At the Margins

Wondering how to improve documentation? Start with a look in the mirror.

by Ed Hock

I meet with a lot of CFOs in my job, and whenever I bring up clinical documentation improvement, I’ve noticed I get a similar reaction: "If we could just get our physicians to pay more attention,” they say, “our documentation problems would be solved."

It’s natural to want to pass the blame, but it’s far more effective to share responsibility.

I’m not saying these CFOs aren’t right. Documentation improvement should largely focus on physicians. But hospital administrators also play a critical role. Could you unknowingly be a roadblock to your physicians' success?

  • CDI Pulse Check

    We've compiled a 13-point "pulse check" to help you evaluate your documentation efforts. Download it today to assess your program's performance, and learn where you may be selling your physicians short.

Here are the top three ways I’ve seen CFOs stand in the way of documentation improvement efforts. Take a look and see if any of them sound familiar.



1. Not staying on top of performance monitoring

Even with the best intentions, it can be tough to stay on top of your physicians’ documentation. But regular reviews are critical. We’re seeing the best of the best review their metrics monthly—specifically, case mix index, capture rate of complications and comorbidities, and use of unspecified codes.

But a high-level review is not enough. It’s crucial to monitor individual physicians’ documentation performance monthly as well. We’ve found that going a step further and sharing data directly with physicians enables them to make informed adjustments on an ongoing basis.

When it comes to their data, physicians often tell me they feel like they’re playing a game they don’t understand. "I don’t see my data enough," they say. "I don’t understand where it comes from, or why it looks the way it does." It’s important to take the time to explain what you're sharing with the physician, and why.



2. Putting CDI operations on autopilot

Many CFOs I’ve met with me tell me how much they initially invested in their clinical documentation improvement operations. Yet when I ask when they last reevaluated their program, there’s often a long pause.

Don’t set up your CDI program and then forget about it. Ask yourself, are the goals we initially set still relevant, or are they totally out of date? What should our new goals be? Does our current staffing meet those new goals?

Most importantly, think through your current processes and training to ensure that you are proactively preventing poor documentation, not just retroactively correcting it.

I’ve seen the power of this firsthand at Baptist Beaumont, a community hospital in Beaumont, TX. Executives there used one-on-one training to increase physician engagement in documentation improvement. The result? $4.2 million in additional reimbursement in the first seven months after physician training.



3. Failing to thoughtfully prepare for ICD-10

We all know that physician training is essential for the transition. Yet, many CFOs I talk to still haven’t pinpointed which physicians contribute most to their biggest risks. Others know who the culprits are but haven’t identified the new concepts their physicians will need to document for each high-risk code. Mistakes like these can derail your ICD-10 transition.

Most importantly, not everyone takes the time to think through whether or not they’re preparing in a way that physicians will respond to. So put yourself in their shoes. They have hundreds of things going on every day. Ask yourself what’s in it for them, and why. Then be sure to give them the tools they need in as condensed a format as possible.

Motivate Your Physicians

What should you say to engage physicians in documentation improvement? Download our guide to find out how to pick the right motivator for the right physician.

Learn more about the Advisory Board's Physician Documentation Initiative.





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CDI Pulse Check

Resource | Physician Documentation Initiative

We've compiled a 13-point "pulse check" to help you evaluate your documentation efforts. Download it today to assess your program's performance, and learn where you may be selling your physicians short.



More About Improving Physician Documentation

Learn the tactics you need to tailor your message and motivate physicians to improve their documentation efforts. View the infographic »



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