We’ve all been in situations where we’ve taken the rap for something with undue cause. So why would it be any different in healthcare? A recent Health Grades report shows that hospitals with high quality scores have lower mortality rates compared to those with lower quality rankings. The study also estimates that 234,252 lives could potentially be saved and 157,414 complications avoided annually if all hospitals performed on par with these highest quality-ranking hospitals. Those are impressive numbers, but it does beg the question: do hospital quality scores always accurately reflect the actual quality of care being provided?
While much needs to be improved in healthcare, the challenge hospitals are currently facing with quality scores is that there are confounding factors that can negatively influence scoring. Let’s look at an example: A patient with type 2 diabetes, chronic respiratory failure and history of heart disease is admitted to the hospital with chest pain. This patient, who has multiple illnesses, or comorbid conditions, is expected to have a higher risk of mortality than a patient who also was admitted with chest pains but has no pre-existing health issues. Although suffering with the same symptoms, the patients will – and should – receive different clinical treatment, but the problem is that the clinical documentation of their care does not always reflect this.
Accurately capturing each patient’s severity of illness is a critical factor in attaining high quality measurement scores. Unfortunately, many physicians and hospitals fail to adequately document the full extent of their patients’ illnesses and, as a result, their metrics and outcome scores are grossly understating the quality of care they are providing.
The good news is that this problem can be fixed. Many hospitals have been able to reverse their alleged “poor” quality of care by implementing clinical documentation improvement (CDI) programs. At my hospital, the institution of a physician-engaged documentation improvement program reversed our fortunes, taking us from the bottom quartile of a national quality database to the top – in less than a year. And this experience is not unique; such results have been repeated at organizations ranging from small community hospitals to major academic facilities. An effective CDI program enables providers to create a shared vision, foster the relationship between clinical documentation specialists and physicians, educate clinical teams about those documentation changes that will directly impact their work, and provide progress updates that allow teams to adjust tactical approaches as needed.
Hospitals and health organizations have invested time and talent in preparation for new quality initiatives and payment methodologies. Physicians and hospitals, alike, must recognize that to achieve high quality metrics, including outcome scores, two attributes must be present: First, high quality care must be provided to patients; second, the severity of illness (the risk-adjustment factor) must be accurately captured for every patient. CDI programs will ensure that the hard work and excellent care being provided to patients is reflected in the data being collected and shared with the public. After all, the real impetus for clinical documentation is to fully capture a patient’s health because better documentation enables better care.