Records tech jumps data hurdle in a single bound
New staffer saves time, money, too
Imagine the upheaval of merging with another agency, becoming a wholly owned subsidiary, and having all your nursing staff move to a new office all at once.
As if this weren't enough, imagine also that in the midst of this, you have to decide how to amalgamate documentation systems to meet the needs of patients, staff, and regulatory bodies.
"It was getting so complex, it was hard to know where to start," recalls Meredith Goodrick, BSN, quality manager at Munson Home Health in Traverse City, MI. If ever there was a case for a super-hero, this was it.
Goodrick found a superwoman in an accredited record technician (ART) who is responsible for all coding, compiling all pertinent data from records, and running reports.
Her education in statistical analysis makes her more valuable than a typical clerk, but less costly than a nurse. "She more than pays for herself," says Goodrick. "If she wasn't there, I'd have to have another RN on staff."
Even better, she has given Goodrick instant access to data that have enabled her to catch problems in documentation early.
In 1996, Munson Home Services, a department at a regional health center, acquired Michigan Home Health Care, a smaller privately owned agency in the area that handled both Medicare and private duty patients. At the same time, Munson was on the road to becoming a wholly owned subsidiary of the hospital rather than a department. And all of the field staff at Munson were moving to the Michigan Home Health office, seven miles from the new corporate headquarters.
It was a busy time for the agency. "We had two very different companies," says Goodrick. "Michigan's documentation system was fairly automated and computerized. At Munson, everything was paper. The 485s were generated on computer, but everything else written out."
As part of the unification process, Munson was trying to change Michigan's subunit structure to a branch operation. That meant a consolidation of records, among other things. "There were seven years of medical records at Michigan that had to be added to seven years of our records," says Goodrick. "Things were a mess. Some of them were stuffed in boxes. No one knew for sure where to find things."
The first step was to determine which jobs overlapped and were duplicated, says Goodrick. Every clerk's job was studied and a flow chart made of all job duties. "We wanted to see whose job was focused on the branch clinical aspects, and who worked for central operations," Goodrick says.
One flow chart focused on plans of care and billing. At the time, a staff nurse would submit admission charts to clerks, who made copies and passed admissions packets to one of two quality improvement nurses. These two nurses would code and review them for any errors, pass them on to data entry for input, and then review them again for typos and other more substantive corrections.
"We thought one review on computer would be enough," says Goodrick, "but we were stopped from eliminating the extra review by the coding - someone had to put in the codes."
One of the clinical directors at Munson had worked at a hospital where there was an ART on staff. "They were trained to do the coding, which meant you could be sure of the right billing," she says. "It sounded good. And even better, it just so happened that one of our clerks was finishing her studies and was taking the certification exam."
But hiring the staffer wasn't so easy. Still part of the hospital, Goodrick spent three months justifying the request to human resources and the hospital president. "I had to tell them how much time they would spend doing coding, and how much it would cost."
One good thing about the delay was that it showed Goodrick just what a good financial deal ARTs were. While they cost about $1 more per hour than the high end of clerks' hourly wages, that's still about $4 less per hour than a starting nurse salary.
"We knew we needed this expertise, and with OASIS coming on line, we really wanted to have someone with a statistical background," Goodrick says. The financial arguments swayed the hospital, and in April 1997, the ART started work.
Catching errors and other benefits
The merger with Michigan Home Health brought another 30,000 annual visits to Munson. But because of the ART, no additional QI nurse had to be hired. The ART also allowed Goodrick to identify staffers who were having coding problems. They were put through orientation again with the Michigan staff who came as part of the merger.
While freeing up nurse time was a big goal of the program, there have been other benefits, too. For example, the hospital's orthopedic surgeons recently decided to put all total hip and knee replacement patients on anticoagulation medications. "We had a clinical path with nurses seeing patients twice, but all of a sudden, they were seeing them three to five times depending on anticoagulation needs. We thought everything was going smoothly, and I asked the ART to do a cursory check of records."
Immediately, the technician discovered a major problem with orders: The clinical pharmacists were calling in medication orders to central intake, but there were no signed physicians' orders. That was immediately corrected through an initial order stipulating that the pharmacists would manage the anticoagulation program.
Another problem was also discovered: Over five visits, there were sometimes four nurses. "It was a real continuity issue," says Goodrick. She found that nurses were told they had to do blood draws on a strict schedule, which often precluded the same nurse doing most, if not all, of the draws. After a meeting with the core team on the anticoagulation program, it was determined that the schedule could be a little more flexible.
Goodrick says neither of these problems would have been discovered so quickly without the ART. "We had the continuity indicator, but the way it was written, it wasn't looked at for people who were in for less than a month. We never would have found it. Now, we have rewritten it to include those hip and knee replacement patients."
The ART has kept Munson up to date with statistics, she says. "Some of our clerks were good with computers, but it would take several times of telling them what we wanted before they ran the right thing," she says. "The ART does it right the first time. She understands what data I want, and the different methods of collection. I can tell her I need to know the utilization on wound care, and she can look it up immediately because she knows the codes. I know how many days it takes to get 485s out of the office on any given day. I know how many people were discharged last week. I have more information, better information, in a more timely manner."
Would she hire another one? Yes, says Goodrick, and she hopes to have that wish fulfilled in the next year or two.
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