Chart Documentation & Capture: The Heart of Your Reimbursement
Over the years, the practice of Emergency Medicine continues to become more difficult. The usual suspects of concern include decreasing reimbursement dollars, eroding payor mix, increased patient volumes, increased malpractice costs, physician shortages, increased government scrutiny, etc. At times, I wonder how our health care safety net has survived this long without a crash of epic proportions. However, Emergency Physician have proven to be a resilient group that faces challenges head-on and finds a way to survive to see another day. The American public is very lucky that the E.D. physicians of this country have not placed their pocketbook ahead of patient care, like many other houses of medicine, which only provide services to those who can pay and pay good rates.
As most of you know, chart documentation and capture is vital to the financial livelihood of each practice. With the advent of template charts and increased education in documentation, most physician practices I have reviewed have become very good at documenting their services in a compliant and efficient manner. Templates tend to be faster and more cost efficient than dictation; therefore, the physician practice has reduced the time from service provision to collection for services by several days. Furthermore, many of the hospitals have implemented scanning or other methods to accurately account for all of the E.D. records such that the physician group can bill for all of their charts. I would say that lost records, while still a problem for many, are much less of a problem than in the good old days. Now comes the new challenge, ELECTRONIC MEDICAL RECORDS .
As most of you know, many hospitals are making a major push to implement electronic charting systems to eliminate the paper. They invest millions of dollars into these systems believing the sales speak that while most costly on the front-end, they will realize great savings through efficiency. The sales people all have fancy graphs and formulas that illustrate the savings and hospital CEO's and CFO's salivate without evaluating the downstream effects of their decisions. With certainty, in the perfect world, these electronic records and ordering systems will create efficiencies for some; however, at what cost to others?
Over the last two years, several of my clients have been forced from template or dictation to electronic medical records. In every instance, the hospital chose which medical records system to purchase and implement without consulting the E.D. physicians. Yes, they allowed the physicians to go on the site visit of another hospital that is using the system; however, they had no real decision-making authority. Since the E.D. physicians will be the largest user and most affected, you would think they would value their input in the purchase decision.
As you know, physicians who are skilled at documenting on a template or dictation can usually document their medical record in 2-3 minutes thereby dedicating most of their time to patient care. I have been through the implementation of at least three different electronic medical records systems and what I have seen is scary. Even the most proficient computer literate E.D. physician users are averaging 7-10 minutes to document a record in the electronic record. While you need to be a team player and embrace the change for the betterment of the hospital and survivability of your contract, do you really have enough time to add 5-7 minutes to your documentation of each record? With our ever increasing patient volumes, the answer for most physicians is unequivocally NO . Furthermore, this increased time will likely negatively impact patient throughput times, which in turn will decrease patient satisfaction scores. What a vicious cycle. Let's do the math.
Hospital A treats: 100 patients per day
Staffed Hours: 50 Hours
Current Throughput: 180 minutes on average
Daily Coverage Cost: $7,500
Calculation of Increased time:
100 x 5= 500 minutes or 8.33 hours
Additional E.D. Physician cost to maintain patient throughput at current levels:
8.33 x $150= $1,250/cay or $456,250 annually
Who will pay for this cost? Likely not the hospital as they believe the system will be more efficient because the sales rep told them it would. Couple this additional cost with the current difficulties most electronic record systems have with sending a batch of records to your billing company and you have a real problem. Most electronic records companies expect your billing company to obtain portal access and look charts up individually. This is not only very slow and inefficient, but will likely result in increased billing cost and increased days from service to payment for services.
Now that I have ruined your day, here is how I recommend you proceed. First, become very active with the hospital decision makers on what system they choose as some may fit your needs better than others. Second, look for efficient systems. Third, do time studies so that the hospital administration knows who much extra time this will take and how it will impact patient throughput. Fourth, make sure all physicians have adequate training. Lastly, make certain the vendor chosen has a mechanism to send a batch of charts electronically to your billing vendor rather than portal access. Remember, chart documentation and capture is the Heart of your business from a financial perspective .