Coding Reengineering Force Field Analysis
Strategies for selling the pilot to the physicians
Duke Rohe
Possible Driving Forces / Possible Restraining Forces(leadership) wants it to happen
APCs are coming and this prepares us
Doctors do not like ambiguity
· What to document should be more clear service specific education aids, palm pilot E&M software, back of charge sheets, tip of the week via email
· Coder/auditor is there on site and will let you know when down coding will occur and what documentation areas are missing
Doctors want to know their performance and like to compete
· Comparison to peers (masked) on appropriate/efficient documentation
· 100% of all clinic documentation initially (instead of Medicare only) to evaluate documentation
Doctors like to “first”
· First in the hospital to get this level of attention
· Internal competition is within a service can be high
Doctors want to be assured their work is being billed (and not lost)
· Reconciled assurance that your visit record was coded and posted
· No charge sheets transferred across the street (electronically entered in the clinic)
Doctors like data
· % dictation
· Length of note/cost of note
· Time spent chasing charts (Urology is not in this camp)
· Cycle visit to coding complete /
Doctors resistance to change
· Form has more on it· More areas to check off
· Inertia: like what I’m doing already
Doctors don’t like being told (losing freedom)
· Perception that the coder is running around after you telling you what to code
· Thou shalt dictate
· Filling the new areas of the charge sheet our
Doctor’s/PA’s reluctant to get ‘dinged’ for marking too high E&M /or unsupported documentation
· Unclear on how or too hard to mark/document
· Doctor’s revert to gut feel instead of using calculation
Incentives/threats to document properly don’t hit their pocket books