Education in Neurology Resident Documentation Using Payroll Simulation.
| Autor: | Liang JW, Shanker VL |
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| Jazyk: | angličtina |
| Zdroj: | Journal of graduate medical education [J Grad Med Educ] 2017 Apr; Vol. 9 (2), pp. 231-236. |
| DOI: | 10.4300/JGME-D-16-00235.1 |
| Abstrakt: | Background: Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective: To improve the quality of neurology resident documentation through payroll simulation. Methods: A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback "paystubs" every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results: Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits ( P < .001), with a reduction in the financial loss to 6% ($1,880). Conclusions: Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided. Competing Interests: Conflict of interest: The authors declare they have no competing interests. This project was presented as a platform speech during the 67th American Academy of Neurology Annual Meeting, Washington, DC, April 18–25, 2015. |
| Databáze: | MEDLINE |
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