Over the years, I've interviewed and attended countless presentations by hospital coders and clinical documentation improvement (CDI) specialists to study physician query workflow and its challenges. I'm always struck by the use of the Physician Advisor as the last resort, the big brother who steps-in to kick butt and get queries answered. They call it leveraging a physician engagement strategy to maximize physician response. It seems more like band-aiding a poor process.
Physician Advisors play an important role in CDI and coding. They serve as a clinical resource and educator to physicians on the importance of documentation. They are active in revenue cycle management and utilization review. They encourage physician buy-in, intervene when problems arise, and manage audits and denials.
Using Physician Advisors to chase-down colleagues for query responses wastes MD time and perpetuates the misconception that answering a query is done as a favor rather than an obligation. Then again, what choice do CDI and Coding Managers have? Physicians have limited time and incentive to answer documentation-related queries with no real skin in the hospital reimbursement game.
At a recent meeting, a Coder Manager described her query escalation process like this:
"Our coders are often two-weeks out after discharge, so the response rate to queries is not great. We escalate unanswered queries after seven days to our Physician Advisor. He sends an email to the doctor. Sometimes this works, and the Physician Advisor gets a response. If not, at least he knows who the bad guys are."
Knowing "who the bad guys are" does not address inaccurate documentation or the loss of full reimbursement for a case. The root of the problem lies with the process.
Six Sigma and Lean Management techniques and tools have been around as long as the DRG. We know that successful process improvement requires decision-making based upon verifiable data. However, tracking physician query activity and its impact on quality and reimbursement remains largely a manual process notoriously difficult to measure.
Another Coder Manager once imparted, "Even one unanswered query is not acceptable." Some hospitals employ extreme measures, such as tying physician bonuses to query responses or suspending physicians when queries go unanswered.
A better way to improve the physician query process – make it easier and faster for physicians to respond to queries and create clear visibility and accountability with all query activity tracked and transparent.