General Summary:

The System Physician Advisor for CDI serves as a key liaison between Quality, clinical teams, CDI specialists, coding professionals, and hospital leadership. This role ensures accurate, complete, and compliant clinical documentation that reflects the true severity of illness, risk of mortality, and quality of care provided across Henry Ford Health. The advisor will champion documentation integrity initiatives, educate providers, and drive improvements that directly impact quality outcomes, compliance, and organizational performance. The Physician Advisor will work the quality team to prioritize CDI efforts that support top-decile quality outcomes, as measured through Vizient expected performance, CMS Programs, Leapfrog, and U.S. News & World Report.

Reporting Structure:

• Direct: Chief Utilization Officer

• Dotted Line: Chief Quality Officer

Primary Responsibilities:

Documentation Integrity

·         Review inpatient medical records for accuracy, completeness, and compliance with regulatory standards.

·         Ensure documentation reflects the true severity of illness, risk of mortality, and medical necessity.

Physician Education & Support

·         Provide ongoing education to physicians and advanced practice providers regarding documentation improvement.

·         Serve as a resource for clinical staff on coding, DRG assignment, and documentation requirements.

Collaboration

·         Partner with the CQO, Quality Team, CMOs, Clinical Documentation Improvement (CDI) specialists, coders, and hospital CDI physician advisors.

·         Act as a bridge between clinical and administrative departments to align documentation with organizational quality goals.

Quality & Compliance

·         Monitor documentation trends and identify opportunities for improvement.

·         Ensure compliance with CMS, Joint Commission, and other accrediting bodies.

·         Participate in audits and assist with appeals related to clinical documentation and DRG denials.

·         Drive initiatives that improve quality scores, patient safety indicators, and risk-adjusted outcomes.

Collaboration

·         Advise hospital leadership on documentation practices impacting quality scores, reimbursement, and compliance.

·         Contribute to policy development and CDI program strategy.

System Definitions for Diagnosis

·         Develop and maintain standardized definitions for diagnoses across the health system to ensure consistency in documentation and coding.

·         Collaborate with CDI teams, coding professionals, and clinical leadership to align definitions with regulatory requirements and organizational goals.

·         Provide guidance to physicians and CDI specialists on applying these definitions in clinical documentation.

Key Performance Indicators (KPIs):

·         Query Response Rate: Percentage of physician queries answered within 48 hours.

·         DRG Accuracy: Rate of correct DRG assignment post-review.

·         Severity of Illness (SOI) & Risk of Mortality (ROM) Capture: Improvement in case mix index and quality metrics.

·         Denial Reduction: Percentage decrease in DRG-related denials.

·         Education Impact: Number of physicians trained and improvement in documentation compliance scores.

·         Vizient Expected Mortality Index

·         Vizient Expected Length of Stay (LOS) Index

·         Observed-to-Expected (O/E) Mortality

·         O/E Readmissions

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