A workflow task force affects emergency physician compliance for point-of-care ultrasound documentation and billing

Abstract

BackgroundEmergency point-of-care ultrasound (POC u/s) is an example of a health information technology that improves patient care and time to correct diagnosis. POC u/s examinations should be documented, as they comprise an integral component of physician decision making. Incomplete documentation prevents coding, billing and physician group compensation for ultrasound-guided procedures and patient care. We aimed to assess the effect of directed education and personal feedback through a task force driven initiative to increase the number of POC u/s examinations documented and transferred to medical coders by emergency medicine physicians.MethodsThree months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified through brain storming and email solicitation. The total number and application-specific POC u/s examinations performed and transferred to the healthcare record and medical coders were compared for the pre- and post-task force intervention periods. Chi square analysis was used to determine the difference between the number of POC u/s examinations reported before and after the intervention.ResultsA total of 1652 POC u/s examinations were reported during the study period. Successful reporting to the patient care chart and medical coders increased from 41 % pre-task force intervention to 63 % post-intervention (p value 0.000). The number of scans performed during the 3-month periods (pre-intervetion, post-intervention 0–3 months, post-intervention 3–6 months) was similar (521, 594 and 537). When analyzed by specific application, the majority showed a statistically significant increase in the percentage of examinations reported, including those most critical for patient care decision making: (EFAST (41 vs. 64 %), vascular access (26 vs. 61 %), and cardiac (43 vs. 72 %); and those most commonly performed: biliary (44 vs. 61 %) and pelvic (60 vs. 66 %). Of the POC u/s studies coded and reported for reimbursement, 15.9 % were billed before intervention and 32 % were billed after intervention (p value: 0.000).ConclusionsThe formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing over a 6-month period. Further investigation should assess the long-term effect of the intervention and whether this translates into increased revenue to the department.

Time to establish pillars in point‐of‐care ultrasound

“…Some alternatives exist for PoCUS reports including Electronic Medical Record (EMR) forms, handwritten patient progress notes and report screens completed on the ultrasound machine archived with scan images. There are also dedicated PoCUS IT systems that incorporate PACS, EMR and other program functions …”

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“…The development of a financially viable emergency US program is important to justify the ongoing US equipment purchases, infrastructure support, and operational expenses for EDs. 4,7,8 After implementing this work flow innovation, which included a new documentation and billing process, we have seen 96% and 78% percent increases in point-of-care US examination net technical and professional fee revenue, respectively. Professional fee charges are determined independently by our professional group's separate billing company.…”

Structured Neonatal Point-of-Care Ultrasound Training Program

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