Physician Buy-In and Participation in Clinical Documentation

Premier Pulse     November 2019

By Matthew S. Reeves, DO, MBA, chief of clinical integration, Premier Health

Reeves_HS_350x350Recently, an article* was shared with me demonstrating how poor clinical documentation played a role in the nightmare scenario of a large academic medical center’s closure just two months ago. This is a real case study in our current times with our current payer and regulatory environment. For that reason, I implore you to take note of the lessons learned.

Hahnemann University Hospital closed its doors in September 2019, citing four primary factors putting its long-term viability in jeopardy. Three out of the four factors may not be unique to them. However, it’s the fourth I want to concentrate on here: “the lack of clinical documentation training for physicians that has resulted in a ‘tremendous volume’ of downgrades and denials from insurers.” Hahnemann’s CEO estimated these downgrades and denials resulted in the hospital only being paid for 50 percent of the services provided. Downgrades refer to both Diagnosis Related Groups (DRG) downgrades as well as inpatient admissions being downgraded to observation status.

The CEO didn’t cite a lack of documentation or poor clinical documentation leading to these downgrades and denials. He specifically cited “lack of clinical documentation training for physicians…”

There are two fundamental goals of a CDI program. One is to achieve accuracy through the capture of Comorbid Conditions (CCs) and Major Comorbid Conditions (MCCs) supporting the coding and billing of higher weighted DRGs. The second is to raise the level of quality and completeness of documentation to extend well beyond the reporting of a diagnosis. Premier Health has a mature CDI program that is proficient at the first goal. Our CDI team has a tremendous success rate in capturing the DRG opportunity in the charts they touch. However, that’s the limitation. Our CDI program does not touch every chart. Therefore, the second goal becomes paramount. We can only raise the level of documentation accuracy by training physicians to fully capture the patient story to more closely represent the history of present illness, the physician’s clinical judgment, medical decision making, and clinical rationale for the diagnosis.

I want to draw attention to what Premier Health is doing on your behalf to achieve this second objective of physician education and support. Premier Health has invested in three measures of significant importance over the past year:

  • Premier Health has started a Physician Advisor Program;
  • We have invested in a clinical documentation tool utilizing Artificial Intelligence (Nuance DMA and ENR/CDI) currently being rolled out to our hospitalist division;
  • We’ve converted our CDI platform to a newer product that should allow us to more effectively find and prioritize the documentation with the highest risk (or opportunity) for accurate documentation.

Our CDI team, led by Jeanne Johnson as our system director, and our physician advisors, led by Andrew Maigur, MD, work tirelessly to provide physicians the education, training, and support they need to achieve meaningful improvement in their documentation by communicating the superior patient care that they provide. Together, their teams can and do provide individual reviews of clinical documentation to highlight opportunities. Dr. Maigur’s team of physicians, knowledgeable and adept in clinical documentation, can provide one-on-one education and feedback. Together the CDI and physician advisor teams can provide your physician group/division a subject matter expert to provide group education on an ongoing basis.

I encourage those who can engage with the Nuance documentation tools to do so fully (for now, this is the hospitalists). In the long run, this will provide education as well as improve your documentation for the immediate need. Ultimately, this should save you time, reducing the overall time that it takes to complete documentation.

Premier Health is providing the tools and opportunity to achieve success with the second goal. However, this only works if we have both sides of the interaction at the table and engaged in improvement opportunities. If you are interested in scheduling time with our clinical documentation experts, please feel free to contact Jeanne, Dr. Maigur, or myself. We are honored to serve you.

* When CDI Hit a Speed Bump by Glenn Krauss, August 5, 2019,

Back to the November 2019 issue of Premier Pulse.

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