Quality of care cannot be achieved without good data.
2020 has brought us many looming changes in healthcare. Unfortunately, we have already seen increased reporting criteria, more administrative burden, and many payment cuts. As we address all of these, not only this year but also in future years, we need to make sure we keep our eye on the prize. In our case, the prize is quality patient care.

Healthcare is quickly becoming overregulated, and reimbursements have steadily declined. We need more staff to do more tasks, in order to get paid less. There are many hoops we have to jump through to get services paid, to meet quality reporting initiatives, or to get services or procedures approved – all this to go along with the many other hassles that drain our practices. We must be careful to not allow ourselves to become desensitized to the grind.

Inevitably, I hear about practices that develop checklists or tasks designed to streamline those processes, and staff is trained on how to check the boxes, which are not always related directly to patient care. The signature task becomes how to get paid, not making sure the patient is treated correctly.

Let me share a story with you. My husband recently had an abnormal blood test. I didn’t go into his appointment with him, as I had my own appointment shortly after his. As he walked out, I looked at the stack of papers and orders for testing. You can imagine my panic when I saw the diagnosis of CKD, mild. Remember, this was simply one elevated test.

When I went into my appointment, I questioned the doctor. He told me he felt pretty certain that if it wasn’t that, then it was renal stenosis, and that I shouldn’t worry about the diagnosis, because he had “magic” software that kept the diagnosis from the health insurance company (go ahead, laugh: you know you want to).

Turns out, it was another culprit: a prescription drug that my husband was taking that elevated his numbers. Once that was discontinued, all was fine. But imagine our surprise when a month later, we were assigned a care manager through our health plan because of the diagnosis code used.

This provider actually has a history of using diagnosis codes that get services paid by the plan. He’s not the only one; I have run into it often, not to mention the countless similar stories I hear from others in healthcare.

We can’t treat patients like checkboxes on task lists. Administrative burdens are a struggle for all of us, but we have to approach the data and subsequent care of our patients with integrity. We need to really ask ourselves if those quick-buck ancillary services we have started offering to give us additional context for treating the patient – or would the treatment plan remain the same?

Quality of care should be key, and without good data, that cannot be achieved. That means documenting for the true clinical condition, and not for payer requirements, quality measures, or revenue enhancements.

Strategy is also key. Taking a day to educate staff on the clinical conditions you are offering goes a long way to understanding the intent behind the checkboxes. Staffing changes occur frequently, so this training should be repeated often, and incorporated as part of your compliance plan. Clinical documentation improvement (CDI) programs should be effective in spotting irregularities with problematic checklists, and robust enough to enable good reporting of any issues encountered.


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