Documentation by association.
My home office is located in Merritt Island, Florida, and if you’re not familiar with where that is, you’re not the first. It’s actually five miles from Kennedy Space Center, which is about 40 miles southeast of Orlando. I moved into a home office about eight years ago, after leaving our corporate office of DoctorsManagement in Knoxville, Tennessee, and learning to work in a home environment. While working from home sounded amazing, being a very social person, it really took me some time to get used to it.
Others in the healthcare industry, through the changes brought about by the COVID-19 pandemic, have also found themselves having to find a new work rhythm in a home-based work environment. Learning that you are not the only home worker who is having water-cooler conversations with their dog can be relieving. So, today I thought we might have a little fun, and think of ways our home offices might inspire and assist us with our daily tasks, as auditors and coders. Let’s think outside of the box – well, I guess technically, for many, we are thinking outside of the cubicle!
What I’m actually talking about is using analogies. I was not a good a student throughout elementary, middle, high … well, all of my schooling. But the one thing that helped me was associations. To this day I use them, and I bet you do too. An easy example is our phone contacts. I met a new friend, Rachel, and when I added her to my phone, she rested with four other Rachel’s, two of whom I couldn’t remember to save my life. So beside this Rachel’s name, I put the bicycle emoji, and as her last name I put the name of the gym where I met her, so I have a clever way of remembering her. I realize that I did not invent such a system, but again, association is key.
I mentioned the other day that while teaching the new 2021 American Medical Association (AMA) guidelines, I compiled a sentence that combined all of the tasks that AMA indicated were approved as time-based reportable tasks. This sentence could be memorized to help auditors when working with providers and specific questions arise regarding work performed and time-based services. The sentence is this:
As the provider prepares, he reviews the history, performs the exam, and counsels the patient/family, all while creating orders, interpreting results, and making appropriate referrals, having provider-level communication with others about the patient, all in an effort to ensure ongoing patient health and safety through patient management.
What around your house do you see on a daily basis that creates an association for you, to help you remember documentation standards, or could help you when working with other team members or providers?
My husband and I share our lives with three fur babies – Noodle, Goose, and Flo – all adopted rescues, and all invading our workspace daily! The dog must be included in any association that I would form, and quite frankly, what a great association it can develop.
D – Describe the patient
O – Objectively evaluate the patient
G – Game-plan to treat the patient
“Describe” the patient is even better than words like “history” or “subjective,” because they prompt the provider to stop thinking about the old guidelines and actually visualize the patient, encouraging them to be descriptive. There is nothing about the word that suggests to a provider that there is a box to complete or a form to fill out; we are looking for you to be detailed about the state and condition of the patient.
“Objectively evaluate the patient” is wording very similar to the wording from the subjective, objective, assessment, and plan (SOAP) acronym, however don’t change what isn’t broken. Objective evaluation versus examination suggests that clinical insight determines the evaluation necessary, as opposed to performing a check-listed examination. Therefore, again, this acronym encourages the provider to be descriptive of the patient.
The game plan to treat the patient does not spell out MDM (medical decision-making), and I know that many may have concerns, as we now have an expansive MDM table to quantify documentation requirements. However, the term “game plan” can be more encompassing than MDM, encompassing a plan, diagnosis, or assessment. In order to know a game plan, we must first know what we are up against by identifying our offense and defense. This involves identifying the patient’s problem (what we are up against) and the offense (diagnostic and workups) and defense (treatments) the patient will undergo. This explains to the provider the breadth of these tasks.
I am passionate about dogs, so using dogs works for me, but another thing I am passionate about is, well, going to bed! We start our day around 4:15 a.m., so we start our bedtime routine about 8:30 p.m. – so yes, please do not call my house late! As such, another easy one for me was BED!
B – Brief description of the current problem
E – Exam as clinically appropriate
D – Diagnose and treat
Here is the thing: for a long time, many of us “hid” the idea we worked from home, covering up background noises, working hard to ensure that no one heard a doorbell, a baby cry, a dog bark, or the UPS man at the door. Today, it has become the norm. I’m encouraging you to consider, when appropriate, to seize the opportunity to shake it up and use the new environment to your benefit in training, but again, remember to choose wisely when engaging in this feedback style.
Look for this to be expanded into a full article, with a few more of these analogies to come, and if you come up with any, send them over to me as well.