E-supply chains are not unique to other industries, but it is a concept that is not considered aligned with patient care, when in fact the healthcare supply chain is measured by its ability to deliver value to the end customer: the patient!

The E-supply change, or E Health, will require an E-knowledge or data source that is consistent, standardized, and trusted. The healthcare supply chain, unlike some other industries, begins with the requisition for services and supplies at time of the “Patient Ask,” which is then translated into the medical record by the physician—and thus the supply chain process begins.

Physician documentation has always been the single most critical segment of healthcare documentation in our healthcare delivery system, and physician buy-in is the lynchpin for a successful CDI program. A healthcare event starts with a “Patient Ask,” or statement of events; i.e., information about how an event occurred prior to accessing the healthcare supply chain. It becomes a sharing of information between the patient and the providers—physicians, physician extenders, and other clinicians—which all needs to be translated into comments and style acceptable across the U.S. healthcare supply chain. One of the common links across the supply chain is the narrative diagnosis and/or ICD code. In October 2014, the industry paradigm shift to ICD-10 codes will require a dramatic shift in physician documentation, because:

  • The ICD-10 code sets include greater detail, changes in terminology, and expanded concepts for injuries, laterality, and other related factors.
  • It is all in the documentation and translation of the content to a code.

Physicians have a unique DNA that has not been aligned with the downstream process and stakeholders along the supply chain. The DNA that brings people into healthcare delivery and allows them to make a lifetime commitment is best identified by a key point in the Hippocratic Oath, which states:

  • The health of my patient comes first.
  • I solemnly pledge to consecrate my life to the service of humanity.

Physicians’, physician extenders’, and other clinicians’ DNA is all about how to bring value to humanity through improved health!

So what are the business drivers for physicians and other healthcare providers?

They are:

  • Physicians have been conditioned to document defensively, to create defensible legal medical records. This can translate into concise, specific, controlled clinician comments.
  • Physicians want to be respected, which translates into acknowledgment and recognition for the complexity of care they provide—which also translates into the alignment between complexity and reimbursement.
  • Physicians want to practice medicine; which requires ease of business administration.
  • Physicians want to be paid fairly for knowledge and skill. For the most part, they are not interested in wholesale medical practices.

So how do we align with the physicians to gain their buy-in? First and foremost, it is imperative that there is a benefit realization and value proposition for physicians to embark on a CDI program. Mandating the change will not and has not provided a successful path for many other initiatives.

  • The message of value needs to be aligned with their DNA, so that the program will not place a new burden on their ability to see and take care of their patients.
  • We must communicate a message and demonstrate that improved healthcare documentation requires teamwork, and the goals of a CDI program are aligned with the physicians’ business drivers, as well as the hospitals’ and payers’.
  • It must be demonstrated to the physicians that lack of specificity affects the quality of care, compliance risk, and reimbursement. The educational value proposition program needs to address how a CDI program will support the creation of legally defensible documentation and not put the physician at risk with more detailed documentation.

The first and most important concern of physicians is the health of their patients, and aligning the CDI with that reality will lead towards successful buy-in of physicians to a CDI program, which is critical for the transition to ICD-10 compliance and the emerging healthcare models. We need to align as an industry on the ICD-10 codes, accepting the fact that healthcare is a supply chain with consumers, vendors, services, and products. Documentation must start at the point of need to purchase, where the physician documentation sets off the content for the application of a ICD-10 code which is carried across the supply chain for that event.

About the Author

Ellen Van Buskirk is vice president of consulting services at Axiom-Systems, where she is focused on compliance strategies and public sector healthcare. The mission is to work across the healthcare value stream to meet regulatory challenges facing the industry as it moves through the various levels of reform and change. Van Buskirk brings her expertise of working for many years on the U.K. National Health Service Modernization Program, as well as her experience of working on global and domestic healthcare program change for her clients. Additionally, she has conducted business development efforts in support of ICD-10 migrations and compliance by payer organizations.

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