5 steps for engaging physicians in clinical documentation improvement programs

Documentation issues can cost hospitals millions of dollars per year. While rousing physicians to take a greater initiative in clinical documentation improvement efforts can be a feat in itself, there are several strategies hospitals and health systems can use to improve physician engagement.

The average 250-bed hospital leaves an estimated $7.1 million on the table every year, and that number is expected to grow to $12.8 million by 2020 as a result of other external factors, such as ICD-10 and value-based purchasing, according to Edward Hock, managing director of The Advisory Board Company.

Furthermore, about 60 to 80 percent of opportunities to resolve documentation issues are concentrated among 10 to 20 percent of total physicians.

"We took a step back and asked, 'Does this teach us anything about how hospitals and health systems should tackle this issue of documentation?'" Mr. Hock said at the Becker's Hospital Review 6th Annual Meeting in Chicago. "It points to the idea that physicians should be engaged and trained based on two vectors: Documentation skills and effectiveness."

Hospitals can improve physician engagement in CDI by taking the following steps.

1. Determine which physicians will benefit the most. According to Mr. Hock, hospitals can reap the most substantial benefits in their CPI programs by identifying a select amount of physicians to train. These physicians should have the greatest opportunity for impact, meaning they have plenty of room to improve their documentation, as well as see many patients.

However, it is important hospitals "don't bite off more than they can chew," said Michael Redman, RN, director of care coordination and clinical analysis of St. Joseph Hospital in Bryan, Texas. If hospitals don't have the resources or time to train and monitor a large group of physicians, they should reduce the number of participants.

2. Make a compelling case to physicians using evidence-based reasoning. Physicians will be more likely to understand the need to improve clinical documentation if the hospital leadership uses real life examples to show how documentation impacts quality of care.

Mr. Redman said by starting with the big picture with national trends of clinical documentation performance, then narrowing down to the hospital's performance, the physician's department's performance and then their own, physicians take a greater interest in their performance on a comparative level.

3. Educate through a documentation training session. According to Mr. Redman, an intensive training session over the course of a few days is an important first step to initiating behavior change and ongoing documentation improvement.

4. Provide ongoing progress and performance monitoring and support. It is equally important to continue educational efforts and provide support for physicians on an ongoing basis, according to Mr. Hock. The physician and others present during performance tracking meetings, including the CDI staff, coders and the case management director, discuss the physician's progress to keep them engaged in the improvement process.

Physicians show the greatest improvement when they are able to see how the quality data they care about — such as mortality rates and patient stays — are tied to clinical documentation.

While many physicians are initially resistant to the idea of blocking off an entire hour every other month for check-ins, Mr. Redman said the participating physicians eventually looked forward to their meetings.

"Physicians came in at first kicking and screaming. They said they didn't have an hour for their training and meetings to go over their numbers," said Mr. Redman. "But soon they wanted to see their numbers and the direct impact they were having. We were able to keep that energy going by showing the difference they made and how they were helping their patients."

5. Involve executives. Involving executives in CDI programs, especially CMOs and clinical integration chiefs, creates a "watercooler effect" by spreading enthusiasm and support of the program to physicians, according to Mr. Redman. Additionally, once physicians became comfortable with the process and started seeing positive results, they would talk to other physicians who would then want to participate as well.

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