Tuesday, June 9, 2009

Documentation and Coding Burdens

Medical economics published a great article "The Perfect Storm" and Peter Basch provided some additional commentary on this article and how the perfect storm should mean the end to E&M coding. As he points out prior to 1995 physicians were not paid for documentation but paid for services rendered. The main driver in recent years has been generating sufficient documentation to support the E&M Billing code.
Fear of failing a coding audit has made many senior physicians unlearn documentation skills developed over decades, regardless of whether they handwritten notes, dictate, or use an EHR.
The process of delivering care has been hijacked for the purposes of creating billing codes. In fact diagnostic coding systems can be traced back to King Henry VIII reign and the adoption of ICD coding in the early 1900's for morbidity and mortality. The codes were designed to track reasons for death and have been hijacked in attempt to fulfill a range of other purposes.

Multiple calls for scrapping what is an unfair burdensome system have occurred
In 2002, the Department of Health and Human Services convened a committee that concluded almost unanimously that the E&M system should be scrapped. Among its conclusions: The E&M system was not a fairer way of judging physician effort than the previous self-attestation method, it failed to add any new value, and it added an unreasonable burden to an already overburdened healthcare system

The Medicare Modernization Act of 2003 recommended to the Secretary of HHS that pilots of alternate payment systems be conducted
Unfortunately we remain locked into a process that adds little or no value to the process of caring for patients. There is an opportunity to focus on the value of clinical documentation to contain useful information that helps in the care and treatment of patients.
This is the right time for the Centers for Medicare & Medicaid Services to reissue its call for pilots of payment and documentation schema without E&M coding requirements. This is the right time for physicians to reject the shameful organizing metaphor of E&M coding—"it's not what you do, it's what you document"—and replace it with a renewed focus on what our patients deserve: better healthcare
He's right - for the longest time the call to documentation has been about the coding and billing. We have an opportunity to demonstrate the value of rich meaningful clinical documentation. Instead of asking our clinicians to be data entry clerks filling in forms for the purposes of coding use existing technology and solutions to allow for the capture of rich detailed clinical content that includes the narrative but is computer interpretable. It is possible today - we have technology, solutions and a whole industry of medical knowledge workers that delivers much of what is required already. We can create the additional information necessary to feed the data hungry EMR as part of that process and as a residual benefit this information can feed a new payment system focused on delivering high quality efficient healthcare

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