Guest Post: Physician collaboration: Identifying the keys to success?

by Donald A. Butler

Over and over again in CDI Talk, at the ACDIS conference, local chapters, anywhere two CDI professionals have an opportunity to  interact, it seems,  some very common topics arise. One of the most common it seems is how to gain cooperation and collaboration of the medical staff in CDI efforts.

An early ACDIS poll (March 2008) asked: “How have physicians reacted to your CDI program and query requests?” The results showed that only 40% reacted positively and the balance either neutral or negative.

I have yet to find the magic pill (imagine me sitting here singing Jefferson Airplane’s “White Rabbit”) which, once taken, will ensure physician collaboration in CDI efforts. If only one actually existed.

In recent ACDIS post titled “The CDI Evolution,” Juanita B. Seel RN, CCDS, described the organic development of her program. One of the things that really struck me was the apparent shift in response of the medical staff as her program focused more on completeness and accuracy of the medical record and away from financial implications of queries.

This idea— how to improve physician collaboration— has been foremost in my thoughts lately.  At my facility here in North Carolina, we are in the process of recruiting a medical director who will devote 50% of his or her time toward CDI/coding/HIMS and the balance to utilization review and case management, so I’ve been thinking A LOT about how to work effectively with this individual. And I’ve been wondering if ensuring physician collaboration is actually really simple.  Is the key truly as simple as finding the right hook, which is severity of illness / risk of mortality?  But there have been so many other things that have been discussed andtried!

How important are the various avenues employed to deliver information and promote better understanding?

• Newsletters
• Physician group presentations
• Fliers or posters
• Pocket Cards (or small handbooks)
• Individual on-the-floor ’30 second spots’
• The content of the queries, especially if attachments are used
• Web based content / presentations / Q&A
• Case Studies
• Support from:
  • Physician Advisor / Champion
  • Hospital Executives
  • Medical Staff Leadership
• Other??

What are the other things that folks have found to really motivate the medical staff?

• Public profiling data
  • Core Measures
  • Health Grades
• Quality of Medical Care
• Physician E&M billing
  • Support complexity and risks
• Short term, high intensity service line reviews
• I know that some organizations include unanswered queries with the delinquent records
• Other??

This is the single most important challenge that a program MUST overcome to be truly successful. This is one of the most important areas where we can share our success stories, our tools, our unique organizational variations, etc. So, I put it back out to the rest of the CDI community: What has been the single most effective thing that your program has done to engage physicians? AND, what has been the largest barrier for your program to obtaining physician collaboration?

Editor's note: Butler entered the nursing profession in 1993, and served 11 years with the US Navy Nurse Corps in a wide variety of settings and experiences. Since CDI program implementation in 2006, he has (at the time of this article's original release) served as the Clinical Documentation Improvement Manager at Vidant Medical Center (an 860 bed tertiary medical center serving the 29 counties of Eastern North Carolina).