Impact of documentation training on acute admissions and observations
The fear of RAC audits has permeated many community hospitals resulting in a conservative tendency to classify many patients as observation status rather than an acute admission. The “2-midnight rule” introduced further confusion and ambiguity. These decisions ultimately impact the hospital’s revenue negatively, and often adversely add cost to the patient. The hospital began to see an increase in observation patients to the point where the number of observation patients became roughly the same as acute admission patients. As the hospital administrator researched national benchmarks, he found that his hospital’s relationship of observation patients to acute admissions was an outlier and he needed to find an Emergency Medicine provider that would partner with the hospital to ensure appropriate documentation and classification of all inpatients.
Based on our reputation for revenue growth by intercepting inpatient outmigration and the administrator’s confidence that we understood and had the solution for his acute admission vs. observation status, he invited HospitalMD to provide his Emergency Medicine services. Physician documentation training is standard within our training and education program; and fundamental to establishing medical necessity and optimal coding. We implemented our training program which routinely includes the hospital staff and parallels our physician training. The scope of our training included UR, Case Management, the Nursing staff, and the Medical Staff.
“The hospital was able to increase acute admissions an additional 2.7% of ED patient visits, and decrease observation patients by 2.9% of ED patient visits.”
The hospital was able to increase acute admissions an additional 2.7% of ED patient visits, and decrease observation patients by 2.9% of ED patient visits. The hospital leadership embraced the revenue growth as well as the evidenced-based training and education, and collaboration with hospital staff. HospitalMD physicians and hospital staff are now on the “same page” in terms of how “we” judge medical necessity and clinical documentation.