For nearly two decades, Clinical Documentation Integrity (CDI) programs have struggled with one persistent challenge: physician engagement. And it is no mystery why. Traditional CDI has been built on a workflow that requires reviewing physicians’ notes, generating administrative queries, and interrupting clinical workflows, all in the pursuit of capturing diagnoses that often feel disconnected from the physician’s clinical reality.

The industry knows this.  

The countless white papers published by vendors, consulting groups, and professional associations repeat the same recommendations year after year: engage physicians early, share data, provide education, offer peer-to-peer training, show them quality metrics! Yet despite the repetition of these well-intentioned suggestions, almost no organization has truly delivered successfully on them using the traditional approach.  

Every clinical leader knows why: these tactics simply don’t work within the traditional CDI 1.0 model.

Why Traditional CDI Cannot Engage Physicians By Design

Two core flaws have kept CDI from meaningfully transforming physician documentation behavior:

1. Inadequate and Irrelevant Metrics

Most CDI programs evaluate performance using outdated, operational metrics such as query volume, response rates, or working DRG shifts. These metrics:

• Say nothing about provider-level performance
• Do not reveal true severity of illness documentation opportunity
• Provide no insight into the impact of clinical documentation on organizational performance/organizational metrics

Physicians, especially physician leaders, simply cannot engage with metrics that lack clinical relevance or do not reflect their actual documentation practices.

2. Workflows That Interrupt Physicians Instead of Empowering Them

Whether the workflow involves traditional reviews, AI-powered tools, or consultant-revamped workflows, almost every solution in the CDI 1.0 world results in the same outcome: More queries. More prompts. More interruptions.

Every new “severity capture solution” being deployed today ultimately relies on one thing: identifying more opportunities to ask physicians to document more diagnoses. And with AI evolving quickly, some technologies are now triangulating symptoms and lab values to “suggest” diagnoses that the physician may not even consider clinically significant for the patient, introducing serious potential compliance risks. In other words, the industry is polishing old workflows, hoping to produce new outcomes. But the result is the same:

• Physician burnout increases
• Query volume increases
• Documentation quality does not meaningfully improve at the source
• Denials related to insufficient documentation remain unchanged or are on the rise
• Industry performance metrics have hit diminishing returns
• And organizations continue to make large investments without knowing the true improvement opportunity

Recently, I encountered a healthcare executive who perfectly illustrated this dynamic. Despite acknowledging that their organization had significant severity documentation opportunity, they ultimately declined a far more effective CDI approach because they were already committed to a multiyear “transformation project.” The project was still built on the same historical model that has never solved the problem, yet the momentum behind it made it difficult for leadership to change course.

The Untold Truth: Executives Are Making CDI Decisions Without Physician Leaders in Mind

While physician engagement is constantly emphasized, most CDI decisions are made in ways that exclude meaningful physician leadership input. Yet physicians are the ones who suffer the downstream operational impact: more training, more prompts, more administrative distraction, and more compliance exposure. I speak to physician executives every week who clearly recognize the value of accurate severity documentation and understand how ClinIntell’s approach transforms it. But when CDI plans are put in motion, these physician leaders are rarely given the insights they need to advocate for (or against) the initiatives being proposed.

This needs to change. Physician leaders should not be passive recipients of decisions that increase their physicians’ workload. They should not “bow their heads” simply because CDI initiatives supposedly support CMI improvement. And they certainly should not accept solutions that offer no measurable way to reduce queries or demonstrate actual documentation behavior change.

Physician leaders deserve better. And so do their physicians.

The Four Questions Every Physician Leader Should Ask Before Approving Any CDI Initiative

These questions have never been answerable, until ClinIntell. Any physician leader presented with a CDI/documentation initiative should insist on clear, data-driven, physician-centric answers to the following:

1. What is the true opportunity to improve severity documentation for my specific physician group?

This cannot be benchmark-based. Physicians are rightfully cautious with benchmark comparisons in this space because they lack clinical meaning. Instead, leaders should demand objective, provider-level estimates of opportunity in CMI, GMLOS, and Quality Risk Adjustment. Without this level of precision, any CDI initiative is essentially operating blind.

2. If my physicians participate in this/another CDI initiative, what measurable improvement will we see by year-end?

Healthcare leaders are being asked to invest heavily, often millions, in CDI technology, consulting, and staffing. They should be able to quantify anticipated gains in CMI and Quality Risk Adjustment. If these projections cannot be provided, the initiative lacks strategic grounding, and WILL fall short of delivering on its promises.

3. Show me how this solution will actually reduce queries or prompts for my physicians.

Every solution on the market claims to “improve documentation quality.” Very few, if any, prove that they can reduce query volume. Physician leaders should ask:

• Which of these vendors’ clients have demonstrated fewer queries after implementation?
• How many physicians completed the proposed training or education?
• Did performance improve, or at least sustain, subsequent to training?
• If AI tools are prompting diagnoses, how is compliance risk being managed?

If the vendor cannot answer these questions with real client data, physicians are being signed up for more workflow interruption, not less.

4. How will the organization objectively incentivize physicians for participating and improving documentation?

If improved documentation increases organizational revenue and risk adjustment accuracy, the physicians doing the work deserve an objective incentive model. But any incentive tied to query response rates or traditional CDI 1.0 metrics should be rejected immediately. Query response rates, for example, do not reflect improvement in documentation quality.

ClinIntell clients are equipped with objective, physician-level performance metrics that directly reflect documentation severity-documentation quality and improvement, and therefore serve as the only fair way to incentivize physicians.

What ClinIntell Clients Are Achieving And Why It Matters

ClinIntell’s clients have rewritten the playbook:

• Executives gain visibility into true severity documentation opportunity
• Physician leaders receive provider-level insights to guide engagement and strategy
• Documentation practices improve on a clinically meaningful, short list of conditions
• Query volumes decrease, sometimes materially
• Performance metrics rise, without adding queries

This is CDI 2.0, driven not by administrative review, but by clinical behavior change empowered by predictive analytics. No other firm in the industry can provide these insights. And without them, health systems continue to invest heavily in tools and transformations that ultimately increase physician disruption and fail to deliver sustainable improvement.

A Call to Physician Leaders: Your Voice Matters More Than Ever

The industry has changed. The stakes have changed. And physician leaders must change their posture in CDI decision-making. Before approving any documentation-related tool, workflow, or program, physician leaders should demand answers to the fundamental questions above. These questions were unanswerable for decades but with ClinIntell, they finally are. Your physicians deserve an approach that improves outcomes without increasing administrative burden. Your organization deserves clarity on the true opportunity for improvement. And you deserve a seat at the table armed with the insights required to lead instead of follow.