1. Compliance Corner FY15 Q1
OHSU Department of Anesthesiology and Perioperative Medicine
Norm Cohen MD, Suzanne Simmons MBA, Eileen Browning CPC

2. Overview FY15Q1Compliance Procedure notes – authors and cosigners
Agenda
Overview FY15Q1Compliance
Procedure notes – authors and cosigners
Post op pain orders from surgeon
Concurrency for OB
Multiple cases on one anesthesia event
Breaks

3. Overview FY15Q1 Compliance
Comparison FY14Q1 – FY15Q1
Great improvement over the past year and from the break transition, Thank You!
FY14Q1
FY15Q1
% chng
Deficiencies w/o OL
1287
988
-23.0%
Overlaps
187
350
87.0%
Total
1474
1338
-9.0%
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Overlaps by month 38 52
333
183 90 77

4. Procedure notes
Procedure notes need to be authored by one of the clinicians performing the procedure. If documented by a CRNA or resident, cosign by the faculty required.
If authored by another clinician not signed into the case, they are acting as a scribe and need to follow the OHSU scribe policy:
Scribe includes statement: “I (name) am functioning as scribe for (provider name)in their presence.”

5. Fun and Games #1
What one event needs to occur prior to placing a block or epidural for post op pain?
1) The surgeon needs to pay for the procedure.
2) Candy should be provided for all staff.
3) An order or request from the surgeon needs to be documented in the patient’s chart requesting assistance with post op pain management.
4) An H&P update needs to be done prior to the procedure.

6. Post op pain orders from surgeon
Medicare requirement as of November 2013 that surgeons order for post op pain be documented in the patient chart as well as anesthesiologists acceptance of the order.
Our compliance rate leveled off at 85% of cases documented correctly.
Responsibility falls on the regional team first if involved, otherwise the anesthesia team for the case.

7. Fun and games #2
C-sections, tubal ligations, and labor epidurals are all considered the same when determining concurrency.
1) True
2) False

8. Concurrency for OB cases
Placement or maintenance of an epidural for L&D is an allowable activity while medically directing.
Labor neuraxial analgesics are not included for concurrency edit of number of cases medically directed simultaneously.
C/S and BTL’s are considered surgical procedures and are included in concurrency and medical direction edits.

9. Multiple cases on one anesthesia event
Increase in number of anesthesia events with two separate cases documented.
Predominantly OB and trauma bring-backs.
If it is discovered too late to correct by opening an adhoc anesthesia event, use quick notes to identify 2nd case anes start and stop.
Please advise billing (Eileen) via .

10. Break Relief
Revised break policy effective in June Working well most of the time now.
The most common residual issue is overlapping time or solo provider time. Please remember:
Faculty may not work solo while medically directing a resident. It is your responsibility to obtain coverage.
When coverage occurs the staff involved should document so their minutes match exactly on the concurrent cases.

11. Questions????