In most healthcare organizations clinical documentation improvement is a growing movement. If it is not it should be. We all have ICD-10 to thank for that. Now we are charged with engaging the doctors to help us help them provide excellent care and correct reimbursement. A few years ago I consulted with a hospital's CDI group with one of the more interesting approaches in gaining physician involvement. During physician in-services the CDI nursing staff donned their best 80's hair band wigs and broke into song. Some might say their approach was a tad unorthodox. But guess what? It worked.
If your singing voice is best left in the shower, here are a few simple yet effective tactics in gaining physician involvement.
Top 10 Ways to Promote Physician Involvement:
1) Make it easy for him / her to respond to queries; Paper or EMR
2) Ask for their input around Query Topics (ATN, Cerebral Edema, Hemiplegia)
3) Recognize / Reward them when they answer a query; positive reinforcement by whatever seems appropriate in your environment;( mostly I’ve seen candy, personal notes, gold stars…bribery work wonders!)
4) Ask to present a case study to the M&M Committee; highlight how CDI can affect the outcome of a case.
Example: Start with MS DRG 66, patient expires shortly after admission. A great way to illustrate that coders can’t code from CT / MRI reports. Typically these patients have cerebral edema / herniation as the mechanism of death, CDI can facilitate a query (concurrently or retrospectively) so that the physician has the opportunity to include the diagnosis.
Contrast: DRG 66 w/o MCC or CC with a Risk of Mortality of 0.4% or DRG 64 w/ MCC with a Risk of Mortality of 24%
5) Always speak, query, or demonstrate in terms of SOI and ROM; not reimbursement.
6) When you hear complaints or “I don’t have the time” ask “how can I make it easier for you Dr.” ?
Example: “ Top admitters” are busy, may be swamped. Consider accommodating them by collecting their queries, sitting down with them in a convenient location. (See #10)
7) Invite a physician(s) to your monthly CDI meeting, ask for their expertise with a difficult case (See # 10)
8) Use the Physician Lounge as a convenient place to educate and inform, but be respectful that it’s their “sanctuary” from patients, families, hospital staff, conflicts and sadness.
9) Start a Lunch and Learn type meeting.
Example: This month “Neuro” is the focus. Arrange a Neurologist, Internal Medicine, or Hospitalist to give a short presentation about CVA vs. TIA. Then the CDI team presents coding and documentation challenges of CVA vs. TIA. (Ensure the physician speaker stays for the CDI part)
10) ALWAYS SERVE FOOD
TERESA ENGEL, RN, CCS, CDIP, ICD-10 CM/PCS Trainer
Director, CDI Services
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