A few physicians remained behind after the conclusion of a CDI training session at an academic medical center. There were some general comments about how much the hospital might benefit economically from improved clinical documentation. But then one of the organization's physician leaders, an orthopedic surgeon, offered the following example of how he makes decisions about which patients need a joint replacement. He said, "It's simple, if my kid's tuition is due, the patient needs a replacement. If I'm leaving on a tropical vacation, then they can get by with conservative treatment."
I was only a few feet away disassembling the presentation equiptment, and I stopped for a moment - shocked at the statement. But, I soon realized that none of the physicians in the group seemed shocked. I also noticed that no one was laughing, so the statement was apparently not said in jest either. It struck me that no matter how much we try to present clinical documentation training in its "pure form", the issue of economics and money, is a constant one. Economics is an underlying theme. While it's not a good idea to focus solely on the economic impact of improved clinical documentation, perhaps it is best to acknowledge it. If the physicians in the audience are sitting there thinking about how the hospital will benefit economically, we're probably better off addressing the issue head on.
During one of the next training sessions that I conducted (not at the same hospital), I related this story to the audience and then followed up with, "Look, we all know that there are differences in reimbursement, sometimes significant differences, based on our choice of treatment and the documentation that describes that treatment. We all also know that it's just not okay to make our choices for patient care based upon the price tag." This introduction served as a good segue into a discussion about clinical documentation needing to reflect all of the clinical evidence in the patient's record. Of course, if left unchecked this introduction can also lead to many other comments from physicians about medical necessity, health plan limitations, certs, and pre-certs, ad infinitum. That alone is evidence of the significant issues that we need to muck through to get to and focus on improving clinical documentation practices. What side-bar conversations are your physicians having after their clinical documentation training session is over?
