Over the past few weeks, we’ve taken on the task of disproving the misconception that hospitals only have two options for emergency department management: hospital-employed physicians or turn EM physician management over to an outside group.
The first post of our series addressed a common challenge: recruiting EM physicians; the second focused on leadership and accountability. In this, the final post of the series, we look at performance management, documentation, and revenue.
The Pressing & Perilous Challenge: Performance Management
Tracking an ED’s operational and financial performance requires considerable work, time, and data. With an entire hospital to oversee, gathering, monitoring, and analyzing up-to-the-minute ED reports is difficult but imperative; the ED is your hospital’s front door and drives both its reputation and admissions. Here are three options for you to consider:
1. THE BIG, INEXPENSIVE (BUT TAXING) OPTION
Take on the task — but work closely with your HIM and coding department to devise an automated system of monitoring and reporting the metrics that matter most: ED performance, physician productivity, PQRS, population health, resource utilization, and all factors that impact patient satisfaction and your medical director’s ability to make researched-based decisions.
Meet regularly with the medical director to review, evaluate progress toward goals, and devise process improvements.
2. TOO SWAMPED? DIVIDE AND CONQUER.
Rather than burdening a single person, divide monitoring and mentoring responsibilities among different administrators, preferably according to individual interests and skill sets. Be aware, disbursement does have its drawbacks: It requires frequent collaboration and coordination among C-suite counterparts to prevent information silos.
3. CONTINUOUS OVERSIGHT
It is possible to outsource only your ED’s operational and/or financial management to an organization that specializes in ED management for hospital-employed physicians. You maintain control; the group stays abreast of the ever-changing reimbursement rules, guides the ED team to reach hospital goals, and is fully accountable for the results.
POINTER: If you elect to outsource, make sure the group pairs tools and service to move the proverbial needle: First, robust reports that track every ED metric that matters, and second, a hands-on, day-to-day clinical/management leader that works closely with your ED medical director to improve those metrics.
The Challenge You Don’t Know You Have: Documentation & Revenue
The most insidious challenge to ED RCM? Believing that it’s running fine — when you’re actually leaving your money on the table. Avoid this fate by periodically requesting a free audit from a reputable, external RCM organization that specializes in emergency medicine.
If it reveals you’re missing out on revenue your ED has earned, act quickly with one of the options below.
1. THE BIG, IMPACTFUL (BUT FORMIDABLE) OPTION
If your audit shows ED providers are often unclear in their documentation, omitting crucial details, and/or simply wording information incorrectly, help them: Invest in, develop, and implement a clinical documentation improvement program that can be tailored to assist each provider in bettering his or her individual documentation skills.
2. ADD PERSONALIZED SUPPORT
A strong CDI program will garner better, faster, longstanding results if you back it with real-time feedback and oversight from a dedicated ED RCM specialist. He or she should work closely with your ED clinical staff, revenue integrity experts, and coders to ensure concise, complete, and fully compliant documentation, clean claims, reasonable A/R rates, etc.
One drawback: Building a CDI program anew is costly and time-consuming, and until it launches, your money continues to languish on the proverbial table.
3. COVER ALL BASES
Offload all of the aforementioned tasks to an external RCM service that specializes in emergency medicine coding. Select one that offers all of the above services, boasts an outstanding compliance record, and can deliver a worthwhile return on your investment — i.e., an improved chart accuracy rate that recovers more revenue per chart.
(NOTE: The American Health Information Management Association and the Association for Clinical Documentation Improvement Specialists offer strategies and resources to help hospitals educate their providers and develop CDI programs.)
This post concludes the series on the challenges of hospital-employed EDs.
