One of the biggest challenges in getting a clinical documentation improvement program off the ground is getting engagement with—and the attention of—physicians. Multiple speakers in the afternoon sessions of AHIMA’s CDI Summit, in Alexandria, VA, addressed this obstacle and how they’ve overcome it.
Sandy Ellis, RHIT, BS, of Michigan’s Oakwood Healthcare, said that CDI efforts in her organization had been focused on ICD-10 until the most recent delay, but then it switched to improving documentation in general. Oakwood then brought in a consulting company that specializes in CDI and physician engagement. That company conducted a database analysis to identify which physician groups and specialties would be most impacted by training sessions.
One of the best methods Oakwood deployed to ease tensions between physicians and CDI specialists, all of whom are RNs, was sending CDI specialists on rounds with physicians.
“When we sit down and the doc is documenting more, we can do a real-time verbal query. That really is key to the program,” said Jeanette Lyons, RN, BGS, CDI supervisor at Oakwood.
Ellis said that their ultimate goal is to reduce necessity to query. Once docs met with CDI staff, they just got it. They understood how to document from the beginning.
“We don’t want to bother them—we want the documentation that truly demonstrates severity of a case. When we’re able to meet individually, they understand our knowledgebase and skill set…some of the light bulbs went off with that,” Ellis said.
Now, physicians that were CDI’s loudest critics number among their biggest boosters, according to Ellis.
“Our most vocal detractors are the ones that really flipped their performance. They’re the biggest promoters and reaching out to other physicians,” Ellis said.
ICD-10 Teamwork: CDI, Coding, and the Provider
A year and a half ago, CDI and HIM team members at Pennsylvania’s Reading Health System decided to start talking to providers in the systems ambulatory sites to determine how prepared they were for ICD-10. To do this they did an ambulatory audit to identify high risk behaviors, high-volume areas, and departments where they could get the most bang for their buck.
They then developed an elbow-to-elbow method of training physicians—sitting down with them while they documented a patient encounter to give feedback and suggestions in real time.
“One on one works best—it allows us to develop a rapport with a provider,” said Susan Simonson, RHIA, CCS, of Reading.
Once ICD-10 was delayed, Reading took ICD-9 and ICD-10 “off the table” completely and instead focused just on improving documentation.
The team used a variety of techniques for doing this. They created “tip cards galore,” hosting department and specialty group meetings, creating an Intranet site full of common coding scenarios and tips, and they publish regular newsletters that are sent out to physicians.
The organization also reorganized their structure so that coders and CDI specialists all report up to HIM. This allowed them to pair up each CDI specialist with a coder. Even though coders work on- and off-site, they’ve found that these partnerships increase collaboration and help raise coders’ profiles among physicians.
The Reading team also found that appealing to physicians’ competitive nature helped incentivize better documentation.
“Physicias love metrics,” said Lori LaFaver, BSN, RN, CCDS. “Whatever concepts we’re teaching them, that’s what we’re auditing. The more you audit them and show them the results, the more they push themselves.”