CDI Success Hinges on Understanding Physician Psychology

While the science, research, and surgical techniques that fill physicians’ textbooks have changed, very little about the way physicians are trained psychology has changed since 1908. Physicians are trained to think and act independently—and with the utmost confidence in themselves. Nurses and clinical documentation specialists (CDIS), however, are taught and learn in groups, where collaboration is required for success.

Understanding this difference is crucial to getting physician engagement in clinical documentation improvement (CDI) programs, according to Dr. John Showalter, MD, MSIS, and Leigh Williams, MHIIM, RHIA, CPC, CPHIMS, who presented together Monday at AHIMA’s Clinical Documentation Improvement Summit taking place this week in Washington, DC.

AHIMA's Melanie Endicott introduces CDI Summit speakers Dr. John Showalter and Leigh Williams.

AHIMA’s Melanie Endicott introduces CDI Summit speakers Dr. John Showalter and Leigh Williams.

“I don’t care how trauma surgeons act,” said Showalter, a physician and chief health information officer at the University of Mississippi Medical Center. “If you believe you can make mistakes and be wrong, you can’t sleep at night. Their [surgeons’] thought process is not a normal person’s thought process. Use that to help get them engaged [in CDI].”

CDI professionals are more likely to get engagement with these types of thinkers by providing physicians with data and knowledge. For example, a doctor will be more likely to change their documentation if it’s communicated to them that their case mix index will be more accurately reflected if they document “acute respiratory distress” instead of “shortness of breath,” Showalter explained.

Finding Common Ground

In their multi-year long quest to improve physician engagement with CDI, Showalter and Williams—who once worked with Showalter a UMMC and is now the administrator of business systems at the University of Virginia Health System—conducted extensive research to find out what motivates individuals who work in healthcare. By surveying nurses, physicians, health information management professionals, business office workers, administrators, and other healthcare stakeholders, Showalter and Williams came up with a list of four motivating factors that unified everyone across the spectrum:

  1. Patient care
  2. Patient experience
  3. Financial stability
  4. Reputation

In a sense, the term “patient experience” is something everyone in healthcare is working to improve, and documentation can help this. CDIS’s can tell physicians that they need to improve their documentation so that they have better notes, which keep a patient’s family informed.

When it comes to financial stability, however, CDI professionals are on thin ice with physicians when they start talking about money, Williams noted. Therefore, it’s important to emphasize that the reimbursement landscape is changing, with a focus on pay for performance. If physicians understand that their practices and hospitals could fail if they don’t evolve too, CDI stands a better chance of helping them improve their documentation.

If you want to get a doctor fired up, Showalter said, mention the Centers for Medicare and Medicaid Services emphasis on star ratings—where a provider’s quality is rated on a scale of one to five stars. This, ultimately, speaks to providers’ and physicians’ reputations.

“There is not a doc who wakes up and thinks ‘I’m a one star doc,” Showalter said. But if a CDIS says, “You’re not a one star doctor because you deliver bad care. You’re a one star doctor because your documentation sucks,” physicians understand that, he said.

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