Guest Post: Building successful relationships with physicians

by Sue Egan, CPC, CCDS

Let’s face it, working with providers isn’t always a positive experience.

It can be tough providing them education or getting responses from queries. Busy providers typically don’t want anything to do with coding. When they hear anything about coding or documentation they often think it means more work on their part.

Luckily, I’ve had essentially a positive working relationship with my physicians over the years so coders and CDI professionals often ask: “What is your secret for getting along so well with doctors and engaging them to change behavior?”

Trust me, although it may be difficult, building a relationship with your providers can make both of your lives easier. Here are a few ideas that could help:

• Clarity supports both physician and facility reimbursement: Let physicians know that if the hospital is asking for documentation, it will better support their billed services as well. Complete and accurate documentation will hold up to increased scrutiny by payers.
• Demonstrate why: When you ask a physician to change the way he or she documents in the medical record, show them why that change matters. Show how accurate and complete documentation enables appropriate risk adjustments for the patients a physician treats. Remind physicians that good documentation can prove that the patients he or she treats really are sicker than others. This approach is more effective than stating the hospital will get a higher paid DRG.
• Pick your battles: Knowing when to step away will help you keep a positive relationship with a provider.
• Pick your timing: Regardless of how important your particular documentation improvement point may be, if the provider’s patient just passed away (or they’re having a bad day or any other difficulty), now is not the time to share—they won’t remember what you tell them. Let the provider know you recognize the situation and will reschedule a more appropriate time to discuss.
• Be available: That more appropriate time may not always be more appropriate for you but be as flexible as possible in your availability for one-on-one education. This could mean coming in early to meet with a physician before his or her first case in the morning or it could mean giving up a lunch period. Recognizing the physician’s workload demands and being flexible will yield many benefits to the relationship.
• Be prepared: Physicians will ask you a question once, maybe twice, where you can say, “I don’t know,” but chances are they won’t ask a third time. Be creative in your response. Instead, try saying, “You know, I just read something about that, let me go back and make sure I am giving you the most updated information,” or “I just saw something on this, I am not sure if it was CMS or carrier directed. Let me find it and get back with you.” Once you lose a physician’s trust, it is very difficult to regain it.
• Don’t waste their time: One of the biggest complaints relates to queries providers deem as a waste of time. Make sure the query is:
  
  • Addressed to the right physician/provider
  • Based on accurate information
  • Relevant to the patient care being provided
• Walk in their shoes for a day: Offer to round with them. There you can provide real-time documentation advice and education to the provider. See how busy their days really are. In most cases, you will be amazed at how much they get done.
• Be a better listener: Providers often express frustration about coding and documentation guidelines which seem clinically incongruent or insignificant (e.g., family history for the 85-year-old patient). Sometimes a provider may just need to vent this frustration and you might just be the kind ear even if you may not have a resolution to offer. Listening and understanding go a long way in building rapport.
• Ask questions: Ask your provider how they translate a patient visit into medical record documentation. Questions that might solicit opportunities for improved documentation may include:
  
  • What questions are they asking when interviewing the patient?
  • What concerns do they have?
  • What is the patient experiencing? Use this information to point out how the documented note can better demonstrate the patient’s current condition and treatment plan.
• Share the good as well as the bad: When a physician is doing a really great job documenting timely, accurately, and completely, give them a shout out. Or, when they answer queries in a timely manner that helps your CDI team, let them know. A quick note with a smiley face or even a gold star will be very much appreciated. Positive recognition given to one physician often results in other physicians inquiring how he or she can get recognition.
• Sports and (other interests): Engage physicians in discussions other than how they can help you or what additional elements may be needed in their documentation. Relationship building can be accelerated when you engage physicians in areas of personal interest. Gaining an understanding of a physician’s college coach, conference, and team standing, and discussing this information with a physician can go a long way to building a relationship. But sports aren’t the be-all, end-all. If you know a doctor has a particular interest (e.g., cooking, piano, horror movies, or painting), learning a little about that interest can go a long way. Expanding your knowledge is a good thing, and building your relationship with that provider is a great thing.
• Empathy: Remember physicians are busy with competing priorities. Providers often get interrupted while they are dictating and/or documenting their notes, and when they leave something out of their notes, it is not intentional.

One of our principal responsibilities is to make the physician’s job easier while ensuring that their data as accurate as possible.

Avoid approaches that make them feel like they have done something wrong. Let providers know your job is to make them look as though the care they provide is as good on paper as it is for their patients.

Editor’s Note: Egan is an associate director with Navigant Consulting and has been working with providers of all specialties for more than 25 years. This article originally appeared on Revenue Cycle Advisor. Opinions expressed are that of the author and do not represent HCPro or ACDIS. Contact her at sue.egan@navigant.com.