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In February 2015, the American Hospital Association (AHA), in conjunction with Executive Health Resources, launched its inaugural clinical documentation improvement (CDI) survey, “Emerging Trends for Clinical Documentation Improvement in 2015,” to help determine the main barriers to CDI success. Many powerful insights related to physician engagement in CDI programs were revealed by the survey’s participants, which included more than 1,000 CDI, coding, health information management (HIM), and other professionals in CDI programs across the United States.

About the Survey

The survey was promoted nationwide and the results reflect a balanced representation across the country (plus Washington, D.C. and Puerto Rico). The provider landscape represented was diverse and included small hospitals of under 200 beds (27.3 percent), midsize hospitals of 200-plus beds (33.7 percent), and multi-hospital systems (28.9 percent).

Most programs (87.9 percent) represented in the survey results either are in a growth or mature stage of their CDI program, well past the inception phase.

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Ralph Wuebker, MD, MBA

Dr. Ralph Wuebker serves as Chief Medical Officer of Executive Health Resources. In this role, Dr. Wuebker provides clinical leadership within the company and works closely with hospital leaders to ensure strong utilization review and compliance programs. Additionally, Dr. Wuebker oversees Executive Health Resources’ Client Services teams, who provide onsite education for physicians, case managers, and hospital administrative personnel and help hospitals identify potential compliance vulnerabilities through ongoing internal audit. An expert in CMS regulations, medical necessity compliance, utilization review, denials management, and program integrity efforts, Dr. Wuebker also serves as an industry thought leader and editorial advisor to the media, as well as a highly respected and distinguished industry speaker.

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