Obtaining Relevant Radiology Request Information University of Wisconsin Hospital and Clinics...
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Transcript of Obtaining Relevant Radiology Request Information University of Wisconsin Hospital and Clinics...
Obtaining Relevant Radiology Request
Information
University of Wisconsin Hospital and Clinics University of Wisconsin-Madison, Wisconsin
Quality Care
demands Quality Information
Problem
Lack of accurate, salient clinical information on radiology requests may lead to:
» Suboptimal performance/interpretation of exam » Coding and billing inaccuracies» Potential medico-legal implications
Who should be gatekeeper?
Vision
Identify need for improvement for benefit of organization
Root causes Identify solutions Educate physicians and staff Involve institution in ongoing compliance
Team Members Quality Improvement Department (Team Leader) Radiologist - Body Imaging Laboratory Medicine Physician Information Systems Physician Director, Emergency Department Radiology Administrator Transplant Floor Unit Clerk Unit Clerk Educational Coordinator Information Systems Project Leader Oncology Program Assistant Management Engineer Ad Hoc Team Members (Physician Billing Mgr, UWHC Fiscal Mgr)
Goal
To increase to 90% the number of radiology requisitions with accurate and appropriate salient clinical information.
Suboptimal Exams/Interpretations
Improvements Would Result In: Technologists focusing on area of concern Quality radiologist interpretation Better communication between referring
clinician and radiologist
Coding and Billing Inaccuracies
Develop documentation standards for Radiology, Lab, Pharmacy, ECG, etc
Potential Medico-Legal Implications Medicare requirements
» Federal Register 42CFR424.10 - 11 Medical necessity
» all procedures (radiology and non-radiology) must have a clinical condition to be a payable service*
Frequency » must be appropriate for clinical condition*
(*refer to Section 18.14(a)(2) and 18.35(a)(2) of the Social Security Act)
Implications of MedicareNon-Compliance
Over $33K lost/written off in monthly Medicare charges
If reason for exam not substantiated, cannot bill
HCFA audit could result in:– Allegations of Fraud– Fines
Root Causes
Clinician verbal/written order interpreted incorrectly
Order transcribed/entered into system incorrectly
Radiology handling of information
Solutions
Developed an Acronym (CYA) to Assist Clinicians in Remembering Required Information» C Current diagnosis» Y Why you want the exam » A Already known history relevant to the study
being requested
Solutions (cont’d) Educated clinicians, radiologists and staff Visual reminders Incentives to house staff for providing
adequate information Mandated correct pager numbers be
provided
General Ordering Rules
DO NOT give the following as the ONLY information» “R/O” (alone)
» “Possible”
» “Probable”
» “Suspected”
» “Pre-Op”
» “Screening”
DO list specific clinical dx, signs, sx, or patient complaints» “RLQ pain”
» “malignant renal hypertensive disease”
» “SOB/cough, R/O pneumonia”
» “Accident--give type”
Benefits of “CYA” Ordering
Documents “medical necessity” of ordered test Quality patient care Good customer service Prevents unnecessary phone calls Correct coding and billing benefits entire
organization’s bottom line
Implementation
Piloted program on Hematology/Oncology Inpatient unit» Educated clinicians and staff» Developed a team logo “Quality Care Demands
Quality Information”
Quality Care demands
Quality Information
Implementation (cont’d)
Target inpatient implementation (2 units) completed July, 1997– Pre-implementation compliance: 52%– At peak of our efforts: 67%
House-wide ambulatory clinic implementation initiated February, 1998
Internal Medicine, Surgery and Oncology Clinic Implementation
Percent Compliance of CYA Program - Pre and Post Implementation
64.4% 65.3%
49.9%
74.5% 75.6%
64.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CurrentDiagnosis
Why AlreadyKnow nHistory
CYA Variables
Perc
en
t C
om
plian
t
Pre-implementation2/2 through 2/14
Post-implementation2/23 through 2/28
Implementation (cont’d)
Gave ‘report card’ of what was needed to bring in compliance
Re-checks and follow-up done after implementation
Implementation, Phase B
Compliance fell, implemented Phase B “No Data, No Study” Project employees hired Notified clinicians that lack of compliance
would result in refusal to study effective July 1, 1999
Lessons Learned
Identify specific problems Team should have physician/staff make up Identify gatekeeper early in process Obtain buy-in from department chairs Identify areas of non-compliance, focus
education Educate in large setting and one-on-one
Lessons Learned (cont’d)
Provide specific feedback Pilot an “easy” area Present updates and findings to hospital
administration, Compliance Committee Be prepared to take hard approach (“no
data, no study”) Orient new medical staff
How Are We Doing Now?
Two-years post education and implementation
Compliance Rate = 98% (ambulatory procedures only)
University of Wisconsin-MadisonMargaret L. Birrenkott, MBA
Administrator & Director, Business Services
Department of Radiology
Education Team Members:Kris Leahy-Gross, RN
Fred Kelcz, M.D.Carol Hassemer