Top Clinical Officers at Health Systems and Hospitals Rising to Financial Challenges

Chief medical officers and other top clinical officers are playing an active role with financial teams.

Chief medical officers and other top clinical officers are more closely involved in financial affairs than in the past.

One of the most salient observations at this summer's HealthLeaders Chief Medical Officer Exchange was that top clinical officers are being encouraged to engage with chief financial officers and their staffs to help address financial challenges at health systems and hospitals. This cooperation is essential as health systems and hospitals face tighter financial margins.

Aimee Becker, MD, CMO of UW Health, says she works closely with the Madison, Wisconsin-based health system's chief financial officer. "All of our leaders are expected to possess a business acumen, including our physician leaders. That business lens has to be part of how we care for patients. Our physician leadership structure includes triads and dyads, where our physician leaders work in partnership with our administrative colleagues. Through these partnerships, we are executing on the right patient care in financially responsible ways."

UW Health sees financial opportunities in providing value in care, she says. "One specific example is inpatient flow optimization work. When you think about patient navigation, whether it is through our emergency departments, through elective admissions, or through surgical processes, patient flow is key. From a process improvement standpoint, by being more efficient and providing the patient with the right care when they need it, there is a financial benefit that comes with that."

Value-based care requires cooperation between clinical leaders and financial leaders, says Daniel Durand, MD, chief clinical officer and chair of radiology at Baltimore-based LifeBridge Health.

"We are looking at the current value-based contracts that we have and the different terms of the contracts. We look at which contract terms that we like, which contract terms that we want to do more of in the future, and which contract terms that we want to do less of in the future. On an annual basis during the budgeting cycle in combination with others such as the chief operating officer of the medical group, we look at the value-based contracts that we are in and think about the new budgetary items we need to focus on—we look at the capabilities that we don't have today that we need to excel in value-based care such as actuarial analytics, physician-facing reporting, contract alignment at the physician level, access solutions, and patient navigation hubs," he says.

Durand and LifeBridge's physician leaders are also focused on cost-cutting, he says. "In cost cutting, we are getting rid of unused space in our bricks-and-mortar facilities, minimizing inventories, getting rid of high-cost supplies that have acceptable alternatives, and limiting premium labor. These are great ways for a health system to focus resources on where they are needed most and get rid of waste."

Optimizing clinical documentation

A primary area where clinical activity has financial implications is clinical documentation.

Accurate and timely clinical documentation is a top priority at UW Health, Becker says. "We are trying to make it easier for physicians and advanced practice providers to do accurate and timely documentation. That work has a host of secondary benefits, including improved risk adjustment, meeting quality metrics, and coding integrity. It makes sure we get paid, but it is really about doing the right thing for patient care, and it is part of our professional obligation as physicians and advanced practice providers."

At UW Health, there are coding reviews that occur behind the scenes to ensure the integrity of clinical documentation, she says. "The clinical documentation integrity team is fact based and data driven. We have a physician medical director who is involved with this work, too. They work to leverage the functionality of our electronic medical record, Epic, using standard, templated note documentation to improve both the integrity of the documentation in real time as well as to make it easier for busy physicians on the front-end."

The coding team works closely with clinicians, Becker says. "Our coding team conducts coding reviews and, sometimes, they seek clarification through coding inquiries with our physicians. As we have done this documentation integrity work at the clinical service level, we have seen that the coding inquiries have decreased considerably. It has been a big satisfier for our physicians who have been part of this work on template review and optimization."

Technology plays a key role in clinical documentation, Durand says. "Whenever you have some kind of documentation solution, usually they are electronically oriented. No one is using paper charts or paper billing anymore. All of this is now digital, meaning that it all can benefit from tools such as natural language processing and artificial intelligence as well as electronic workflows. Every one of these solutions that we put in play gets vetted by both compliance and information technology staff."

There are multiple paths to good clinical documentation, he says. "One is a delayed loop, where you have coders looking for key patterns to generate insights for physicians, so that when they document in the future, they include certain key information. There is obviously a lag in this pathway, and there are people who will say that you get your biggest bang for your buck when you present clinicians with information in real time in their workflow. We have a variety of different pilots and operational programs that fit that description, where people are prompted with an algorithm that is doing natural language processing. When clinicians use certain words, it has reimbursement implications and sometimes it has penalty implications, too. Often, penalties arise unnecessarily when clinicians do not use clinical terms thoughtfully. That can result in miscoding."

Clinical documentation is a primary responsibility of clinicians, Durand says. "The future of clinical documentation will be more and more digital. The physician will be focused on a process to make sure that they have done a truthful and complete documentation. We want to be truthful because we do not want to ever over-document, but we want to be comprehensive because we do not want to under-document and either underrepresent the patient's medical risk or underrepresent the services that were provided."

Related: The Exec: Physicians Play Key Role in Healthcare Administration