For years, physicians have grappled with balancing quality care delivery and an ever-increasing administrative workload. This challenge often results in disengagement from key initiatives as they become overwhelmed by tasks such as documentation, compliance, and electronic health record management.

Clinical documentation initiatives (CDIs), in particular, have historically struggled due to poor physician engagement. Given that accuracy and precision in documentation impact everything from reimbursement to quality measures, physician involvement is often mandated. Unfortunately, this reinforces the perception that these initiatives are merely tedious administrative duties.

As long as reimbursement and risk adjustment models depend on specific documentation rules and regulations, documentation optimization initiatives will remain a necessity. Given this and the growing importance of high-quality clinical documentation, both healthcare administrators and physicians must acknowledge the following:

Documentation initiatives and/or efforts are here to stay. (Yes, even with fancy ambient AI-listening technologies).

If that’s the case — and it is — then both parties must also understand and accept the following:

Physician engagement in documentation initiatives is critical in the current environment.

By considering these statements from their unique perspectives, both administrators and physicians can uncover the elements necessary to solve the age-old challenge of poor physician engagement in documentation initiatives.

‍

The Challenge

For more than a decade, the industry’s efforts to secure physician buy-in and participation in documentation initiatives have delivered only short-term results, failing to achieve meaningful, long-term engagement.

The focus has consistently been on involving physicians in the CDI process, rather than fostering a process centered on genuine improvement in documentation practices. These are not the same. If true engagement means working together to achieve shared goals, then identifying truly engaged physicians — or groups of physicians — remains a significant challenge.

There are many reasons why physicians are typically disengaged in documentation initiatives, including:

• Documentation initiatives are perceived as administrative rather than clinical responsibilities
• Physicians often view queries as a questioning of their clinical acumen or judgment
• There are no true incentives for engaging or participating in CDI initiatives
• There is no data to assess performance, set goals, or take corrective actions
• Based on their experience with the CDI query process, changing documentation practices appears to be an insurmountable task

Common practice is to assess physician engagement with the query response rate metric. This alone highlights the fact that we are assessing engagement in the process, rather than improvement in documentation practices.

The query process is governed by rules and regulations that the CDI program must follow. However, these rules often create administrative noise for physicians, making the process feel like a challenge to their clinical judgment. Additionally, because of the structure of the queries, physicians often leave without the insight needed to improve their documentation and prevent similar queries in the future. As a result, there may be participation, but not true engagement.

‍

The Solution

The solution to engaging physicians in documentation initiatives does not lie solely in getting them to adopt CDI processes that assist in capturing true patient severity. That would be trying to solve a problem with the same mindset that created it.

Instead, the best approach is to align incentives between the two entities, making engagement in the CDI process a natural outcome.

Consider the following analogy: Your employer offers free access to a gym and fitness trainer, recognizing that creating and supporting a healthy workforce benefits everyone. John, an employee who isn’t a fan of exercise, ignores the offering. To address low participation, the employer introduces significant benefits and savings for employees who achieve specific, measurable fitness goals within the year. These incentives appeal to John more than the inherent benefits of being healthy. While John may eventually come to value the benefits of working out, this realization will likely happen later.

Aligning incentives stands a better chance at engaging physicians in initiatives such as accurate, severity documentation.

Where the industry missed the mark

The industry and physicians share a common goal: accurately capturing the clinical conditions patients experience and are treated for. However, the focus has often been misplaced. Instead of addressing the root causes of poor documentation practices, efforts have centered on simply engaging physicians in the CDI process. In the past—and sometimes even now—physicians were incentivized to respond to queries, a metric still used as a proxy for “engagement.” This approach ironically rewards participation in a process that exists only because documentation standards remain subpar.

How to align incentives with CDI

The missing piece in achieving accurate clinical condition reporting and engaging physicians in severity documentation initiatives is not workflow optimization or prompt tools, as these clearly haven’t solved the engagement issue. Rather, it’s credible physician-level performance data and actionable insights that are key to driving true engagement.

The current traditional approach fails to provide physicians with clear, 80/20 actionable insights into their performance on severity documentation (query rates still don’t count). Physicians need a clear understanding of the key clinical conditions to prioritize in their documentation efforts. Effective CDI engagement isn’t about achieving perfection in documenting every condition; it’s about focused, intentional improvements that align with targeted performance goals. By emphasizing strategic efforts over unrealistic perfection, we can better support physicians in meaningful documentation initiatives.

With the introduction of advanced predictive analytics, an organization can leverage sophisticated insights to identify which conditions have the most impact on the initiatives they are optimizing. By identifying this short list of conditions, the organization can set clinical goals aimed at improving the reporting of these conditions, which, in turn, influence key metrics that resonate with physicians (e.g., LOS, CMI, expected mortality values, etc.).

Setting clinical goals for improving the reporting of conditions that only physicians can diagnose empowers them to take ownership of documentation. This approach differs significantly from relying on external processes to influence documentation practices. To drive change, we must enable better reporting that backs up the clinical work done, delivering this information in a succinct, accessible format that supports physicians without adding complexity.

Group and individual physician performance data keep physicians honest on performance, and when they soon realize the work CDI has been doing for years actually helps them achieve their clinical goals, the CDI initiative is seen as leverage and engagement is more often self-driven.

‍

Conclusion

In summary, engaging physicians in a process that is perceived as administrative or questioning their clinical judgment was always doomed to fail. It’s not a problem that CAPD and other physician-centric tools have been successful at solving, either. Instead, to engage physicians in documentation efforts, we need to align incentives with a clinical goal, whereby achieving accuracy in documentation is a requirement to improve performance.

Not only does it align incentives, but this model has repeatedly demonstrated that when analytics are paired with training and monthly reporting, it can change documentation practices — even in specialties that are typically difficult to engage in the query process.

Below is the performance for a thoracic surgery group. No expensive software was implemented to prompt the surgeons, nor was there an increase in the number of queries generated — just a healthy clinical discussion about conditions that were under-reported due to a lack of awareness of their value.

‍