Q&A: Provider engagement

As part of the fourteenth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Maria Gracia (Gigi) Donohue, BSN, RN, CCDS, regional manager of clinical documentation excellence at South County Health in Florida, answered these questions. Donohue is a member of the ACDIS Furthering Education Committee and the ACDIS Florida local chapter. Though CDI Week 2024 has now past (September 16-20), ACDIS wanted to continue highlighting additional expert advice from our committee over the next few weeks. For questions about the committee or the Q&A, contact ACDIS Editor Jess Fluegel (jess.fluegel@hcpro.com).

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

• Our providers are very engaged with CDI. I provide educational sessions for them, and I am a part of the new provider orientation. They have an understanding of the CDI program’s goals.  We meet with our physician advisor on a regular basis to give him feedback, including “physician scorecards” we present to him, since he is the medical director for the hospitalist group.

Q: After years of little change, the percentage of respondents who reported their medical staff as “highly engaged” saw a notable increase from 13.45% to 16.76%, according to CDI Week Industry Survey data. Have you seen this at your own organization in the past year? What advice do you have to help CDI professionals move the needle and join this trend of increased engagement?

A: Yes, I’ve seen this. Since I joined this organization and started the CDI program in September last year, our provider response rate is in the mid to upper 90% range. Our agree rate averages in the mid to upper 80% range. 

My advice to CDI professionals is first to develop a relationship with their providers. Ongoing rounds to be visible to your providers are extremely important. Education about CDI is also very important. You need to be able to understand and relate to the fact they have a very busy schedule and have to see many patients. 

Q: When asked how frequently they conduct physician education sessions, 30.05% of respondents reported monthly and 26.86% reported quarterly, though 26.86% said they do so “as needed.” How often does your CDI program conduct such sessions, and what advice do you have to make the most of these educational opportunities? If your program conducts them as needed, how is that usually determined?

A: As the manager, I do the educational sessions quarterly and also as needed if our medical directors request an educational session. In those sessions, I use the records of patients that have been cared for in our hospital as case studies.

Q: Each year, we hear that provider engagement is a top concern or problem area for CDI programs. Why do you think CDI programs have such trouble in general engaging the medical staff? What have been your biggest challenges with gaining provider engagement? What have you done to address and improve this?

A: As I mentioned previously, developing relationships with providers is extremely important. CDI professionals have to listen to their frustrations and understand that they are often working very long hours. Do verbal education with the providers if they have a question regarding a query. This also helps develop trust. I tell my team to be patient with them, even if a provider is not responsive. When I do my education sessions, I never talk about reimbursement; I only talk about how they can impact severity of illness, length of stay, and risk of mortality of their patients through their documentation. I explain to them that specificity of documentation increases their mortality score, Healthgrades scores, and hospital scores. 

Q: According to the survey results, about 61% of respondents have a full-time or part-time physician advisor, a small decrease from about 64% in 2023. Just 9.0% plan to engage one in the near future, while 15.16% have no plans (an increase from 12.75% in 2023). Why do you think fewer CDI programs of late might have a physician advisor or plans to engage one? Do you feel a physician advisor or champion is beneficial to CDI? Why or why not?

A: Physician advisors are very important to a CDI program because they can speak to the providers and help them understand the goals of CDI. They are the support for CDI. They can educate the providers as well and give input on issues where CDI and coding may approach clinical situations from different perspectives.

Q: When asked how they measure the effectiveness of their CDI provider education program, the most common measurement selected was improvement in CDI metrics (77.79%), followed by feedback from providers (52.26%) and reduction in documentation errors (34.84%). How does your organization measure its CDI provider education? What advice do you have to help CDI programs better track their success in this area?

A: Our health system determines the effectiveness of CDI provider education by measuring the query response rate and agree rate. I developed a benchmark for a response rate of at least 95% and an agreement rate of at least 85%. With the help of our physician advisor, provider scorecards are made based on this data.

My advice is to develop a system of measuring the response rate and agree rate monthly. Use CDI metrics that will include each individual CDI professional’s response rate and agree rate. Identify types of responses outside of “agree” and “disagree” (e.g., “noncodable response,” “other codable response”). Also, do an audit of CDI queries to determine if there is a CDI issue or a provider issue, so it can be appropriately addressed.

Q: Do you provide formal education to your providers, and if so, how (i.e., one-on-one, group presentations by service line, informal coaching, tip sheets, newsletters, etc.)? How is education content decided (i.e., based on hospital standards, individual provider needs, etc.)? How have your provider education/engagement models changed over the last few years?

A: Yes, we do provide formal education. Education is provided during provider orientation, quarterly, and as needed per any medical director’s request for a specific service line. Because I started the CDI program September of last year for our health system, I have discussed with my revenue cycle director, CFO, CMO, and our physician advisor about the importance of also doing a routine educational session for each service line in the future, as I have done this in all previous health organizations I worked for. We are also developing tip sheets that our providers can use. If a provider has a question regarding a query, I make myself available to them via phone call or email and do a one-on-one educational session.