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Gain support from medical staff with ongoing education

HIM Connection, November 28, 2006

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It's a common complaint among HIM directors-a lack of support from the medical staff. However, to ensure proper documentation and reimbursement, the HIM department needs that support. Establishing it requires getting physicians to understand what HIM does and how its responsibilities affect the entire organization.

"If I have 20 years of experience and all the credentials, and there's a consultant with five years of experience, the physicians will listen to the consultant," says Glennda Gore, RHIA, executive director of corporate compliance and former director of health information services at McAlester (OK) Regional Health Center. "I'm not sure why."

One reason is that physicians don't understand the concerns that are important to HIM (e.g., delinquent records and electronic signatures), she says. Also, the physicians tend to separate their finances from those of the organization. "For many physicians, there's still that brick wall between the two," says Gore.

In many cases, the medical staff think that HIM doesn't directly affect their pocketbooks, adds James S. Kennedy, MD, CCS, senior physician executive at Forensic Technology Inc., Cambio Health Solutions in Brentwood, TN, a provider of change management, financial advisory, and specialized consulting services to healthcare providers and other healthcare businesses. HIM is just part of the hospital, he says. Physicians don't realize that the department is crucial to supporting medical malpractice defense, compliant professional billing, physician-to-physician communications, and more.

Physicians typically see HIM as a library, Kennedy says. They hate doing the tasks that are most important to HIM (e.g., chart completions and discharge summaries), he says.

But with the introduction of severity-adjusted DRGs and pay for performance, it's now even more important for physicians to understand the concerns of HIM and how their documentation will affect reimbursement.

Getting the message across
You can't get physicians to understand what you're trying to tell them if they won't even take the time to listen. Gore and Kennedy offer the following tips for getting your message across and gaining support from the medical staff:

1. Look beyond traditional meetings. "I've tried inservices, but usually they occur during an existing meeting, and I only get five minutes to talk," says Gore. Physicians don't usually come to separate, full meetings, she adds. For Gore, the best approach has been one-on-one education. When a concern arises, she finds the physician and has a discussion, schedules a meeting, or even offers to take the physician out for lunch.

Another approach that's been successful for Gore is using the organization's quarterly physician newsletter to get her message across.

Department managers can reserve space in the newsletter, and Gore typically uses her space to cover JCAHO standards, chart requirements, coding queries, and more.

2. Make data relevant. Examine how the information that HIM generates benefits the medical staff, Kennedy says. It affects pay for performance, physician profiling, and a lot more. Show physicians the impact that the information has on their day-to-day practices, he says.

Interpret and discuss case-mix, DRGs, and financial data with physicians, says Kennedy. "It will start a dialogue on why the medical executive committee should care about HIM-related concerns."

Develop a document integrity program that requires HIM to work with the medical staff and quality improvement, he says. The medical staff need education from the quality officer on how HIM affects quality scores from healthcare-ratings organizations such as HealthGrades, as well as public databases.

3. Find a champion. Try gaining the support of one physician and having him or her be your advocate, says Gore.

Case management has a physician advisor, but HIM often does not, adds Kennedy. However, HIM needs physician advocacy. Go to your organization's administration and make a case for having a paid advisor by emphasizing quality and compliance, he says.

Editor's note: The above article was adapted from the newsletter Medical Records Briefing. For more information or to order, call 877/727-1728 or go to www.hcmarketplace.com/prod-140.html.

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