In the world of Clinical Documentation Improvement (CDI), physician engagement is a critical yet often overlooked aspect. The lack of engagement is not limited to specific regions or specialties—it's a universal problem.

Despite the increasing focus on value-based care, efforts to ensure physician involvement in CDI initiatives have been insufficient. Many organizations prioritize software, productivity measures, and workflows, but fail to invest in research and tools to support physicians. The success of a CDI program hinges on active physician participation.

In this blog post, we'll explore the top five reasons behind physician disengagement and propose actionable solutions to increase physician engagement.

Lack of clear expectations set by leadership

Physician engagement in any initiative is limited when the expectations, goals and value proposition remain unclear.

Many CDI programs lack active involvement and direction from top-level healthcare executives, mostly due to the bottom-up approach of the traditional model. Setting expectations at the highest level requires credible analytical insights that allow for reasonable goal setting, action plans and accountability.

Appropriate communication from leadership sets the tone, influencing the entire organization.

The "Why?" attached to severity documentation

Historically, a major challenge has been physicians perceiving CDI as questioning their clinical judgement and improving solely hospital reimbursement and finances.

However, the current healthcare environment calls for accountability to adhere to value-based care standards, as is assessed via several population based metrics. Quality scores and ratings at the hospital and provider level compel providers to ensure that the reported data aligns with the medical complexity of the population they serve via severity documentation.

Lack of provider level performance and actionable data

More than a decade since the inception of CDI programs, query response rates are still used to evaluate a physician's performance and engagement with the CDI program. It seems ironic that fulfilling administrative duties like answering queries is the basis for determining a physician's active involvement in the program.

Furthermore, assessing a provider’s engagement in an initiative via a metric that is dependent on the scope of the CDI program and the CDS themselves, is a sure way to lose credibility with providers. This may lead to physicians simply answering queries to appear good on paper, without actually changing their long-term documentation practices. Are physicians who rarely receive queries the best documenters, or are they simply less responsive or intimidating to query?

Poor reporting and inadequate feedback

The familiar adage goes, "If you don't measure it, you can't manage it." This also applies to physicians, as they can't improve what they can't measure.

By providing actual data for comparison, physicians' competitive nature will drive them to enhance their documentation habits.

Sharing query response rates alone is insufficient since high-performing physicians should ideally receive fewer queries after leveraging the program's long-term benefits.

Insufficient tools to create an easier process

Physicians who understand the "Why?" and strive to do the right thing can easily become frustrated when they lack efficient tools to support their efforts.

A physician's optimal performance should not depend on them becoming CDI and Coding subject matter experts, especially since those can be considered “black boxes” in a medical school curriculum.

Instead, we should be providing them with the most appropriate and fastest route from their current documentation practices (Point A) to delivering accurate severity documentation on specific clinical conditions at the point of care, without disrupting their workflow with additional clicks (Point B).