Physician engagement in several healthcare initiatives is crucial to attain organizational goals and improve performance on related metrics. When it comes to severity reporting and the CDI initiative, long-term sustainable improvements are also highly dependent on physician engagement.
Even though the impact of accurate and compliant clinical documentation has a domino effect on performance data for many other higher visibility healthcare initiatives, it does appear that physician engagement in documentation-related initiatives is usually low.
Delivering high quality care cost-efficiently is a driving force for most if not all acute care organizations and it is essential that physicians are engaged in the underlying initiatives that help you achieve those overarching goals. Even today, physician engagement initiatives don’t seem to be formalized and adopted across the industry and perhaps that makes sense since strategies that are geared towards engaging physicians should never be a one-size-fits-all approach. There are indeed universal fundamental strategies as it pertains to physician engagement, but if these are implemented without taking into consideration culture, service lines, and provider feedback and input, one may instead sabotage the initiative.
One hypothesis worth considering that could help explain poor physician engagement in documentation initiatives is the manner and approach in which CDI was introduced many years ago. How clear were we with regards to what the organization was trying to achieve with the program and what the physician’s short-term and long-term role was? For example, in the short term, physicians should answer queries appropriately with the intent of using the queries as a learning tool over time for accurate upfront documentation of specific diagnoses.
With proper alignment, consistent messaging, education, and credible data, physicians can be empowered to “do it right the first time” when it comes to documenting impactful severity adequately. Ideally, all organizations should strive toward physicians having a documentation ownership mentality. One of the quantifiable indicators of that would be lower query rates with sustained performance on specific clinical conditions and shift the role of CDI towards a safety net instead of a crutch for commonly encountered high severity diagnoses.
This active participation in the severity reporting initiatives can only be achieved if the physicians are well informed, agree with the changes we are asking them to make, and have access to credible provider-level performance and actionable data. While there is no magic formula that you can implement overnight to achieve physician engagement success in severity reporting, here are 5 strategies to consider when trying to increase physician engagement in your severity reporting initiative:
1. Connect the Dots for Physicians
One of the keys to engagement is to ensure physicians understand the reason why they are being asked to adapt their documentation practices. Physicians show the greatest improvement when they are able to see how certain clinical outcomes – like mortality and length of stay – are directly linked to their appropriate documentation of patient severity.
Many physicians may resist the idea of taking time for education on clinical documentation, however, once they see quantifiable results, they tend to look forward to these discussions and data reviews. Traditional query response rates and other age-old metrics simply do not allow for this. Instead, we must properly identify what physicians care about and track the related metrics that hold them accountable for performance.
2. Share Relevant Data
Sharing credible provider level performance and actionable data with physicians frequently over time drives change only if physicians are well informed on how the metrics are calculated, what they represent, and what key action items they need to implement to improve performance. Most providers don’t truly understand the impact of their documentation on CMI and Capture Rates. Consider a scenario where a Neuro-surgeon is told that cerebral edema is being under-reported for her specific neurosurgical population – not because she does not know what cerebral edema is and/or how to treat it, but rather that the diagnosis cannot be reported from the Radiologist’s report and has to be in her notes. Now consider a second scenario but swap out cerebral edema for acute systolic heart failure for this same provider. The chances of success in those two scenarios are implicit but powerful.
3. Identify a Physician Leader
Identifying an engaged physician leader is extremely advantageous to engage a larger number of physicians in that service line. We are not referring to your typical Physician Advisor, but rather an individual specific to a service line who is respected by their peers, sees patients alongside their peers, and whose performance data indicates that they are a high performing documenter of severity. Physicians are familiar with the “see-one, do-one, teach-one” approach during their training years. That same approach can be leveraged to achieve improved performance and long-term engagement.
4. Add True Value by Being a Subject Matter Expert
The bottom line is that physicians are extremely busy and are already being held accountable for several metrics.
The severity reporting initiative and its constituents are in a unique position to add value and save physicians’ time by coming across as subject matter experts in a way that resonates with physicians clinically. This is of course assuming that the purpose of the severity reporting initiative has been appropriately relayed and that it is meant to reflect the true complexity of their patient population and not to question their clinical judgment.
For example, helping a physician understand the short and long term clinical and quality implications of documenting acute kidney injury alone versus acute kidney injury due to acute tubular necrosis when their patients meet the clinical criteria, will more likely gain the favor of those physicians over time as opposed to highlighting that they did not answer a query on ATN.
5. Accountability and Empowerment
We all are aware of many other metrics that physicians pay close attention to as there is widespread reporting and discussion of those metrics within the organization (e.g., Mortality and LOS ratios). Since accurate clinical documentation and severity reporting data impact the value of those ratios significantly by impacting the “Expected” values, it becomes crucial to embrace advanced analytics that represent the provider’s performance on documentation and reporting of specific clinical conditions.
ClinIntell’s analytics enable organizations to set SMART Goals and share actionable data with physicians based on their specific and unique patient populations which not only empower providers but also allow for documentation performance to join the ranks of other metrics for which they are held accountable for.
Book time with us here to review ClinIntell metrics such as CMI Documentation Score and other quality related severity documentation performance metrics for your physicians as well as actionable data based on your Medicare publicly available claims data.