My journey in the Clinical Documentation analytics space spans over a decade. Throughout this time, I've been involved in assisting CDI teams with their physician documentation education initiatives. One recurring theme that has surfaced is the challenge of measuring the ROI from these educational efforts and solutions. Whether you're contemplating investing in a full-time educator, consulting, or tech solution, it's crucial to consider several key factors when assessing or measuring impact.

Challenges in Measuring ROI for Physician Education

Despite repeated education initiatives, physicians often revert to default documentation practices, particularly in the absence of real accountability for training completion or meeting performance objectives. After an education session with providers, you may see a decrease in queries, but how do you quantify your ROI? CDI programs tend to only show financial impacts based on queries. Historically, there has not been an impact metric on documenting accurately the first time, especially at the specialty or physician level.

This underscores the importance of setting clear performance goals. Traditional CDI metrics like query rates, capture rates, or analytical methodologies like benchmarking and cohort comparisons, while valuable in its own right, may not fully equip organizations to assess current performance or establish reasonable severity documentation goals.

Moreover, education content must be tightly linked to specific performance goals to effectively measure its impact. Vague objectives like reducing queries through education efforts can be challenging to evaluate since various factors beyond education may influence outcomes.

The Pitfall of Financial Impact based on CMI

A major pitfall seen across the industry has been having a financial impact based on CMI. COVID has shed light on these assumptions. CMI is primarily based on the mix of patients seen and documentation improvement is only a part of this equation. Trying to calculate ROI on physician education based on CMI is unfruitful.

My perspective shifted when I joined the ClinIntell team. It became evident that providing education in isolation isn't enough to change physician documentation practices sustainably. What’s sustainable is when education efforts are backed by sophisticated analytical insights and linked to group and organizational severity documentation performance goals. By moving away from traditional approaches and focusing on tailored strategies, we've effectively eliminated the industry-wide struggle of the Yo-Yo effect when it comes to accurate documentation. This Yo-Yo effect has the industry in a cycle of spending. Whether it’s additional CDI staff, consultants, or tech you’ll see some initial benefit followed by more spending to address the same issues a year down the line.

Maximizing Efficiency with Population-Based Analytics

Unlike other firms in the industry, ClinIntell adopts a population-based approach, which initially took some adjustment for someone deeply entrenched in traditional CDI analytics. However, I soon realized the value of tailored physician documentation training facilitated by population-based analytics with a clinically expected value. This approach adheres to the 80-20 rule, maximizing efficiency by focusing efforts where they yield the most significant results. By having this clinically expected value and seeing where documentation gaps exist, we can calculate an ROI based on closing these gaps for the health system, facility, specialty, and provider.

The most effective formula is:

1. Population-based analytics with clinical condition-focused metrics.
2. 24/7 access to a training mobile app with documentation tips and individual metrics.
3. Monthly reporting at the physician and group level.

Moving Forward: Collaborating for Sustainable Documentation Improvement

We all know what physicians and surgeons do in the hospital setting. They diagnose, treat, and address health maintenance. Although documentation can get complicated as we all must play in the same CMS guideline sandbox, let’s move the industry forward by providing physicians and surgeons with the correct metrics. Let’s stop making them sit through poorly attended education sessions on CMI, coding guidelines, and query results.

Instead, let us utilize population-based insights which will allow us to:

• Set clear documentation goals that can be measured.
• Provide them with the top 10 – 12 significant clinical conditions where they have a gap.
• Provide them with training made by and for physicians.
• Allow the physicians to see trends in the population they serve, and the documentation gaps closed due to their efforts.
• Easily converting these gap closures into financial impact will enable the health system, facility, or specialty leaders to see the ROI on their investments.

As these leaders collaborate with their physicians to see documentation trends and address issues quickly, the long trend of the industry Yo-Yo effect is eliminated.

Click here to learn more about ClinIntell’s Data-Driven Severity Documentation Mobile Application.