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Jeff Waugh, MD, PhD Fellow in Pediatric Movement Disorders Massachusetts General / Boston Children’s / Harvard University.

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Presentation on theme: "Jeff Waugh, MD, PhD Fellow in Pediatric Movement Disorders Massachusetts General / Boston Children’s / Harvard University."— Presentation transcript:

1 Jeff Waugh, MD, PhD Fellow in Pediatric Movement Disorders Massachusetts General / Boston Children’s / Harvard University

2  Over two audit cycles in 2011, our largest insurer markedly increased the stringency of audits  For Residents and Fellows: - 97% of all inpatient notes were downcoded - 53% of all outpatient clinic notes were downcoded  Mean outpatient value lost : $232 per note  Inpatient notes lost 71% of billed value 2

3 3 % of “Correct” Notes Over one year, we reduced downcodes from 54% to zero.

4  Three key changes: - Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and department 4

5 Conservative savings estimate: $23,892/individual/year x 26 fellows + residents: $621,200 per year 5 ROS Not new Medical Dec Making Physical Exam Undercoded Overcoded History

6 1.Family fills it out while waiting 2. Clinician reviews, signs, and dates it 3. Admins scan into medical record 4/12/12 6

7 7 93% % of ROS meeting “Complete” criteria

8  Three key changes: - Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and department 8

9 A Survey of Residents and Fellows: - Anonymous, Internet based survey - 24 responses: 8 fellows; 16 residents 9 Survey results: Residents and Fellows stated that they  Had not been adequately trained in the business of medicine: (100%)  Would like feedback on their own billing performance: (76%)  Could adjust their billing to fit the visit level: (46%) Several residents added that they recognized their knowledge gap, but had no one to teach them.

10  One-on-one sessions with every trainee, 3+ notes each  Utilized a very powerful force: righteous indignation  Rather than hours of tedium, trainees learned the few points that needed polishing  Emphasized that clinical care and clinical billing are separate but dependent skillsets – one is useless without the other 10 strengths

11  Three key changes: - Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and department 11  Primary motivator of trainees: saved time - Notes go faster when you know the rules - Low code? Titrate dictation accordingly - Shifted learning from day one of 1 st job to progressive throughout residency

12 12 Words used per note n = 76 notes, 3+ for each trainee

13 Average Level: 3.4 Average Level: 3.8 We improved average level by 11%, Improved average note value by 16% 13

14 44 clinics per year x average of 4 hours (patients) per clinic x $96/note in improved mean level x 26 residents and fellows $438,000/y in improved billing, just from resident clinic. Spillover benefits? 14

15  Scott Pomeroy, MD, PhD  Frank Davis, MHA  Angeliki Medrano, CPC, CPMA Please Contact me with Questions: 15


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