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Building Physician Engagement Around CMS Risk Adjustment and Clinical Documentation

At RISE Nashville this week, we heard over and over that engaging physicians around clinical documentation is a struggle. These feelings echo what statistics have been saying for a long time: in a 2013 survey by the RAND Corporation, physicians described “time-consuming data entry” as a major source of professional dissatisfaction. 

Strong CMS risk adjustment is built on a foundation of strong clinical documentation and risk adjustment is vital to clinical and financial success in the value-based care world. Given the consequences, it’s important to build physician engagement around CMS risk adjustment, and the clinical documentation that supports it.

So what can be done? Different physicians have trouble with documentation for different reasons. Pulling these factors apart can help executives adjust their management tactics to meet both their clinicians’ and systems’ needs. The following are three obstacles to risk adjustment and the clinical documentation that supports it, and ways that Apixio helps overcome each one.

Physician engagement obstacle #1: “I don’t know why this is important.”

A doctor filling out documentation for CMS risk adjustment codes.

The first type of obstacle is the “information gap.” It occurs when physicians have limited awareness of the financial and clinical impact of risk adjustment and HCC codes. They may be focused on other types of documentation (such as those needed for Meaningful Use or PQRS), seeing additional patients, supervising their staff, or one of other myriad duties.

To be fair, it’s hard to grasp the idea of HCC codes at first, how they connect to the rest of the patient medical record and how they are different from ICD-10 or other administrative coding. Without understanding how HCCs specifically fit in, it’s easy to think that a risk adjustment documentation mandate is just to “do better,” rather than to improve documentation in a very precise way.

Many practices solve this obstacle with education and information sessions. Apixio adds to these efforts by effectively tying together what documentation is present, to construct as full a picture as possible of a patient’s chronic conditions.


Physician engagement obstacle #2: “I don’t have time.”

Glasses resting on a stack of CMS risk adjustment charts.

Physicians might put up this opposition if they know about HCCs and risk adjustment documentation but feel that it is not worth their time. There are so many documentation burdens on physicians these days, and it is significantly cutting into time seen patients. A 2013 study in the American Journal of Emergency Medicine found that 44% of physicians’ time in a community emergency room was spent on data entry, while only 28% was spent in direct patient care. In this context, risk adjustment might seem like one in a long line of factors preventing physicians from spending more time practicing medicine.

It’s difficult to deal with this type of objection, but one tactic is to remove as much of the risk adjustment burden as possible from the physician. Apixio does this in several ways. First, Apixio can extract documents from any electronic health record (EHR) and any document type (HTML, scanned file, PDF) in a seamless way.

Second, because much of the documentation collation is done on the back-end, physicians can rest assured that the documentation they do finish will be found and used, even if it’s buried in an obscure visit note. Since every document is ready by a computer, each increment of their documentation time is worth it.

Physician engagement obstacle #3: The digital adoption curve

A doctor holding a paper medical chart, standing in front of shelves full of paper medical charts.

Lastly, some physicians fall short of documentation standards because they are poor at data entry in an EHR. EHR systems are not easy to master. They give physicians less control over their documentation workflow, and they force physicians to complete more fields than they’ve previously had to. Plus, at a very basic level, the sheer number of different interfaces and workflows to learn, adopt and use is staggering. In a very short time physicians have had to acquire significant technological skills, and it’s no surprise that some are still adapting.

Apixio deals with this obstacle in several ways. Apixio’s Iris cognitive computing platform can process many different types of document files, not just electronic health records, including scanned, faxed, and PDF notes. As physicians transition to EHRs, Apixio allows for some to move more slowly than others. Also, Apixio’s HCC Profiler has a Documentation Gaps module that identifies places of missing documentation to aid in the educational and informational efforts of physician practices.

Closing the risk adjustment documentation engagement gap

To build physician engagement around documentation, healthcare leaders can identify specific obstacles and address them in a targeted way. Whether it’s a matter of more information and education, or more technology, there are ways to move forward and ensure that risk adjustment does not suffer.

If you’d like a demo of Apixio’s HCC Profiler, simply email

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