Q&A: The Role of the Physician Advisor in CDI

 Editor’s Note: As part of the fifth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Zachary Fainman, MD, co-medical director and physician advisor of care management at Advocate Luther an General Hospital in Park Ridge, Illinois, offered his insight into the role of the physician advisor in CDI. Fainman provides oversight over care management, social work, utilization management, government audit and CDI, a position he has held since 2011. Fainman is also the founder of the physician advisor committee at Advocate System. Contact him at zachary.fainman@advocatehealth.com. Rebecca Hernandez, RN, BSN, CDI program supervisor works with and educates CDI specialists, nurses, physicians, and other healthcare practitioners to ensure accuracy and timely clinical documentation in the medical record. Contact her at rebecca-l.hernandez@advocatehealth.com.

Q: Can you describe your role as a physician advisor to CDI?

A: As physician advisor to CDI, I act as an interface with physicians and CDI specialists. I also give my input on issues where CDI and coding may approach clinical situations from different perspectives.

I work hand in hand with Rebecca Hernandez, our CDI supervisor, in reviewing CDI department and physician metrics, and troubleshooting physician/CDI dynamics. In addition, Rebecca and I provide individualized physician education using their real time clinical cases and translating the case into quality data metrics to explain why CDI is critical to their practices as well as to the institution.

Q: Can you describe the engagement and collaboration of your medical staff in CDI?

A: The issues of trust, respect, and credibility are paramount in achieving engagement and collaboration.  My 20-plus years of clinical experience, as well as my knowledge of regulatory requirements from both governmental and private payors, has been helpful in gaining credibility.

Rebecca’s experience as a critical care nurse, as well as her exposure to multiple healthcare systems as a travel nurse, has gained her respect along with credibility. Thanks to the hard work of our CDI specialists, coders, and leadership, I believe our medical staff is extremely well engaged and collaborative.

Q: What has been your most successful approach for obtaining physician buy-in?

A: I sincerely believe our most successful approach has been individualized and data-driven education.  Rebecca, in collaboration with our medical directors and coding manager, has put together succinct straightforward clinical case studies which provide a clear and relevant picture of how CDI impacts not only revenue, but quality metrics as well.

As in any CDI program, one of the challenges is to get the physician to attend an educational meeting to gain buy-in. One way we get physicians to attend is by respecting their time constraints. So, we remain flexible with our meeting times and venues. Once we get the physicians to attend, they are grateful for the explanation and will actually seek out CDI specialists for their input.

Q: Does your medical executive committee have an escalation policy or other policy requiring physicians to respond to queries/CDI clarification in a set time?  Can you describe its effectiveness?

A: Yes, queries are expected to be answered within 24 hours. If not, the physician receives follow up communication (method of their choosing) from CDI specialists. If there is still no response, within an additional 24 hours, the physician advisor will contact physician and he is unable to obtain response, will escalate the situation to the chief medical officer. So far, this process has been very effective. With a medical staff of about 1,400 physicians, only a few have been escalated to the chief medical officer level.

Q:  What are your biggest challenges with getting physician buy-in?

A: Again, trust is a big issue. At first, physicians believe only the institution will benefit from CDI by realizing an increase in revenue. Once the CDI/physician advisor staff establishes credibility with the medical staff, this issue is abated.

Fear of litigation or government audit is also a barrier. Once the physician is convinced that accurate documentation may in fact positively impact these issues, these barriers are also mitigated. Physicians must be shown that staff and leadership of the institution really do care about them and demonstrating that CDI can aid in presenting an accurate picture of physician performance is one way to prove this.

Q: What do you think the role of the CDI physician advisor is/should be in terms of program advancement and analysis?

A: This again is a dual role between physician advisor and CDI leadership. Data must be available as to the impact on metrics such as length of stay, risk of mortality, severity of illness, case mix index, and complications among other measures. Also, this is a continuous process and does not involve a “one time” meeting. The accuracy of the data is crucial, if not accurate, credibility is at risk.