Baptist Health South Florida leaders share why physician leadership and input have been essential to the system's preparation for ICD-10.
Clinical documentation improvement in preparation for the transition to ICD-10 might not seem like a fun topic, but Baptist Health South Florida in Miami has tried to make the initiative a little more entertaining for physicians.
"What we've done with our clinical documentation improvement program is we labeled it 'CDI: Miami,'" says Lorena Chicoye, MD, Baptist's corporate medical director of managed care. "The physicians on staff seem to think this is the most amusing thing on the planet."
Having a sense of humor is far from the only way Baptist has engaged with physicians as part of the documentation improvement process, however. Physician leadership and input have been integral parts of the CDI program the nonprofit health system started about two years ago, according to Dr. Chicoye.
"In our five larger hospitals, we decided to start the program with a steering committee composed of physician leaders from each hospital," she says. "These physicians would also be very much involved in the ICD-10 conversion."
Thanks in part to this tactic, she says the CDI program has been doing "exceptionally well." The case mix index at all of the system's hospitals has skyrocketed, and the organization added nearly $14 million in additional reimbursement to its bottom line this year because of improved documentation in the medical records.
These results stem from Dr. Chicoye's understanding of the importance of getting the medical staff on board with CDI, says Paul Weygandt, MD, JD, MPH, MBA, CPE, vice president of physician services at J. A. Thomas & Associates, which is part of the technology corporation Nuance Communications. Baptist partnered with Nuance to improve clinical documentation.
"Presenting CDI as a clinical initiative with physician involvement changes everything," says Dr. Weygandt. "The CDI program provides essential infrastructure for the transition to ICD-10 because the physicians working in the inpatient setting will need assistance."
Dr. Chicoye and Mauricio Palma, MD, director of CDI at Baptist, have shared three best practices for effectively engaging physicians and improving clinical documentation processes.
1. Involve practicing physicians as soon as possible. When a hospital or health system begins a CDI initiative, they should bring physicians into the conversation immediately, Dr. Chicoye says. Hospital executives should let staff physicians know exactly what the hospital leaders are doing and how they're going about it.
"They should be the first to know," she says of the physicians. "They're the ones providing the work and the documentation in the medical record. If they don't know the day-to-day impact, they're not going to support you. They're just going to think, 'Eh, the hospital is doing more stuff to me,' rather than, 'The hospital is doing more stuff for me.'"
2. Make sure they understand what the transition means for them. It's crucial to ensure that physicians are well-educated and that they understand what documentation improvement and the ICD-10 transition mean for them, according to Dr. Chicoye.
"I have been going out there with Dr. Palma and explaining to the physicians what ICD-10 means and how it's going to impact them," she says. "They get kind of the 20,000-foot view of this thing and don't think it's going to affect them directly. They need to be aware of how it's going to affect them."
Baptist is accomplishing this through physician education on the floor about the ICD-10 format, Dr. Palma says.
"We're educating our physicians on a daily basis," he says. "The education is face-to-face and one-on-one."
3. Assemble a team of CDI specialists who can deliver physician-to-physician education. Baptist couldn't accomplish its physician education goals without its CDI specialists. When recruiting the specialists, Baptist specified a preference for applicants with a medical degree and received an "incredible response" from all over the country, Dr. Chicoye says. Many international physicians have shown interest in the program.
"Our team here is from many different cultures, many different countries," she says. "We are assembling a very multicultural, very interdisciplinary team to work collaboratively with one another and then go on the floor and have conversations with physicians."
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The Financial Risks of Transitioning to ICD-10: Key Considerations for Hospitals and Health Systems