Note from the Associate Editorial Director: CDI as physician helpers

By Melissa Varnavas

In this edition of CDI Strategies, readers will find two articles asking for feedback regarding physician engagement activities (one an invitation to share success stories with ACDIS Editor Linnea Archibald and the other to participate in survey about physician engagement). As noted in those articles, physician engagement repeatedly tops the list of CDI challenges.

Why?

“I strongly believe that physicians want to do the right thing,” wrote Kristie Perry, RN, MHSA, CCDS, CCS, a CDI specialist at Erlanger Health System in Chattanooga, Tennessee, in her 2017 CDI Week Q&A. But just like everyone these days, physicians get pulled in 100 different directions and have 1,000 different distractions.

“Physician wellness and the ‘burnout syndrome’ (which does not have an ICD-10-CM code, thus a query is needed) is a current hot topic,” wrote James S. Kennedy, MD, CCS, president of CDIMD, Physician Champions, recently on LinkedIn, referring to a February 11 article from the American Medical Association “Physician burnout: 10 work factors that hinder your well-being.”

Kennedy explained that burnout contributed to his own extended hospitalization and led to him to his current role as consultant. He encouraged others to recognize physicians’ struggles.

“Old folks like me remember when we worked every other night… had both an inpatient and outpatient practice and published our home phone numbers in the telephone book, which patients did call,” he wrote. “Today, [physicians deal with] bureaucratic wrangling with insurance companies, cumbersome electronic record entries and structure, redocumentation of patient conditions in an ICD-10-CM language that differs from the clinical language and increasing competition from physician ‘extenders.’”

In fact, several healthcare organizations in ACDIS’ home state of Massachusetts declared physician burnout a “crisis” after a January Medscape survey showed 44% of physicians meet the criteria for burnout, an October 2018 study showed that 70% are unwilling to recommend the profession to their children or other family members, and a September study in the Journal of the American Medical Association (JAMA) showed that more than 30% of physicians regretted their career choice. (Read more about these studies in the January 24, edition of CDI Strategies.)

CDI professionals see and feel the reality of these statistics every day. Yet, according to a recent ACDIS poll, less than half of the respondents round with physicians.

“I always loved to round but do understand why it is a difficult practice,” writes Laurie L. Prescott, RN, MSN, CCDS, CDIP, CDI Education Director at HCPro, in Middleton, Massachusetts, in response to ACDIS Facebook post. “I think we need to recognize that what works for one provider, will not work for another. We need to be flexible and creative in our approach to provider education. Everyone learns differently, and we need to adapt to the specific situation.”

The trope of frustrated physicians exhaustedly asking CDI specialists to just tell them what they should write used to be an amusing anecdote about their lack of understanding the nuances of documentation and coding requirements. But effective programs need to look past this and approach physicians with so much extra kindness, offer 10,000 reasons for the necessary documentation effort, and devise ever more clever and useful ways to assist them not just with query responses but other challenges, such as cumbersome EHRs, that negatively affect their daily workflow and documentation capabilities.

In her Q&A, Perry recounted an exchange with a typically challenging physician who told her the reason he cooperated with her was because she worked so closely with the clinical staff and tried so hard. “That did not happen overnight. That has come from blood, sweat, and some tears for sure,” she said, adding that “persistence will pay off.”

Persistence and patience for sure, kindness definitely. I’m sure you all have many stories you could share; please send them our way and let’s show the world how CDI helps physicians every day.

Editor’s note: Varnavas is the associate editorial director of ACDIS. Contact her at mvarnavas@acdis.org.