In this episode, Dr. Terrance Govender, Vice President of Medical Affairs at ClinIntell, discusses solving the physician engagement puzzle and clinical documentation, and why it matters for hospital finance.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- What hospital finance leaders often overlook when evaluating potential solutions for improved financial outcomes and revenue protection.
- Advice to finance leaders who want to strengthen the link between their providers and their organization’s financial performance without shifting the provider’s focus from patient care.
- Examples of where targeted physician education directly improved a hospital’s bottom line or quality metrics.
- What barriers to consider when uniting clinical, coding, CDI, and finance.
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Dr. Terrance Govender. Dr. Govender is the Vice President of Medical Affairs at ClinIntell. He has an extensive background in clinical documentation and has worked across South Africa, the United Kingdom, and the United States. Dr. Govender is passionate about leveraging advanced data analytics to align physicians’ clinical narrative with administrative goals. His work focuses on transforming clinical documentation practices, promoting engagement, and sustainably enhancing severity reporting in healthcare systems.
In this episode, we’re discussing solving the physician engagement puzzle and clinical documentation and why it matters for hospital finance. Welcome, and thank you for joining us, Dr. Govender.
Dr. Terrance Govender: Hi, Kelly. Thanks for having me. I’m excited to be here. Thank you.
Kelly: Yeah. Well, let’s go ahead and jump in. So, what is one thing hospital finance leaders often overlook when evaluating potential solutions for improved financial outcomes and revenue protection?
Dr. Govender: It’s a very interesting question, Kelly. And I think probably on the tips of many CFOs’ tongues, when I look at the situation based on my experience in the industry, I think there’s really two components. There’s the component of making our current efforts that have been geared towards improving financial outcomes and protecting revenue, our current efforts, gearing them to a more lean approach. And then there’s a second bucket which really talks about taking a closer look at our approach in general. And are we just doing what we used to do better, or are we really getting to the next level? So, when you look at those two sort of entities, meaning optimization and making it lean versus taking it to the next level, there are really two sort of buying mindsets that a CFO or other leaders should have. What are we trying to achieve for the organization? Are we just trying to clean things up? Or are we really trying to sort of squeeze more juice out of the orange via innovative approaches?
Kelly: Very interesting. So, Dr. Govender, what advice would you give to CFOs and other finance leaders who want to strengthen the link between their providers and their organization’s financial performance without shifting the provider’s focus from patient care?
Dr. Govender: Well, firstly, I think, Kelly, it’s not whether we would like to work with physicians and whether physicians would like to work with administrators in this day and age. It’s a given. And that’s because the center stone is accountability around performance data. So, everyone has to play nice in the sandbox. The challenge is, though, historically, when you look at some of these metrics that organizations monitor and measure, especially when it comes to finance, things like case mix index, things like capture rates, etc., these are metrics that make sense to executives and other leaders. They know when it goes down, what it means, when it goes up, what it means. But the lack of understanding or the realization that all of the metrics that we monitor at the highest level are usually driven by ICD-10 codes, which are driven by clinical conditions, that piece is lost. And so why I highlight that is because if you dissect what I just described, well, it’s the missing link between administrators and the physicians, which, as you know, they have to work together. So rather than holding our physicians accountable to administrative metrics, which are the legacy metrics that our industry was exposed to, ClinIntell is suggesting a population-based approach with physicians where we’re able to talk to physicians in clinical condition language or which clinical conditions are being underreported. And that really bridges the gap between the two because physicians are trained to focus on and diagnose clinical conditions on their patients rather than improving case mix index, if you may.
Kelly: Sure. No, thank you for sharing that advice with us. Can you share an example of where targeted physician education directly improved a hospital’s bottom line or quality metrics?
Dr. Govender: When it comes to targeted physician education, I think there are many organizations across the country that can say we’re delivering targeted physician education around documentation and severity documentation improvement, etc. But to demonstrate a direct improvement in the hospital’s bottom line from true improvement in documentation is when the physician does it right the first time, not when the physician answers a prompt and/or a query. Now, I say that because that is the most efficient way of capturing severity. But when you now educate physicians not on what they could have said or what they should have said on a single medical record, but rather when you educate physicians on population-driven insights. So based on my patient population, these are the clinical conditions that are being underreported, and here’s why. A lot of it has to do with my clinical documentation practices.
But now this targeted approach where we talk the clinical condition language and speak just in clinical terms with the physician, giving them a definition of a condition like acute respiratory failure, that now means something to the physician because they can now adapt or adopt that insight with every single patient. It’s a very different approach where you’re educating physicians on a single medical record, but rather, you’re educating them with condition insights on their population. The value there, Kelly, is that it’s the gift that keeps on giving because, as I always describe, for a physician to assess cardiovascular disease risk on a patient happens within seconds in a physician’s mind. Why? Because population insights have told that physician what are the risk factors for cardiovascular disease. ClinIntell’s insights do the same thing when it comes to severity documentation or clinical documentation. It awards clinical documentation a seat in the physician’s clinical decision-making thought process. So, the physician is thinking acute respiratory failure when they are seeing the patient with the mindset of, “Does my patient have acute respiratory failure? And if they do, here’s what I need to document, and I need to say what I did about it.” That mindset is completely different to targeted education on a single medical record, which says you could have done this, whereas you did that.
Kelly: Yeah, definitely. No, that makes a lot of sense. I love that example. With increasing scrutiny from payers, many coding professionals are becoming hyper-conservative when coding patient charts in an effort to mitigate the risk of denials. So should organizations continue to take this approach as a strategy to reduce claim denials?
Dr. Govender: It’s a very knee-jerk approach, Kelly. It’s something that– it works. It’s going to the doctor and saying, “Doctor, my arm hurts when I do this.” And the doctor says, “Well, then don’t do that.” So, you can stop denials by not coding certain diagnoses. It’s a very reactive approach. It’s not a long-term approach. But many organizations, what happens is when they put the brakes on certain clinical condition reporting because of a higher scrutiny or perhaps prevalence of denials– like when malnutrition was the hot topic for a long time, many of them put the brakes on that condition, and then they never really, in the long term, actually recover because to recover means they’d have to go and fix all of the pieces that weren’t efficient and sufficient documentation on that condition, and they never really have addressed that with the physicians. In the meantime, by putting the brakes on, not only do you lose revenue value, but you also lose risk adjustment value for that condition being reported. So, the coders may be doing you a short-term favor, but in the long term, you are getting significant impact, in a negative way, on both your reimbursement and risk adjustment metrics.
Kelly: Yeah, I know claim denials is a big topic right now. Do appreciate that insight. What barriers do you encounter and/or consider when it comes to uniting clinical, coding, CDI, and finance, otherwise known as the 2.0 model?
Dr. Govender: Yeah, so with the 2.0 model– I’m glad you mentioned denials as well because you’re absolutely right. Insufficient documentation makes up for more than 50 or 60% of denials in the industry. We’re actually doing a webinar on June 19th on denials, and it’s about addressing the problem of when you put the brakes on a condition, how do you go back and fix it and not just let it lie low? So just in case anyone’s interested with regards to the 2.0 model, which really talks about building upon the 1.0 model, the CDI 1.0 model, which is reviewing of charts, submitting a query. And now we’re building upon that by saying, yes, continue to review charts, but based on a target list of conditions, we want to empower physicians to do it right the first time. The difference here is, in the second scenario, it’s not only adding the physician population insights; those population insights also inform the executives of what goals and strategies to deploy across the organization. The barriers that we find– everyone in the industry, in healthcare especially, they love talking about silos. “We need to break down silos.”
It becomes a consulting sort of cliché. “We got to break down–” everyone knows it should be done. Hardly anyone is actually doing it. So, one of the biggest challenges is that everyone wants to be the best performer of their little entity. And, of course, when opportunities to identify areas to improve come about, instead of saying, “Yes, these are opportunities,” many individuals feel as though– if I could use this analogy– we’re calling their baby ugly. And it’s not about that. It’s about true improvement in performance. So, I think the whole mindset of doing things, it’s the leaders, I think is the biggest barrier, is because not having an open mind or realizing that your one perspective is actually a very limited view of a problem that the industry is trying to solve. As soon as you can get rid of that– which is really driven by ego in most cases, Kelly. But if you can take that out of the equation, then actually the door opens up for collaboration and the leverage and use of insights and not just information anymore. It’s very valuable, but it needs either a reinvigoration of the mindset of our current leaders or a replacement of many leaders with those that have a different mindset towards this problem.
Kelly: No, I mean, that makes a lot of sense. Thank you for sharing that with us, Dr. Govender. And we really appreciate all your insights into solving the physician engagement puzzle and clinical documentation and why it matters to hospital finance. And if a listener wants to learn more, contact you to discuss this really fabulous topic further, how best can they do that?
Dr. Govender: Yeah, thanks for the opportunity to share that because changing physician documentation practices is not an insurmountable task. Everyone at ClinIntell, it is our passion. It’s what we get up in the morning and we strive to do. If you are interested in learning more about how we’re doing it and the success we’re achieving, my name is Terrance, T-E-R-R-A-N-C-E. I’ll make it easy: terrance@clinintell.com, C-L-I-N-I-N-T-E-L-L dot com. Just our website has a wealth of information. You can sign up for our webinars. I’m also on LinkedIn, Terrance Govender. Reach out anyway. We’d love to connect, and we’d love to share the insights into the work that we’re doing with your audience.
Kelly: Great. Well, thank you for sharing that with us. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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