I’ve worked as a CMO at hospital systems for much of my career, and one thing that I’ve learned is the importance of knowing how to speak doctor. This means listening for clues one physician shares with another about a patient that are critical to their immediate assessment and delivery of patient care. Physicians can communicate a lot of information very quickly, in very few words, and because other clinicians are trained to understand and to act quickly, the system worked… most of the time. Until recently. Now short written notes or verbal handoffs are a thing of the past and what is being conveyed about patients’ conditions may not be clear or may be buried in charts with note bloat, which is a real problem for money, patients, and predicting risks. Here are the three big problems you need to fix to get ready for population health:
Problem #1: Say what you mean
The way doctors speak is different than the coding language needed for billing and hospital payments. The impact is real, unrealized revenue for a hospital or health system when care is provided, but not documented by a physician in the EMR. The last place I worked realized $9 million of traditional revenue by fixing physician documentation up front, and Swedish Medical Center secured more than $18 million in appropriate reimbursement. Better translation of what doctors say up front through a Clinical Documentation Improvement (CDI) program brings predictable financial improvements.
Problem #2: It’s in the patient story details
When a doctor’s clinical documentation leaves clues everywhere in the chart pointing to a risky condition, but sparse clinical documentation leaves out specific details, good care may not look like it. That carries big risks for physicians and healthcare organizations that need to look good on scorecards and quality outcomes. When clinical speak indicates a potential condition, complication or cause for treatment, but it isn’t translated into co-morbidities or diagnosis codes in a record, a patient receiving healthcare may look much healthier than he or she really is. I can’t tell you how many times I’ve seen a chart when a patient spent three days in the ICU being treated for sepsis, which is a very serious and expensive situation, but the chart classified the patient through codes as having something close to a bladder infection because the diagnosis was not properly identified. In today’s competitive healthcare environment, a doctor cannot afford to look bad to payers or patients.
Problem #3: Know your patient population
Your crystal ball better predict the future correctly. When it comes to population health and accountable care, the rules are changing. If your charts don’t accurately reflect how sick your patients are or the conditions you treat in your community, there will be no path to population health management because you won’t really know your populations.
Healthcare is changing and everyone is assuming more risk ‒ physicians, provider organizations and even patients ‒ and in order to stack your team with the right types of providers, who are resourced to deliver the right services that your patients want and need, you have to know what those needs are and what they will be in the future. Accurate clinical documentation that starts with physicians today is a prerequisite for predictive modeling. No one wants to prepare for one patient population and then look back later wondering why mortality is so high or the level of care and resource drain is so much greater than anticipated. That is a problem we are solving for today.
And it starts with physicians. Hearing and understanding them, and then helping them translate what they do into the appropriate documentation is key. What a physician sees when he looks at a chart may seem completely obvious, but we live in a world where unless the words are documented in that chart, the care being provided won’t count. It’s time to retrain doctors to explain what they do in a language everyone will better understand, and reap the clinical and financial benefits. We can do this with the basic building block of a clinically-focused CDI program to help with the translation.