3 tips from Hawaii Health CFO Money Atwal
Physicians play a critical role in a healthcare organization's financial success. Without proper coding and documentation, hospitals miss out on critical revenue. Physicians must be educated on the importance of proper documentation and coding, and trained on how to do it. Without additional training, physicians commonly provide services that aren't coded and billed for, or omit certain required documentation, leading to denials — both of which hurt a hospital's bottom line.
For CFOs looking to shore up revenue streams, engaging physicians in clinical documentation improvement is a great place to start. However, simply dictating coding "how-to's" won't be effective; instead, CFOs must engage physicians and help them understand the 'why' behind CDI programs, says Money Atwal, CFO and CIO, Hawaii Health Systems Corp., East Hawaii Region. CFOs who do this are more likely to gain physician support for initiatives — significantly improving the chances of their success.
Mr. Atwal helped lead a documentation process improvement initiative at HHSC, which began five years ago as the health system implemented its EHR system. In order to speed physician documentation, the health system implemented a voice recognition technology from Nuance. Once processed, a clinical note is entered directly into the EHR. "It doesn't flow through anything," explains Paul Weygandt, MD, JD, MPH, MBA, vice president of physician services at Nuance.
The tool allowed for near real-time turnaround on clinical notes. In the past, it may have taken more than 24 hours for a radiology report to be returned to a referring physician. Now, the process takes 2-3 minutes, says Mr. Atwal.
In addition, physicians work through structured templates to help ensure all necessary documentation is included in the note. The new processes have reduced the health system's days in accounts receivable from 100 to 56; the health system hopes to further reduce this to 45 days in the next few years, says Mr. Atwal.
The initiative's success is due, in part, to Mr. Atwal's ability to gain physician support for the program. He believes four best practices were key to the success:
1. Identify and collaborate on a regular basis with physician leadership. Don't initiate a new CDI initiative without first gaining the buy-in of physicians for it, says Mr. Atwal.
"Get medical executive endorsement, and do this as soon as possible," says Dr. Weygandt.
How do you gain buy in? Explain how the change will improve the organization's finances and sustainability, but focus more on what the change will mean for patient care. "Doctors are there to provide for patients," he says. Timelier reporting can improve patient care, so that is a benefit that should be shared with physicians early, before any reporting improvement projects begin.
2. Involve physicians in selection and implementation of technology and operational solutions. Physicians who help select the technology will be more engaged, and more concerned with in its success.
3. Apply Six Sigma strategies and lean processes. Doing so make coding and documentation processes easier for physicians, allowing more time for direct patient care. The benefit to the CFO is quicker documentation turnaround time, which leaders to faster claim submissions and payment.
4. Focus on physician workflow when considering innovation. Let physicians examine various technologies and assess workflow impact and improvements.