Inpatient resident documentation on admission H&Ps, daily progress notes and discharge summaries is intimately tied to how SFGH, a publically funded safety net hospital that provides 20% of all inpatient admissions to the city, is reimbursed. More specific diagnoses are coded to heavier weighted drgs that lead to higher reimbursements. For example, there is a difference of thousands between simply writing congestive heart failure and acute on chronic systolic heart failure. Moreover, the way residents document becomes ultimately translated into how SFGH gets evaluated by numerous external agencies. The case mix index and expected mortality ratios are ways by which our hospital is compared to others. 

There is wide variation between resident documentation as well as varying degrees of awareness of the titanic implications of how the language residents use affects reimbursement and ultimately the hospital's public opinion, both among residents and seasoned attendings.

While the clinical documentation team has already been able to affect much change, there is still plenty more to be done. I believe there are very simple sustainable ways we can change how residents document because as the adage goes, "no money, no mission."