Sugar’ approach funnels $10 million into hospital
A small investment has a big return
Reasoning that you catch more flies and completed medical charts with honey than vinegar, a medical information director in New Jersey has developed an innovative system of rewarding doctors who complete charts on time rather than punishing those who don’t.
Using gift certificates, lottery tickets, and even trips, David Chin, RRA, director of medical information at East Orange (NJ) General Hospital, has whittled his pile of delinquent charts from about 2,000 before the new system to about 400 currently. And at one point it was as low as 174 charts. What’s more, the faster chart completion pace has trimmed an estimated $6 million off the hospital’s account receivables list.
The program’s success has completely eliminated the need for the fines and suspensions traditionally used in medical record departments. "We use all positive incentives and don’t do any negative," says Chin.
Like many creative solutions, Chin’s began as a reaction to dire realities: The fining and suspension system the hospital previously used was driving away business. "The problem with [fines and suspensions] was that our hospital was seeing a direct effect on admissions. Our census was dropping, and dropping, and dropping. The physicians who were suspended were literally taking their patients to other hospitals."
Chin and his staff began brainstorming solutions and hit upon the positive reinforcement approach.
Prizes are awarded for physicians meeting certain goals. For instance, a physician who completes his histories and physicals within 24 hours gets a New Jersey lottery ticket. The largest prize awarded so far was a four-day trip to the Bahamas. To qualify for the drawing for the trip, physicians had to complete all of their charts on time for a month Chin says 13 of the hospital’s approximately 100 doctors qualified for the drawing. Other prizes offered include gift certificates to local stores and a limousine-driven trip to a Broadway play in New York City.
But Chin especially praises an Adopt-a-Doc program for maintaining consistently good record completion. Members of his 15-person staff are assigned to groups of physicians and work with them individually to get the charts completed. This includes pulling the charts and guiding the physicians through the process to make sure they are finished.
The staff even gives their doctors adoption certificates as their new "sons and daughters."
Besides producing a more convivial workplace, the program has a bottom-line impact the $6 million reduction in accounts receivable. "It has a direct effect on reimbursement," says Chin. "If the charts aren’t completed on time, then the hospital isn’t going to be reimbursed. And we know right now in the health care industry how important that is. Managed care is squeezing a lot of dollars out of health care. . . . It’s much more important to keep accounts receivable as low as possible, and that’s what we try to do."
Commitment is key to program's success
One key is a commitment from both the staff and physicians, says Mark J. Chastang, president and CEO of Exxex Valley Healthcare, the hospital’s parent company. "Both the physicians and the employees have made a commitment to do the best job possible, and that has resulted in millions of dollars that were due the hospital being collected in record time."
Reward programs obviously can be successful, but they must be closely managed, says Rose Dunn, RRA, CPA, FACHE, vice president of First Class Solutions, a St. Louis-based consulting company. In some loosely managed reward programs, "If a physician walks into a department and pulls his charts into a workroom to do, he gets a reward," she says. "He may not have done anything, other than have a cup of coffee and chatted with a colleague, then left. Meanwhile, he walks out with a lottery ticket that may be worth $900,000."
Those physicians are getting the same treatment as doctors who faithfully do their chart completions on time, which might antagonize the prompt physicians, she says.
At East Orange General, the physicians obviously are responding well to the more positive and helpful approach, says Chin. "The doctors seem to really thrive on it. They’re getting the personal attention they don’t get at other hospitals.
"It also helps me out because it gets the whole staff involved in chart completion, and not just one or two people," he adds.
David Chin, director of information services, East Orange General Hospital, 300 Central Ave., East Orange, NJ, 07019. Telephone: (201) 672-8400.
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