In today’s complex reimbursement landscape, physician engagement has become a key differentiator for hospitals aiming to improve both clinical and financial outcomes.
During a recent discussion at Becker’s 10th Annual Health IT + Digital Health + RCM Conference, Accuity hosted leaders from several health systems to talk about how their organizations are bridging the gap between clinical documentation and revenue performance.
Here are three key takeaways from the discussion.
1. Engaged physicians drive measurable impact
When physicians take ownership of documentation and coding processes, the results can be dramatic. Atlanta-based Emory Healthcare saw physician involvement in denial reviews lead to $70 million in overturned denials last year, according to Jessica Nave, MD, vice president of CDI, coding, and revenue integrity.
“When you have people who are dedicated to this work and good at it, the impact is huge,” Dr. Nave said.
Arlington-based Texas Health has seen similar gains, according to Amy Papst, MD, chief quality and medical officer. Dr. Papst said physician engagement helped the system move from a two-star to a four-star CMS rating.
“Helping them understand and bridge those gaps really made a difference in their engagement,” Dr. Papst said. “Explaining how it translates into a score or a star is important because they’re proud to work in a place that’s providing high-quality care.”
Panelists stressed that engagement efforts must be formalized and funded. Dr. Nave recommended appointing physician leads within each specialty to serve as revenue cycle liaisons.
2. Education, collaboration, and technology
Panelists agreed that one of the biggest barriers to physician engagement is a lack of awareness about how documentation affects reimbursement. Lynchburg, Va.-based Centra Health CMO Pradeep Singanallur, MD, noted that clinicians are often focused on patient care rather than coding nuances.
“We need to take away some of the work that we’re giving to the providers and simplify things,” Dr. Singanallur shared. “Everything needs to be part of your natural workflow, and you don’t have to worry about it at the end of the day. If we don’t respect their work-life balance, we’ve already lost.”
Dr. Nave also described the importance of reframing documentation as a partnership.
“I tell everybody, we’ve got a team behind you that’s coming in, and they’re going to help catch it if you are forgetting a diagnosis,” Dr. Nave said. “I am trying to reframe how we think of documentation in the hospital and that we have these resources to help, rather than annoy.”
The panelists also emphasized the use of automation and electronic medical record tools to reduce administrative burden. At Emory, Dr. Nave’s team addressed hundreds of outpatient lab denials by redesigning the EMR to automatically suggest appropriate diagnosis codes.
3. AI is promising but requires guardrails
All three leaders saw potential for AI in reducing manual work. Emory is already deploying AI tools in denial management and concurrent CDI reviews. Texas Health uses AI post-coding, pre-bill to ensure optimized DRGs. Centra Health applies AI for chart flagging and ambient listening, even helping reduce denials.
Dr. Papst added that AI’s value lies in efficiency, not replacement. “It can help us be more efficient, but we need the right guardrails and attention to detail,” she said. Dr. Singanallur and Dr. Nave echoed that sentiment, highlighting the fact that payers are already using AI for denials and organizations that don’t risk falling behind.
“We need our own AI solutions while we let people actually work on contracting and banding together for regulatory change and guardrails,” Dr. Nave said. “I’m very excited, and I think it’s going to change the efficiency of the revenue cycle.”
