Concurrent Surgical Patient Safety Indicator Evaluation Results in More Accurate Reporting and Reimbursement
By Harvey, Dale | |
Proquest LLC |
We sought to determine whether concurrent (before discharge)
We performed an
There was a total of 700 charts reviewed during the timeframe of the study. There were 276 records reviewed in the preC versus 424 in the postC time periods. The vast majority of errors were the result of coding inaccuracies: 225 (81.5%) preC versus 365 (86.1%) postC (P 4 0.1117) followed by issues with documentation: 26 (9.4%) in preC versus 40 (9.4%) postC (P 4 1.0000). The other reasons for rebilling being required include identification of a present on admission diagnosis: six (2.2%) in preC vs 10 (2.4%) in postC (P 4 1.0000) and delay in physician re- sponse to a query: eight (2.9%) preC vs nine (2.1%) postC (P 4 0.6169). The modifications made to the patient's chart are listed in Table 1.
Total charges in the preC group were
Over the last decade, pay-for-participation has transformed into pay-for-performance such that high- performing providers receive financial incentives. However, it has continued to morph and now is more punitive with penalties for ''poor'' performance despite known inherent inaccuracies in the use of administra- tive data.1
One of the major challenges with these penalties is that performance is defined by metrics from the UHC and collected based on administrative data. Our error rates of over 80 per cent for both preconcurrent and concurrent coding demonstrate this well. Moreover, the slightly higher error rate in the concurrent group emphasizes that these errors are difficult to eradicate and perhaps more readily identified using concurrent coding.
In a previous study by the authors, we performed physician review of PSIs identified by codes. In this article, the overall positive predictive value of admin- istrative detection of PSIs through billing codes was 83 per cent with positive predictive values as low as 67 per cent for some PSIs.2 These findings are consistent with the literature that notes a positive predictive value for coding ranging from 29 to 83 per
Despite all of the issues with the approach of using administrative data for safety monitoring, it is unlikely to change. The current setup of postdischarge review goes through thorough documentation review to en- sure accuracy of coding at odds with efficient billing. Many private insurers have a 72-hour limit from the time of discharge to bill a patient stay. This makes it very challenging for documentation nurses to complete their assessment and make changes to codes when necessary. In fact before concurrent coding, reviews took over three months to complete, thereby delaying rebills and consequently reimbursements. Another important finding is that the recodes requiring rebilling decreased significantly after postconcurrent coding, which should result in more accurate UHC reporting and more timely and appropriate reimbursements.
Based on our initial data, concurrent coding while patients are in the hospital can significantly decrease the time to review charts. It may be more sensitive as well identifying slightly more coding errors, but be- cause these are identified early, less rebilling is re- quired. As we move more toward a punitive system with lost reimbursements and fines for poor perfor- mance, concurrent coding may be a prudent approach to address these problems. Given that up to two per cent of
REFERENCES
1.
2. Ramanathan R, Leavell P, Stockslager G, et al. Validity of
3. Borzecki AM, Kaafarani H, Cevasco M, et al. How valid is the AHRQ Patient Safety Indicator 'postoperative hemorrhage or hematoma'? J Am Coll Surg 2011;212:946-53.
4. Utter GH, Zrelak PA, Baron R, et al. Positive predictive value of the AHRQ accidental puncture or laceration patient safety in- dicator. Ann Surg 2009;250:1041-5.
From the *
Presented at the Annual Scientific Meeting and Postgraduate Course Program,
Address correspondence and reprint requests to
Copyright: | (c) 2014 Southeastern Surgical Congress |
Wordcount: | 1278 |
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