Difficult Physician

I am the only CDI for a 100+ bed hospital and for 2 very small hospitals, so doing anything extra outside of reviews is very difficult. Recently, we have had some changes in the CDI department and prior to coming onboard there was a lot of tension between CDI and the Hospitalist’s.  I have reached out to each of the 4 Hospitalist’s to find out their preferred method of communication.  We have one particular Hospitalist who frequently complains about the amount of query’s and they type of query’s they are receiving. Instead of going to CDI or the CDI manager they go to a manager who doesn’t have anything to do with CDI and then that information has to be relayed back to us. In this particular instance, the Hospitalist saw that I was there and even looked at me, but didn’t want to talk with me. This Hospitalist doesn’t want to be queried no more than 25% of the time and doesn’t want certain query’s sent because they will just answer Unable to Determine if these are sent, which is what happened this week. All of query’s sent this week, affected either the DRG, were an MCC, CC or affected the SOI/ROM. I also ran the percentages of query’s they had received for the 1st and 2nd quarters and they only receive 15% of the query’s  sent out for each quarter.

So my question is, How do I build a relationship with this particular provider, especially if they purposely don’t want to talk with CDI?


  •   A very difficult situation and not easily resolved. Do you have any idea why there is so much friction between the hospitalists and CDI? Often, a lack of understanding why CDI is important leads to misunderstandings and you can be perceived as the 'enemy" instead of a professional trying to help them. 
      A physician advisor or chief of medical staff should intervene in this circumstance as only peer-to-peer interaction will likely be most effective.
      Administration may also need to get involved- clearly they saw a need for CDI and your services are not cheap. If you are not getting the necessary cooperation they will have to intervene. In my opinion, the non-CDI manager the physicians are going to should refer them to directly contact the CDI manager and not be a go-between.  
      Finally, peer pressure may help. If Admin can share patient acuity, DRG and severity data for the patients each hospitalist cares for, the uncooperative MD may see that his/her patients are not a sick as his peers. Of course, each physician should only be identified by letter or number known only to themselves. 
     Good luck. Please follow-up with how things are going. 
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