Exploring the future of the physician query.
Pardon me, Doctor. Do you have 20 minutes to answer this query?

The physician query has become the primary tool for hospitals and practices to clarify physician documentation for proper reimbursement and accurate quality reporting. However, today the process for query creation, delivery to physicians and response tracking remains cumbersome, inefficient and difficult to measure.

By and large the greatest problem with the query process is physician responsiveness. In most hospitals, physicians respond to less than 80% of queries. The low physician response rate is the result of a burdensome administrative process.

To begin with, query processes are not yet standardized or streamlined. Typically, physicians receive queries from many different people in different ways. For example, during a patient’s hospital stay, physicians receive "concurrent" queries from Clinical Documentation Specialists (CDSs). CDSs concurrently review the physician’s documentation and query when a potential opportunity to clarify or make the documentation more specific exists. Physicians often receive these queries on paper sticky-notes in the chart, faxes to secretaries, hospital email (sometimes personal email), and verbally by phone or in-person.

At the same time, hospital coders, quality staff and second-level reviewers, retrospectively (after the patient is discharged) query the physician regarding charts that still contain unclear or missing information. Physicians are asked to respond to queries by updating the patient record or answering directly on the query form.

Responding to queries is time-consuming. For example, physicians must read the query, remember the patient, find an available computer, log in (often remotely), open a program and make about 30 clicks to review the chart and respond by updating the record. The entire process can take 15-20 minutes per query.

Other factors contribute to low physician responsiveness to queries. Many physicians remain unclear on the coding requirements that necessitate they document in specific ways and therefore do not recognize the importance of queries. For queries post-discharge, physicians often have forgotten details of the case and also feel unsettled about amending finalized documentation for legal reasons. Further, without any real skin in the hospital reimbursement game, physicians are not motivated to improve documentation beyond what is necessary for patient care but required for billing and coding.

As a result, hospitals are risking millions of dollars in annual revenue and their reputation, driven by underrepresented publicly-reported quality scores, because physicians find current query processes confusing, difficult and time-consuming.