Why we need to talk about the money

The days of separation between clinical and financial teams in healthcare are gone. Better documentation means better care and a stronger financial story.

Historically, talk of healthcare finances has been conducted behind closed doors, away from the earshot of the physicians and care teams, despite the impact it has on them and the services they provide.  But these days, it’s becoming impossible to maintain silos between administrative and clinical teams, and – quite frankly – it is not a holistic way of approaching patient care.

The reality is that in healthcare, the primary goal is to provide the best patient care possible, and right now, just as every clinician is working hard to keep his or her patients healthy, every member of the healthcare finance team is working to keep the organization afloat to continue providing quality services and programs to their communities.  With so much at stake, transparency and collaboration are key, and implementing strategies, technology, and processes that support physicians and quality patient care while meeting regulations will lead to a strong financial bottom line.

As the director of clinical documentation integrity at Swedish Medical Center, I have worked with both administrative and clinical teams to deploy technology, institute processes, and educate staff in the most strategic and effective ways possible.  What we have found is that when our physicians are able to focus on telling their patients’ stories, the quality of care improves and, as a result, we see a boost in appropriate reimbursement. Technology – such as templates and check boxes –can be helpful, but we cannot allow these to replace the patient’s story.  In order to ensure the quality of our documentation, we implemented a clinical documentation improvement (CDI) program in 2011, and here are some of the lessons we have learned:

Telling the whole story
We have learned that when a physician is given an easy way to tell the patient’s health story, from admission to discharge, this information is critical to teams throughout the organization, capturing all the details needed for proper documentation, treatment and coding.  After all, you can be an excellent physician, but when you aren’t documenting the details, no one will know and you won’t be reimbursed for the care you provided.

Not everything is a top priority

After three years of identifying obstacles and working through CDI challenges, we have found that more than half of our clarifications to physicians are regarding severity of illness and risk of mortality, and these added clinical details in the chart, help us provide better quality care.

Reducing denials
We’ve taken a collaborative approach to fixing the documentation challenges our physicians face.  By meeting with specialty groups and showing them how they are doing – looking at data and number of claims denials – we work through the details that need to be addressed to remedy the situation.

The days of separation between clinical and financial teams in  healthcare are gone.  Better documentation means better care and a stronger financial story.  Regardless of changes or delays in policies, focusing on programmatically improving clinical documentation in a way that supports rather than impedes clinical workflows and patient care, will help keep both clinical and teams prepared, and  help support appropriate reimbursement.


To learn more about the impact clinical documentation improvement has on an organization’s bottom line, visit Nuance at ANI in booth #832, June 22 – 25 at the Venetian Palazzo Hotel in Las Vegas, or schedule a clinical documentation assessment meeting.

Tags: ,

About Jennifer Woodworth

This was a contributed post by Jennifer Woodworth, Director, Clinical Documentation Integrity Program (CDIP) at Swedish Health Services in Seattle, Washington. If you're interested in more content like this, visit the Healthcare section of the blog.