Are Academic Medical Centers Better Performers In Clinical Documentation?

  • Dr. Terrance Govender
  • August 07 2017

The inner workings of a successful clinical documentation initiative will depend on many factors, including leadership, physician engagement, internal culture, technology, and clinical documentation specialist competency (just to name a few). Many Academic Medical Centers (AMCs) have branding that associates them with clinical excellence, prestige, and innovation. One might assume that along with many other things, they excel when it comes to accurate, complete and precise clinical documentation.

I thought that we should take a closer look at the data to see if that is, in fact, true. Based on 2015 CMS data and ClinIntell’s unique capability to identify severity documentation opportunities from a patient mix analysis, it appears that the entire industry still has some work to do:

2015 CMS CMI Expected CMI CMI Gap
Academic Medical Centers (U.S.) 2.06 2.20 0.14 (6.8%)
Entire Industry (Non-AMCs) 1.71 1.83 0.12 (7.0%)

The above table represents the reported CMI for their respective Medicare populations of AMCs across the U.S. compared to the rest of the industry. It also provides us with the expected CMI based on their unique patient mix analysis. By focusing on the gap and not CMI alone, a valid comparison can be made.

As you can see, the gap is 0.02 higher for AMCs when compared to the rest of the short-term acute care hospitals across the country. However, on a percentage basis, the AMC gap is slightly lower. So overall, the quality of documentation is similar between the groups and there is no evidence that AMCs are generating higher quality clinical documentation.

Within the AMC group, it appears that AMCs in the Pacific Region are the poorest performers when it comes to reporting severity, with a substantial CMI gap difference of 0.06 between all AMCs and AMCs within the Pacific Region:

2015 CMS CMI Expected CMI CMI Gap
AMCs Pacific Region 2.34 2.54 0.20 (8.5%)
AMCs Industry 2.06 2.20 0.14 (6.8%)

Let’s be curious and find out which AMC is the worst performer within Pacific Region group (you may be surprised…):

2015 CMS CMI Expected CMI CMI Gap
Stanford Hospital and Clinics 2.42 2.67 0.25 (10.3%)
Entire Industry (Non-AMCs) 1.71 1.83 0.12 (7.0%)

Now, when I mention Stanford, chances are very high that you don’t, by default, associate them with being poor performers in much, let alone clinical documentation. Stanford has a CMI gap that is about double the non-AMC average. However, as the acuity of Stanford’s patient mix is higher on a percentage basis, the gap is not as different, but still significant:

2015 CMS CMI Expected CMI CMI Gap
Stanford Hospital and Clinics 2.42 2.67 0.25 (10.3%)
Entire Industry (Non-AMCs) 1.71 1.83 0.12 (7.0%)

As surprised as you may be by Stanford Hospital and Clinics being the worst performer in the Pacific Region when reporting patient severity via accurate clinical documentation, they are by no means the worst performing AMC in the country (e.g., Hospital of the University of Pennsylvania has a CMI gap of 0.26). So, even though a leading institution may provide excellent clinical care, it does not necessarily mean they also generate excellent documentation.

If you work at an AMC, I’m sure you know, firsthand, the daily challenges that you face in your efforts to achieve optimal documentation of patient severity of your patient mix. I have my own theories based on my own experiences – they range from physician egos, to poor leadership, to large numbers of residents contributing to the chart.

The data suggests that despite the additional complexity that often exists at AMCs, on a percentage basis, on average, their documentation quality is similar to the rest of the industry.

“I had been an academic all my life. As academics, you tend to believe the smartest people are in academia.”

-Sebastian Thrun


Dr. Terrance Govender
VP of Medical Affairs, ClinIntell, Inc.