Physicians play a high stakes game to identify quality problems

Today most people in and out of the healthcare industry really don’t know the path to the top of quality rankings or the “best of” lists. Healthcare leaders are beginning to understand it has something to do with what physicians are putting (or not putting) into patient charts, but very few know what to fix. Physicians are caught playing the game of Catchphrase, where they have to get the word or phrase right by translating clinical care into words that matter in patient charts. This helps everyone deliver the highest level of care, and supports government regulations, such as ICD-10 and payment models. It’s a game physicians have to win.
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Physicians play high stake games if documentation is not thorough

Many physicians today are baffled by how quality of care is measured, and how that information makes its way to the public in different ways and with varying degrees of credibility. Not only are hospitals publicly ranked in terms of quality performance, consumers can now read online reviews, and compare physicians and hospitals based on details they probably don’t know much about, such as C-section rates, medication protocols and mortality (whether a death was expected or not).

It used to be clear: If you did a good job healing patients, they were usually satisfied. If they felt you and your care team treated them properly and with compassion, doing the best you could with their health concerns, it usually translated into “quality of care.” Happy, satisfied patients subsequently translated into a solid paycheck, a strong pipeline of referrals and a great reputation.

Not anymore. Nobody is disputing that quality of care is important, or even that it needs to be measured and reported publicly. Physicians and healthcare leaders support rewarding and even emulating top performers, but what they question is the way quality is being measured. People need to understand how hospitals or physicians get to the top or the bottom percentile of lists published by HealthGrades, Leapfrog or CareChex. And, more importantly, clinicians need to know how to identify and fix problems related to quality—even if it turns out to not be about the care delivered at all.

Today most people in and out of the healthcare industry don’t know what really drives public quality ratings. Healthcare leaders are beginning to understand it has something to do with what physicians are putting (or not putting) into patient charts, but very few know that today these are driven by billing and claims data, and fixing that is not enough.

 

Clinical Catchphrase

Physicians are caught in the game of Catchphrase. You may know the game. There are different teams where one player provides clues while the others try to guess a common word or expression before time runs out. The team that can name the desired “catchphrase” more often before time runs out wins. In a way, that is what’s happening in healthcare today, but the stakes are higher.

“Doctor speak” doesn’t naturally translate into terms that support the business of healthcare (ICD-10 codes, medical necessity) or top quality rankings, and if the catchphrases aren’t there for coders, payers and regulators, then the care doesn’t translate into reimbursement and quality, creating holes that can live in in the patient record, impacting future care and hospital metrics. I work with physicians and healthcare leaders to educate teams about how to speak the same language to put this clinically relevant information into patient charts and pull it through the process to improve both the clinical and financial side of healthcare using clinical documentation improvement (CDI). And it works.

A new study using public rankings shows that Nuance CDI clients outperform other hospitals in national quality rankings. When clinicians improve the details in their clinical notes, it helps other caregivers get a clearer picture of the patient (especially in today’s EHR-driven world), and their notes support higher quality rankings. More importantly, this approach to CDI shows caregivers where gaps in quality of care actually exist that impact the patient.

 

Is it a quality problem or a documentation problem?

This part is not a game. Hospitals need to know when they have a real quality problem vs. a documentation problem masquerading as a quality problem.

“By catching documentation problems masquerading as quality problems and differentiating documentation problems that affect quality numbers, we’re able to remove that debate from the discussion and have a better discussion around what is really a quality issue.”

R. Hal Baker, MD, FACP, Senior Vice President, Clinical Improvement and CIO, WellSpan Health

I work with hospitals and physicians to improve clinical documentation and eliminate the gray areas, so they find and attack the root of real quality problems and deliver better patient care.

While words matter, it’s not enough to just find the catchphrase and fix documentation. To truly improve patient care, hospitals and physicians need to make sure their patient records tell the patient’s true story, reflecting the quality of care delivered and ultimately demonstrating that in the rankings that are reported to the public.

View CDI Quality Impact study

Measuring the real impact of quality can be hard if patient records do not provide a complete, accurate view of the patient’s needs and reflect the quality of care delivered. Learn how CDI can impact quality rankings to the public.

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Dr. Anthony Oliva

About Dr. Anthony Oliva

Dr. Anthony (Tony) Oliva is the vice president and chief medical officer for Nuance’s Healthcare division. Dr. Oliva draws on more than 15 years of executive healthcare experience. As chief medical officer, he personally has been involved with the implementation and expansion of clinical documentation programs since 2004. Previously serving as chief medical officer for Borgess Health, Dr. Oliva was accountable for the clinical practice of medicine across all Borgess Health entities including ambulatory care, hospital care and extended care services. He is currently Board Certified in Family Medicine. Dr. Oliva received an M.S in Medical Management from Carnegie Mellon University Heinz School of Public Policy & Management. He is a Certified Physician Executive, a designation earned from the American College of Physician Executives.