Onsite Clinical Documentation Improvement (CDI) programs are designed to enhance the accuracy, completeness, and specificity of medical documentation. When these programs operate remotely, they face several difficult challenges that reduce their effectiveness:
- Limited Provider Engagement
Onsite CDI specialists can interact directly with physicians, fostering real-time discussions and education. Remote CDI teams lack the immediacy of face-to-face interactions, which can delay queries and reduce responsiveness. Provider engagement is crucial to the success of any CDI initiative, fostered by regular interaction with physicians. The long-standing excuse that physicians are too busy for conversation is just that, a crutch and excuse that does not hold water as most hospitalists are willing to discuss a case from a physician documentation perspective, provided the discussion does not center around queries and diagnoses only. The medical record always needs improvement from a communication of patient care perspective that supports the physician’s assessment and plan.
- Reduced Real-Time Collaboration
Effective CDI relies on collaboration between CDI specialists, coders, and healthcare providers. Being remote hinders spontaneous, real-time discussions, making it harder to clarify documentation issues promptly. Remote CDI hinders collaboration by virtue of the fact that the mainstay is submitting queries via email. Queries are impersonal and do not address systematic ongoing deficiencies in physician documentation. Collaboration between physicians, physician advisors physicians, case management, and utilization review is stymied by an offsite presence of CDI.
- Delayed Query Resolution
Onsite CDI specialists can quickly clarify queries by directly speaking with physicians, whereas remote programs rely on electronic communication, leading to potential delays in responses and query resolution. Queries by email lack the individualized touch and opportunity for CDI to provide short documentation educational tips for physicians that facilitate better organized documentation, streamlining their documentation. Physicians desire instruction on how best to chart in the EHR, saving precious time while they juggle multiple time-sensitive priorities.
- Loss of Context in Documentation Review
Remote CDI specialists miss out on non-verbal cues, in-person conversations, or additional patient chart details that are better understood when physically present in the hospital.
- Decreased Influence on Physician Behavior
Onsite CDI specialists build relationships with providers, reinforcing documentation best practices through in-person training and feedback. Remote CDI teams struggle to maintain the same level of influence and education with programs providing minimal documentation training that is sustainable over time, the backbone and fundamental framework of durable net patient revenue that drops to the hospital’s bottom line. Witness the increasing volume of payer clinical validation denials and DRG downgrades. While I agree that payers are egregious and push the envelope in issuing denials, many denials are self-inflicted with poor documentation of the patient story, clinical information, and clinical facts that support the diagnosis. I encourage all CDI professionals to review some of these payer denials and look beyond the clinical indicators that support a diagnosis. One must review the record holistically and see what the record says and conveys.
- Variability in Hospital Processes
Each hospital has unique workflows, and onsite CDI specialists can adapt more quickly to facility-specific procedures, while remote teams may find it harder to navigate local nuances effectively.
- Lower Compliance and Adoption
Physicians may be less likely to prioritize CDI queries or best practices if they do not have a direct, in-person presence reminding them of documentation importance. Ongoing continual reinforcement is paramount and key to sustaining physician progress in achieving “Physician Documentation Excellence,” a goal that all CDI programs must embrace.
While remote CDI programs can still be functional with the right technology, workflow adjustments, and effective communication strategies, onsite programs have an overwhelming advantage in physician engagement, overall efficiency, and collaboration with physicians to consistently achieve more robust, effective documentation. There is simply no substitute for onsite CDI presence as the most efficacious strategy and means to collaborate with physicians to facilitate physician documentation, promoting the medical record as a communication tool versus today’s remote CDI programs that perpetuate the treatment of the medical record as a reimbursement tool.