Medical Necessity

Enjoin: Enabling Holistic Clinical Documentation Improvement

October 1, 2019 8:30 pm
James Fee, MD, CEO of Enjoin.

In this Business Profile, James Fee, MD, CEO of Enjoin, discusses the importance of holistic clinical documentation to realize success with existing fee-for-service payment models, as well as value-based care and population health initiatives.

How do you help healthcare organizations?

Enjoin is a highly-experienced, physician-directed company that offers comprehensive solutions for improving clinical documentation. Our goal is to help organizations fully tell their patients’ stories through complete and accurate documentation and coding that reflects the risk, severity and complexity of the patient population, as well as the quality of care the organization provides. Our proven approach can be applied to any care setting, empowering organizations to transform their clinical documentation across the continuum. Through a robust clinical documentation improvement (CDI) program, our clients are laying the foundation for the Triple Aim — better care, healthier patients and smarter spending.

What are some of the biggest challenges you see affecting healthcare organizations?

A significant challenge involves maintaining financial solvency amid the push toward value-based care. With reimbursements declining and denials increasing, it is difficult to move toward pay-for-performance while continuing to succeed in fee-for-service arrangements. There are so many diverse initiatives happening, and consequently, there are numerous ways an organization can be judged. Unfortunately, as entities work toward success in the various programs, they often don’t approach the work collaboratively, especially when it comes to the translation of clinical care or clinical documentation. The reality is whatever an organization’s goals are — whether it be assuming more risk, optimizing current performance, reducing denials or facilitating population health management — the focus needs to be on improving documentation and coding because if those fully and accurately reflect the patient encounter, then everything else will fall into place. Conversely, if an organization trains providers to document based on a single desired outcome, they can lose credibility and physician buy-in for the work because the rules may change as different objectives take priority. The key is to train providers to document a concise, transparent view of the patient’s story that will meet organizational objectives across all areas of quality reporting, risk tolerance, financial performance and clinical excellence.

Another issue with which organizations wrestle is big data. It seems like everyone is trying to determine the best ways to leverage the large quantities of information that are now available. Due to our deep experience, we’re able to offer insights into how to turn data into actionable and operational information. Our practicing clinicians and clinical coding experts are positioned to support an organization’s providers, helping them create the exactness needed for documentation without additional burden, which allows them to maintain the physician-patient relationship and avoid burnout.

How do your service offerings address these needs?

Enjoin delivers a highly collaborative experience. As a first step, we assess where a client is on its CDI journey and work to understand its goals. Our team identifies vulnerabilities through data analysis, chart reviews and CDI process assessments. We’re able to offer predictive analytics to illustrate the areas that will have the greatest impact for the organization. Based on this information and extensive conversations with organization leaders, we then craft a customized strategy for realizing better documentation and coding at the local setting and across the continuum.

As we start to develop a program, we take into consideration the organization’s existing data and technology capabilities. Over the years, we’ve come to appreciate that organizations are at different places with regard to technology and data, so we build our offerings around an entity’s readiness for change and growth, using the organization’s current investments to frame the program.

A fundamental component of our services is peer-to-peer, specialty-specific provider education grounded in clinical practice. Our board-certified physicians offer clinical insight and coding know-how. Since our physicians are actively practicing medicine, they can provide a real-world view of how to improve documentation based on evidence and what they are seeing in their own practices. This level of expertise and practical advice goes a long way toward fostering provider engagement and buy-in.

Our documentation and coding specialists include internists, hospitalists and specialists across several disciplines, including cardiology, pulmonology, urology and more. Our physicians don’t just feed information to an organization’s doctors behind the scenes, they are intimately involved in creating the infrastructure, strategy, design and delivery of our services.

What are some key considerations for healthcare leaders when choosing this type of service?

The biggest consideration is whether your CDI partner has clinically practicing physicians who are also credentialed in coding and documentation, so they can link evidence-based medicine with coding and documentation proficiency. Going a step further, Enjoin’s physicians are also thought leaders in the industry and are deeply involved in evolving clinical documentation as a profession, improving the consistency and integrity of the work. Due to this vast experience, we bring a degree of documentation and coding expertise that is unique to the marketplace, helping our clients look beyond their current needs to see what’s possible and transform their operations to achieve better quality and cost performance amid new and emerging payment models.

Another consideration is whether a potential partner can deliver a solid return on investment (ROI). Our clients see a demonstrable improvement in coding accuracy, quality metrics, risk adjustment and physician alignment — with an average ROI of more than 700%. We also focus on knowledge transfer to help organizations sustain the clinical documentation work over time, embracing a train-the-trainers approach.

In a day and age where there’s constant change and evolution, it’s important that a CDI partner embraces a multifaceted approach to documentation and coding that looks at revenue recovery, clinical validation and denial defense to mitigate the risks that are still critical in today’s world but also considers how to appropriately code for risk adjustment and quality measures to enable success in emerging arrangements.

As healthcare organizations implement your service into their day-to-day operations, what advice would you offer so they can best set themselves up for success?

Organizations need to establish a documentation culture where the work becomes part of the day-to-day fabric of care. To achieve this level of commitment requires a multi-disciplinary effort between coding, CDI, quality, physicians and the population health team — and this collaboration must stretch across the continuum. This may mean regular meetings and avenues of communication to support dynamic information exchange.

Organizations also need to be willing to take a step forward and move out of traditional fee-for-service CDI and embrace an approach that facilitates pay-for-performance, value-based care and population health as well. They need to understand that although the financial component is important, so is the quality piece and the impact of holistic documentation on patient care.

Probably the most important thing to fostering a documentation culture is physician support. To fully engage providers, organizations may want to create a physician adviser program that encourages networking across the entire organization. The entity can then leverage these individuals to continuously evolve the CDI program.

How can healthcare organizations learn more about your company?

For more information about Enjoin and how we can help advance your organization’s CDI efforts, go to

About Enjoin

Value-based care and risk adjustment methodologies for payment and performance require increased transparency into providers’ performance and data integrity. With thirty years of direct physician leadership, Enjoin delivers complete solutions for clinical documentation integrity across the continuum and ensures evidence-based care is accurately reflected through precise documentation and coding. Enjoin clients achieve a demonstrable improvement in CMI, coding accuracy, quality metrics, risk adjustment, and physician alignment. For more information, visit


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