3 rd Annual Association of Clinical Documentation Improvement

3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

CDI: Role of the physician champion Richard S. Eisenstaedt, MD, FACP

Role of the physician champion • Objectives – Identify an appropriate physician champion – Educate and train the physician champion – Utilize the insight and expertise of the physician champion • In securing institutional support for the program • In securing physician support for the program • In designing and implementing programs to educate physicians • In setting realistic goals • In designing efficient outcomes measures – Identify, develop, and implement plans for process improvement

Identifying a physician champion • Negotiate expectations – Champion the program – Coordinate program development – Efficient data review – Follow-up response • Identify incentives • Acknowledge barriers

Provide outstanding support • • • Executive leadership Consultant Operations leadership CDI professional staff Administrative support

Six criteria of a physician champion #1. Credibility with the medical staff – Pre-existing leadership role – Active clinical practice – “Good doc” reputation – ? ? employed versus private practice

Six criteria of a physician champion (cont. ) #2. Credibility with hospital administration – Knowledge of and active support for institutional goals – Flexibility – Team player

Six criteria of a physician champion (cont. ) #3. Generic insight about clinical documentation and regulatory oversight – Acknowledges the perverse economics of healthcare – When dealing with arcane regulations • More apt to be amused and fascinated • Less apt to be confused and frustrated

Six criteria of a physician champion (cont. ) #4. Interest in taking on a new initiative #5. Well-developed communication and negotiation skills #6. Thick skin

Negotiating expectations • Time commitment – One time for training – Ongoing • Delineation of – Cheerleading versus – Advising versus – Operational responsibilities (minimize) • Define available resources

Negotiating expectations (cont. ) • Design plans for program implementation – Big picture: PR/marketing – Medical staff education/training • Participate in program evaluation • Develop opportunities to improve performance • Set realistic limits

Negotiating expectations (cont. ) • Identify co-champions – Surgery specialties – Residency program directors – Chief residents – Employed physician network medical director

Identify incentives • Capture entitled revenue based on more precise documentation of care provided • More accurate outcome assessment based on more precise documentation of comorbid conditions • Direct link to safety initiatives that save lives • Tolerable “hassle factor” for the medical staff

Acknowledge barriers • Time commitment • Altered perception within the organization – More corporate, less independent – More administrative, less clinical • Conflicts • Link to a potentially unsuccessful program

Coordinate program development • Organizational marketing: big picture rather than details • Medical staff, resident education – Strategic value: • Financial • Outcome assessment • Safety – Programmatic details

Education and training • Use consultants with a track record of success • Tailor education/training template to meet needs of – House staff – Medical staff – Administrative support staff – Senior hospital administration

Coordinate program development • Anticipate pushback – “This is ridiculous. ” – “What’s in it for me? ” – “Do you really expect me to document complications that impugn my surgical/procedural skills? ” – “What more are they going to expect from me? ” – “Who’s taking care of the patient, me or you? ” – “Who’s going to jail when they find out about this program? ”

Efficient program evaluation • Determine who gets what data how frequently • Capture trends • Ensure reliability

Follow-up response • High priority: immediate MD champion action – Abusive or unprofessional physician behavior • Next priority: ASAP MD champion response – Delayed physician response, despite reminder, for documentation gap with significant financial impact • Routine priority: everything else

Process improvement • Problem: physician response rate lags – Review data at advisory committee meeting: COO, CFO, COS, MD network director – Target hospital-owned practices • Large # of queries • Efficient communication opportunities • Aligned incentives – Create monthly bar graph comparing practice performance – Distribute data at network leadership meeting – Reiterate rationale, goals; discuss barriers – Designate CDI MD champion within each practice that fails to meet target