Case Study: A Physician Leader who Understood Severity of Illness and Made a Difference

A 250-bed hospital in a coastal region of the Northeast implemented a clinical documentation program. The hospital served a less populated area, but because of the location, it also had some elements of a tertiary facility. After an audit of its documentation and a review of records on the unit, the potential to improve documentation and case mix was identified as being quite significant. The hospital was a regional trauma center, and it performed open-heart surgery. This hospital also had several staff physicians who were very interested in quality measures such as HealthGrades.

Specifically, one young physician who oversaw the hospitalists was designated the physician champion for the clinical documentation program, and he started a multiyear initiative to work with physicians to improve their documentation. A strong physician leader is one of the keys to success, and this physician was very compliant yet very persistent. The physician already had earned the respect of the medical staff through some previous medical executive committee work he had done with them. He was able to get the cardiothoracic and general surgeons on board, two groups that can be very challenging. These two specialty groups alone were responsible for significant increases in both case mix intensity and severity under the new MSDRG system. If these surgeons had not received the training, they would not have been aware that detail in the type of congestive heart failure a patient has can make as much as a $15,000 difference in the payment for one case if the documentation is not precise. However, in cases where a patient had a specific condition, and the hospital was using the necessary resources to treat the patient, the hospital would not have been reimbursed at that rate unless the physicians had documented with precision.

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