Dealing with Delinquent Docs
Begging and Bribery Par for the Course
By Anne Miller
ADVANCE Assistant Editor
“We tried to lure them in with telekinesis, but it didn’t work.”
“We get down on our knees and beg.”
“We take ’em out back and rough ’em up.”
These are just a few of the answers ADVANCE received when posing the question, “How does your facility get physicians to finish their paperwork?” As you can see, some health information management (HIM) professionals are able to maintain a sense of humor when discussing this very frustrating problem. Just as death and taxes are inevitable in life, so too, it seems, is the fact that every facility is going to have a few “master procrastinators” who avoid paperwork like the plague.
HOW BAD can the situation be? One HIM professional, who shall remain nameless, uses this story as an example. “Once, a doctor handed me a chart that was 13 months old–he had just finalized it!”
While the absurdity of the situation and the solutions above seem funny, incomplete records in reality cause a myriad of problems for HIM professionals. In a nutshell, this unfinished business negatively affects productivity in the HIM department.
“It delays absolutely everything,” stated Ruth Hauser, ART, director of health information services at St. Francis Medical Center in Lynwood, CA.
For starters, she mentioned it is more difficult to track and access a record that is not completed, even with an automated chart tracking system. It also can be more challenging to file ancillary reports in an incomplete chart because it’s not in the “correct” location.
IN ADDITION, if a record is missing the patient’s history and physical information or if it lacks an operative report, it cannot be coded. “The coder has to interrupt his/her train of thought, phone the physician and then do something else while waiting for a response. It’s mentally disruptive, not to mention time-consuming,” commented David Kroeger, ART, medical records supervisor at Broadlawns Medical Center in Des Moines, IA.
Problems also occur when requested information cannot be released to insurance companies, employers and law firms because the record is not finalized. In worst-case scenarios, incomplete records can affect the follow-up care of a patient. “Some patients want to seek a second opinion when they leave our facility, and they have to wait until their completed chart can be forwarded. Quality of care in these situations is directly linked to the finalization of that patient’s medical record,” Hauser asserted.
So how do facilities spur physician compliance? Fortunately, most institutions have punitive measures in place to deal with delinquent doctors, and in many HIM departments, resorting to bribery is not entirely out of the question. Unfortunately, enacting these policies wastes a lot of the HIM department’s time each week–how much time seems to depend on how large the facility is–and sometimes turns HIM personnel into unwitting physician adversaries.
Pam Conroy, ART, assistant manager of medical records and utilization management at Community Memorial Hospital in Cheboygan, MI, detailed the policy at her facility. Community Memorial, which has 41 physicians on staff, is a 113-bed facility. Operating, delivery, recovery room and history and physical dictations are considered delinquent after 24 hours; discharge summaries after 10 days; and signatures after 15 days. Doctors are notified of delinquencies weekly via a notice in their mailbox. Monetary fines are assessed; and if fines are not paid in full within three months, the practitioner will be referred to the medical executive committee. Corrective action could include the cessation of clinical privileges.
“WE HAVE three people who rotate the responsibility for analyzing chart delinquencies and sending out notices. This task takes between one to two hours per week,” Conroy estimated.
At St. Francis Medical Center, licensed for 510 inpatients, there is one full-time technician in the HIM department to notify the physicians of their documentation delinquencies. Physicians with delinquent records receive two letters and two phone calls. A practitioner who ignores both the letters and phone calls will be placed on suspension and prohibited from admitting any new patients during that time.
When records are finalized, the suspension is lifted. However, if a physician accumulates 30 days of suspension within a 12-month period, it is considered a voluntary resignation from the medical staff. That physician would have to reapply before being welcomed back.
“In addition to these punitive measures, we do have a system to reward compliant physicians,” added Hauser. Their HIM department has a drawing every month; physicians can win dinner for two at a nearby upscale restaurant.
BECAUSE THE medical records department at St. Francis publishes the delinquency reports, the HIM professionals often bear the brunt of the physicians’ anger. “I deal with aggravated doctors all the time. They are full of animosity because we’ve embarrassed them in front of their peers,” said Hauser. “Personally, this does not bother me–punitive measures are the only ‘bite’ we have in our procedures. And I always remind them that the HIM department is only following the physicians’ medical staff bylaws.”
At the University of Texas Medical Branch (UTMB) in Galveston, TX, the HIM department has recently shifted the punitive responsibility back to members of the medical staff. “The HIM department acts as a support for physicians who are trying to complete charts in a timely fashion,” said Jim Braden, MBA, director of HIM for the facility. “However, when we have to send delinquency reports, we address them directly to the chairperson of each department; it is up to that chair to enforce the rules. If there is any animosity on a physician’s part, it is directed toward his boss, which is more appropriate.”
“THIS HAS made our jobs a lot easier because we are no longer in an adversarial role with the physicians on staff,” added Suzi Sims, RRA, assistant director of medical records for UTMB. “The doctors still don’t like to do their paperwork; and yes, they still complain, but they are no longer complaining about HIM professionals. They are griping about their boss.”
Interestingly enough, since re-engineering the procedures, UTMB has experienced a significant decline in delinquent paperwork–from a rate of more than 50 percent of records to a rate of approximately 28 percent. “I directly attribute this to the fact that their own bosses are the ones warning them now,” asserted Sims. *