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The role of a physician advisor in clinical documentation improvement

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The role of the physician advisor in clinical documentation improvement programs has increased greatly in recent years. This can be a great opportunity for medical professionals who enjoy teaching and want a break or a change from traditional clinical medicine. For those who like the challenge of learning the ins and outs of billing and coding requirements and don’t mind spending time keeping up with CMS regulations like the 2-midnight rule, the world of clinical documentation may feel like a bit of candy shop.

There’s a gap between the work of physicians and coders

Hospital systems implement clinical documentation improvement, or CDI, programs to bridge a gap between clinicians’ notes and medical coders. Physicians and other clinical staff document based on their clinical findings and assessments, which doesn’t always translate very well to the actual medical codes (such as ICD-10) that can be used to bill for their services and the resources used by the hospital in caring for an inpatient.

Similarly, coders don’t typically don’t have a clinical background that allows them to fully interpret medical documentation. Moreover, they are very restricted in which aspects of the medical chart they are allowed to use for assigning codes, and they aren’t permitted to code for a diagnosis that isn’t clearly documented in its entirety.

An example of poor documentation. This is what coders are up against.

CDI is more than hospital reimbursement

What results from this is:

  1. Hospital reimbursement that is less that what it could be for the extent of services provided to a patient.
  2. Data that don’t accurately reflect the medical risk of the patients being treated or how severely ill they really are.

The missed reimbursement can be substantial, such as at this Florida hospital, which benefited from their CDI program to the tune of $72.5 million over the course of <2 years.

Also, the skewed data will show up in publicly available databases like Hospital Compare and Physician Compare where it will reflect poorly on both the organization and individual clinicians.

A CDI program, in a nutshell

CDI programs can be developed and implemented by a single hospital system (a “home-grown” program). Alternatively, an outside organization that specializes in CDI can be brought in to put the program into place. A few of the bigger players in this space are:

A CDI program assists physicians in documenting complete and specific diagnoses in their charts, and helps coders by ensuring that the necessary and most appropriate documentation is available by the time a chart is ready to be coded. A typical program has several components to carry this out:

  • CDI specialists (usually nurses with coding training or experience) to review records and communicate with practitioners
  • A computer program that uses natural language processing or other tools to help in identifying diagnoses and potential areas to add specificity to the documentation
  • Policies on various aspects, such as when and how CDI specialists can query physicians about their documentation
  • Ideally, a culture of staff who are engaged and understand the importance of good documentation and accurate coding
  • And… the focus of this article, physician leaders

Where the physician advisor comes in

Since most codes can only be assigned from treating clinician documentation, the buy-in from physicians and other practitioners is a huge part of what makes a CDI program successful. Most hospitals have some version of a physician champion as the program gets underway, which might be the CMO at smaller hospitals. Some dedicate an ongoing position (or part of a FTE) to a medical director to ensure success of the program from a clinical standpoint.

The third-party organizations that sell CDI services and implement CDI programs often hire physicians to assist with the process. These individuals are usually called physician advisors, but can also have the title of physician consultant, physician trainer, and others.

I can’t say with certainty whether all of the companies listed above hire physicians on a regular basis for this role. Each organization has their own practices in terms of hiring physicians as employees or contractors, full-time or part-time, etc. But there are some generalizations I’ll make about what their job typically entails.

As a physician advisor, you can expect different responsibilities depending on the phase of a hospital’s CDI program. During the planning phase or before the client hospital begins with a formal CDI program, a physician advisor is likely to:

  • Review coded charts to identify areas for improvement in documentation or assignment of codes
  • Meet with hospital administration and physician leaders to discuss strategy and plans
  • Work with CDI specialists to develop processes for querying and communicating with providers

During CDI program implementation:

  • Meet with physician groups to discuss the program and its benefits
  • Educate providers on accurate documentation for their specialty and how to respond to queries form the CDI specialist
  • Advise CDI specialists on clinical questions that arise

Some physician advisors continue to have involvement after implementation:

  • Continue to liaise between CDI specialists, coders, and clinicians
  • Monitor for trends and educate providers in areas that can be improved
  • Work with CDI specialists to interpret and implement changes to coding rules

The best and the worst of physician advisor jobs

Being a physician advisor can be a really rewarding position for the right person. In terms of compensation, for many physicians (especially specialists), this won’t compare to what you can make in clinical practice. It might, however, eliminate some of the frustrations that you have with full-time clinical work while still allowing you to spend time in a hospital setting. As a physician advisor working as consultant, you’re likely to get a solid hourly or per-project rate with all travel-related expenses paid for up front or reimbursed.

Speaking of travel, it may be extensive. You might be in a large, inner-city multi-center hospital system one week, and amidst corn fields at a small community hospital the next. This varies from company to company.

Of course, there’s the non-tangible rewards as well:

  • Make a deeply positive impact on the hospital’s financials and reportable data
  • Support high quality clinical care through thorough documentation
  • Help your peers understand confusing CMS requirements

The main challenges are related to human interactions. There will be some physicians you need to work with who think that CDI is a waste of their time. There will also be frustrated clients who aren’t seeing the physician behavior changes that they expected to see. Dealing with unhappy people is a part of any doctor’s job, as you know. You just need to do your best to identify the ways of dealing with whatever conflict arises.

Have you worked as a physician advisor for a CDI company? If so, let me know about it the comments!

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