A big part of knowing how to work with physicians is knowing how to get their attention, understanding their skepticism, and overcoming it. That message was the focus of opening sessions on Sunday morning at AHIMA’s two-day CDI Summit: Advancing the Documentation Journey, continuing through today in Chicago.
Keynote speaker Rae Godsey, DO, MBA, CPC, associate vice president, corporate medical director, Humana, said that physicians would start to document more effectively once they realize why it’s so important to do so. In her presentation, “The Importance of Accurate Documentation and Coding—A Physician’s Perspective,” Godsey explained that doctors are taught only the basics about coding and documentation in medical school.
What Physicians Understand, What They Often Don’t
From her experience working in family medicine, before working at Humana, doctors know that when rounding on patients they need to be payer agnostic. Also, they know the Centers for Medicare and Medicaid Services (CMS) collects all the data from these patient encounters, but they don’t know why.
Of course, clinical documentation improvement (CDI) specialists and coders know that risk scores are calculated based on this data and that CMS uses it to pinpoint healthy and unhealthy patient populations across the country.
“I was embarrassed when I went to Humana and found out how much doctors don’t know. It [the coding and documentation] was more to capture risk and severity, and I didn’t know that … I didn’t know that all the documentation I was submitting was being looked at” by payers, coders, and CDI specialists, Godsey said.
Payment reforms, starting with the Balanced Budget Act of 1997 and the Affordable Care Act—parts of which are still being implemented—have made it more important than ever that physicians understand how their patients’ risk scores are being calculated, since those scores have a direct impact on reimbursement.
“If you can prove to us that this brings value to our patients, we are in,” Godsey said.
For example, before the payment reforms, if a patient who had undergone a total joint replacement called their orthopedic surgeon with a fever and an oozing infection, the patient would’ve been sent directly to the ER, Godsey said.
Now, with bundled payment models for joint replacements, doctors know it’s better for the patient and for subsequent reimbursement if the patient comes into the office for evaluation by a care team that can coordinate acute and ongoing care. This strategy can help patients avoid complications and keep them from being readmitted to the hospital.
From Annoyance to Appreciation
Godsey also aired some frustrations with ICD-10 physicians have expressed.
“One physician threw his pen on the floor,” Godsey told the Summit audience, “and said, ‘There are so many codes for COPD that I want to just choose a code for ‘cough.’”
But, choosing the most accurate code and documenting the condition to the highest level of specificity should result in a more accurate risk adjustment and better reimbursement, as CDI specialists and coding professionals know.
“When physicians do sit down for lunch-and-learn sessions with CDI specialists, they’ll be surprised at how much they’re missing,” Godsey said.