It is important to position the CDI function in a way that the physicians view the services offered by the clinical documentation staff as a value-added service for them. Use the following six activities as a way to develop a better understanding of how the CDI function can better serve physicians.
1. Obtain feedback from physicians
The best way to find out how you can better serve a customer is to ask. And, physicians are a customer of the clinical documentation function. They also serve as a provider of raw material in the clinical documentation supply chain. But, if you think about them as customers, it will help to develop the right approach to the ongoing relationship between CDI staff and the medical staff. Ask physicians for feedback : verbally; with web-based surveys; and through service chiefs. Ask the physicians what they do and do not like about the CDI function. Ask what you can do to facilitate the process for them. Ask how you can be of better service to them in helping to improve their documentation skills overall.
2. Listen and observe physicians
When you ask, it is important to listen. You may find that you can obtain a significant amount of information from physicians by simply listening. Listen to the physicians talk at training functions, during staff meetings, and on the units. Physicians are often quite verbal about what is bothering them. The CDI function is not designed to be a panacea for all physician problems with the hospital. However, if you learn about a physician issue and you can determine how CDI training or support can help, you should act on it. For example, you may have heard a physician mention a problem with the rejection of office bills by a certain payer. The bills are being rejected for medical necessity issues and neither the physician nor the office staff have been able to manage the situation effectively. While you cannot offer your services to analyze the problem and fix the problem for the physician, you can suggest and offer education a training that would benefit both the physician’s practice and the hospital. There may even be some tool that you have or can develop that you can provide to the physician as a takeaway during the training.
3. Demonstrate how the health record is your common ground
The health record is the common ground between the medical staff and the hospital. The medical staff needs the record to treat the patient and communicate with other caregivers. The hospital needs the record to translate its contents into coded data for billing, quality indicators, research, and planning. Telling physicians this will not make them see their responsibility in clinical documentation any differently. However, taking the opportunity to interject the health record topic into physician encounters such as mortality reviews, department meetings, grand rounds, training programs can help get the message across. Using the health record as a tool to accomplish activities in the hospital will likely encourage the physicians to begin to incorporate the same activities in their day–to-day activities. As the EHR becomes more prevalent, this concept will grow in popularity with physicians. Since many physicians are enamored with technology, pulling together the CDI opportunity with the EHR may increase their curiosities.
4. Provide web-based training and web-based resources
Web-based training provides physicians with a great convenience. Web-based training provides advantages for all staff, not just physicians. Increased productivity, less cost, and greater compliance justify the initial investment (Chung et al., 2004). For organizations that already provide web-based training, ask physicians for feedback about their experience with the tool. And, if you can improve the tool to increase physician satisfaction, you should. You can also develop a web-based resource for physicians that provides them and their office staffs with information about billing issues that are related to clinical documentation practices. If your organization owns physician practices, chances are you already have these resources for use by the billing staff. Making this type of resource available to physicians could be one more way to see the importance of clinical documentation, especially for billing purposes.
5. Create co-development opportunities
Some hospital CDI staff members have begun to partner with their physicians to present the success of their CDI program at local, state, and even national association meetings. This type of co-development opportunity can be used to build improved relationships with physicians using the CDI program as a common ground. You can also work with your physicians to design research projects (or even pilots to expand the CDI program) or write papers for publication in academic journals. Physicians, especially those in academic medical centers, have a great interest in having their work published. Any of these activities would bring benefit to both the physician and the organization. The fact that CDI is used as the basis of the activity is likely to make physicians more responsible and accountable for their documentation practices.
6. Establish a clinical documentation advisory board (and pay for their time)
This may be a long stretch for many organizations. But if you think about the minimal cost to an organization for paying a physician to serve on a board for clinical documentation planning, the benefits far outweigh the expenses. If your organization has an interest in this type of venture, you will need to be explicit about the responsibilities of the physician advisors. The advisory board cannot be like every other committee that physicians may serve on in your hospital, since they are not paid for those activities. The physicians would have additional responsibilities. Perhaps you can train them to be peer reviewers or trainers for physician CDI training. If you limit the advisory board member service time to six months or a year, not only would it potentially appeal more to the members, it would also give your organization the opportunity to intensively train several physicians a year in CDI principles. With the right planning, the right physician participants, and the right process the results could prove to be mutually beneficial to the organization and to the physicians. You should consult your compliance officer for specific guidance on how to create the advisory board and work with physicians compliantly. There are certain Medicare anti-trust laws that prohibit hospitals from giving physicians anything of value that would appear to be an inducement to the physician for admitting patients to the hospital. However, if the hospital is paying the physicians fair market value for actual work performed outside of normal hospital duties, this should not be a problem. The activity should be overseen by your compliance team or your general counsel’s office.
