer Health’s CDI solution supports critical reporting for clinical quality and accurate, appropriate reimbursement. The solution includes the following:
- Operations management and consulting
- Customized physician education, training, and engagement
- Workflow and technology optimization
- Quality audits and skills assessment
- Documentation reviews that pinpoint errors, leakage, root causes, and improvement opportunities
- Machine learning and AI that reduces the need for human intervention
- 150+ physicians, nurses, and credentialed coders certified in complex coding
With Conifer Health, hospitals, health systems, and physician practices have achieved the following improvements:
7-10%
improvement in case mix index
30%
improvement in physician query agreement rate
96%
average physician response rate
98%
accuracy average query
Contact Conifer Health today to learn how our CDI solution can help improve physician engagement, outcomes, and reimbursement at your organization.