How many times have you reached out to your physician audience with valuable information on strengthening compliance or looming regulatory changes, only to be met with indifference, resistance, or apathy? As compliance professionals, we are well aware of the pitfalls and opportunities that exist in day-to-day patient care. In addition to wearing multiple regulatory and industry hats, we also have the drive and need to support providers and equip them with the resources required to deliver high-quality patient care. We call email, cajole, remind, and email again. But consider their perspective: overwhelmed with information from payors, vendors, thought leaders, and colleagues, they are trying to find enough minutes in the day to devote to their practice.
Physicians may not always understand healthcare organization operations and likely didn’t get into this field for the money. So, what is the best way to convey this valuable information?
In over 25 years in bedside nursing, managed care, and professional consulting, what I learned is that we can very easily miss the most important elements of communication when faced with sweeping regulatory requirements, fear of audits, and the massive scale of healthcare delivery. The best thing to do is go back to basics. When interacting with your physicians, affirm that it is their documentation and unique insight that is the driver for every action that comes after – coordination of care, treatment, coding, billing, and eventual reimbursement. When you frame those actions as the main drivers of quality patient care, if you show them how it impacts their patients, your physicians will listen.
Speak Their Language
Physicians were not trained to be coders. Do not talk to them in ICD-10; they will not listen. Instead, talk to them in concrete medical and clinical terms. Use examples from their own practice or specialty. Confirm that they, the physicians make the diagnosis; they are steering the ship. Physician champions are important, but very good ones are rare. Do not continue to use an ineffective educator just because they are a physician. This will lessen the impact of what they are trying to convey. If you have coders and business office professionals who have the magic touch with physicians – you are lucky. Leverage them instead.
Ask For Insights
The highly regulated world of healthcare means physicians are being told what to do and how to do it by an increasing number of governmental or payor requirements. Let them know you understand this and are there to help them navigate. Many physicians think the regulations exist to limit their clinical judgment. They do not. However, the guardrails put up around payment integrity mean they are perceived that way because everyone – from their patient to their hospital CEO – is talking about reimbursement and revenue. Turn the conversation to the medical record itself. I will bet no one has asked that MD or physician extender what they would do if the rules were up to them. Why don’t you? It could provide insight into what concerns them the most.
Acknowledge the Struggle
Ask about the roadblocks your providers face each day. Most likely, you will agree. Everyone has their own motivation, but it is more than likely your physicians did not go to medical school to memorize revenue codes and learn about modifiers. It is certainly not why I went to nursing school. But we did go to school to learn the best way to ease suffering and improve our patients' quality of life. If you are a clinician, try sharing that perspective. It is important to tell them everyone wants them to spend as much time as they can doing that, not clicking the mouse.
Show Your Support
Physicians are not providing a product, they are providing a service; both are reimbursable but they are not rendered in the same way. Show them you understand that. Offer tip sheets, best practices, and learning and education sessions. How does the physician learn best? Ask them. Ask them, too, for preferred methods of communication. Most importantly, keep your promises. If you say you are going to come back and visit the office in two weeks, go back and visit the office in two weeks. If you do not, you are just another vendor that is not invested in their success. Sit down with them and emphasize that a quick note for the patient they squeezed in at the end of the day might be the best (or only) documentation of a new or existing condition. Remind them that yes, people do read their notes. We could not do anything without them.
Take the Chance
Many years ago, I was on an inpatient unit, talking informally to a group of interns about documentation when a notoriously uncooperative physician sat down next to us. He gave a loud sigh and shuffled mounds of paper. The interns went back to rounds and I sat down next to him. “Why is a nice girl like you doing a job like this?” He jabbed his glasses at my laptop, my pile of charts. I told him I actually was not nice--I got a crack of a smile at that--but I would be happy to tell him all about 'this' if he had five minutes? Turns out he did. In that few minutes, I was able to share, on his turf and at his own pace why my team and I were fanned out across this busy academic medical center. Why we, as nurses, were not there to pester but to improve. Then the most amazing thing happened -- he listened. Asked a few questions. I asked some too. He shared with me that he had been teaching at the college attached to the hospital for over 30 years. He had seen growth, change, and more than a few setbacks. In his eyes, consultants were outsiders, and positive growth could only be wrought from within. I was able to share with him some stories about the improvements we had brought about at other facilities, and the tools and objectivity we outsiders could bring to entrenched habits and processes.
Conclusion
What did I learn from that interaction? Do not wait for someone to roll out the red carpet. You should not be afraid to use a little humor. If someone is ready and willing to talk, be ready.
Use every interaction as an opportunity and resist being put off by someone who does not initially want to engage. They do not know you yet! The most important thing to remember is to frame documentation and education efforts around the betterment of patient care. We want physicians to take credit for their hard work and for the record accurately reflect the patient’s condition. Ultimately, this will ensure each touchpoint along the patient’s continuum is a well-written chapter in a story of exceptional patient care.
