3 rd Annual Association of Clinical Documentation Improvement Specialists Conference

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

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 – 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