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For cash strapped hospitals the focus of care shifts.

Posted Dec 23 2008 9:14pm
F or cash strapped hospitals the focus of care transfers from the patient to documentation. Many hospitals have made the jump to using electronic or computer based documentation systems in their emergency departments. These computer based systems often offer much better reimbursement capture because they are designed to do that through the us of check boxes that are already coded. The systems are usually complicated and many computer novices have trouble during transition.

In any event the systems are based on a series of clicks with a mouse with some allowable free texting that providers can add in, but free texting is discouraged because it is not already coded in the program's software makeup. Most hospitals will see improved reimbursement rates and higher returns for physician billing with the use of an electronic documentation system. All good news. On a side note there are many platforms to choose from. Most are configured using an al a carte set up where hospitals will purchase only the pieces they want, or rather the pieces they can afford. There are Cadillac systems and there are Ford systems. Healthcare organizations with a little better fiscal standing can often afford the more pricey systems while many places end up with a Ford.

The issue that comes into play is when hospitals are experiencing a negative cash flow and the management team begins to really focus on reimbursement capture. The message that is hammered down to the bedside clinicians is documentation, documentation, documentation. The focus for providers often shifts at that point away from the patient and to the computer to ensure that every single possible check box is checked that is applicable to the care of the patient regardless of the time it takes to complete this task, all in the name of improving reimbursement capture.

On the surface this may seem like the right thing to do, improve reimbursement capture. The problem is, is that with many of the middle class documentation systems the time required at the key board to complete a chart is significant. Nurses and physicians are tied up in front of a CRT which delays care and impedes patient flow, especially in emergency departments. This is especially concerning when a critically ill or injured patient comes into an emergency department and additional staffing resources are required so that one nurse can do nothing but type on a key board. Additional delays in care can be seen with acutely ill patients that need to be transferred to another facility and the transfer crew is often waiting with the patient while last minute documentation is being entered into the computer by nurses and physicians.

Documentation becomes the focus of care and we make a shift from patient centered care to computer centered care. Care is delayed, patient flow in emergency departments becomes sluggish, department crowding is exacerbated, and patients line up in the waiting room to see an ED doc. What are the answers here?

Hiring more staff is not likely to be viewed as a plausible solution especially with cash strapped hospitals. Taking the focus of documentation is not going to happen either. Writing things down on paper and later putting them in the computer which some providers already do is probably not the best idea to advocate for. And often it is difficult to go back days later and fill in the blanks with details, not to mention that typically involves paying providers - nurses and physicians over time while they type away when it is more convenient. So what is the answer? Clearly purchasing a better system on the front end would possibly help but some hospitals can't afford the expenditure. For those of you that are dealing with such issues in your hospital what have you found that works?
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