We had a staff meeting this morning and were told (again apparently...I was away for awhile) that the insurance companies will not pay for care unless we document (basically for them) the same information (ie., IV starts, fluids, rates, actually most of the interventions, etc.) in multiple places on multiple forms. Does this happen in "your" emergency dept/hospital also?
Does this even make sense in emergency depts with over crowding, nursing shortages, the acuity of many of our patients, etc?
The way I see this...and I'm venting now...this leaves the nurse taking care of the chart and not the patient. We charted many years ago to document/communicate the cares, then for the lawyers to prove that we "did" what we said we did....now the insurance companies/medicare are telling us how to chart, thus how to spend our time and direct our cares!!!!
Or is this just "my" hospital? Please share with me.
I agree with the frustration. We too have computer documenting, and actual chart as well, for the doctors quick orders convenience..grrrrr...That's actually where we chart IV fluids start and stop times. My question is...what happens when I leave and the patient is still there. What happens if my replacement doesn't chart start and stop times. You would think it was his/her fault...but you know, it will come back to me at some point because management doesn't take the time to investigate it in the first place.
My question is...what happens when I leave and the patient is still there. What happens if my replacement doesn't chart start and stop times. You would think it was his/her fault...but you know, it will come back to me at some point because management doesn't take the time to investigate it in the first place.
I've gotten that kind of nasty-gram in my mailbox several times. As long as my documentation is good, I simply respond with "IVF infusing at 1900 when I clocked out as noted in nursing documentation." And I print out another copy of my documentation with the appropriate entry highlighted.
Pt assessment, medication reconciliation form, telephone admission orders form (often rewritten for legibility, and often 2 pages worth), MAR, patient-specific care map, core measure form, hand off form when pt goes off floor for tests, the usual flow sheets for admitted holds (we had 54 ER holds in one night this week; the whole hospital only has 240 beds) and, the kicker, if admitted pt is approaching their 24th hour in ED, complete admission H&P form (10 or so pages long).
The root cause of the insufferable increase in this kind of documentation is the shift from the accounting department to the nursing department the responsibility of data input for accounts receivable.
There are 2 acceptable computerized charting systems I have used throughout my career. Most of the others I have used, (had the lowest vendor bids), were friendly only to the back of the house bean counters, (who are the ones who make the decision to buy them), and not a single administrative neuron was inconvenienced by looking at the effect on the productivity of the front line users.
It's that unspoken, unwritten, "it will only take a second for the nurses to do that" mentality that drives me insane. Those precious seconds add up. Non-nursing administrators don't know and don't care. The sell out nursing administrators are even worse because they can plead to no such ignorance. They simply do not care.
Coming from a financial stand point, it is very important to collect revenue where it is used. IV's, fluids, sterile equipment, bedpans, etc are all revenue. The only way the hospitals get paid for these items are if the nurse properly documents or list each individual items on a patient charge sheet.
I know for a fact being a nursing student and working the the ER for 5 months that it is difficult to document when it gets busy. However, I realized it is not impossible.
So what I am saying is if the hospital you work for requires it, then comply.
I have been on both sides of the spectrum, I have been on the finance side, the administration side, and on the floor as a ER student nurse and I saw all the different perspective from every angle and I can see where everyone is coming from. The finance department wants to collect revenue to boost up profit or just stay even, the adminsitration wants nurses to comply but usually they don't and need to come up with genius ideas of how to make nurses comply and then the nurses who don't want change and complain about this and that...while this is going on, i stand on the side and just watch and take it all in.
Coming from a financial stand point, it is very important to collect revenue where it is used. IV's, fluids, sterile equipment, bedpans, etc are all revenue. The only way the hospitals get paid for these items are if the nurse properly documents or list each individual items on a patient charge sheet.
I know for a fact being a nursing student and working the the ER for 5 months that it is difficult to document when it gets busy. However, I realized it is not impossible.
So what I am saying is if the hospital you work for requires it, then comply.
I have been on both sides of the spectrum, I have been on the finance side, the administration side, and on the floor as a ER student nurse and I saw all the different perspective from every angle and I can see where everyone is coming from. The finance department wants to collect revenue to boost up profit or just stay even, the adminsitration wants nurses to comply but usually they don't and need to come up with genius ideas of how to make nurses comply and then the nurses who don't want change and complain about this and that...while this is going on, i stand on the side and just watch and take it all in.
I think that the point of the thread is more about the idiocy of what the insurance companies come up with as billing criteria, not that we don't want to comply or begrudge our hospital getting paid.
It is hard to relate to this particular topic if you are not working in the departments as a nurse.
It is just plain assinine to me to have to document "fluids continue at time of transfer" on a trauma or MI pt., so that the hospital can get paid for fluids that were documented as being started, a rate of infusion was listed, and a charge sticker was placed on the chart. That is some suit out there trying to get out of paying for services rendered to make a buck to pay for the summer house.
It's that unspoken, unwritten, "it will only take a second for the nurses to do that" mentality that drives me insane. Those precious seconds add up
Specializes in Critical Care, Emergency, Education, Informatics.
First of all this isn't a new thing, CMS started doing this about 5 years ago, and it's just now trickling down. All insurance companies follow CMS in this kind of stuff. The hospitals are just now getting gigged for it. And of course it's always nursings fault. :)
It is very frustrating, the ideal world would have computerised documentation that is linked to an inteligent pump that automaticly documented what it was doing. The reality that isn't going to happen.
It is here to stay, so we need to find a way to efficiently capture this information. Even computerized cahrting is a pain in the but when trying to do this. It it truely is a budget issue though. There is a finite amount of $$ available. If you want the new pumps, monitors, etc, you have to be part of the revinue generating part of the hosp. And yes this means documenting the start and stop times of the meds, making sure all meds are accounted for, making sure that the EKG you did on the CP patient that just came through the door at triage got ordered.
Start lobbying your congressman, get your proffesional orginizations involved. Heaven forbid that some in a position of power might actually listen to us for a chnage
Watched "SICKO" by Michael Moore yesterday. All the additional "hoops" the insurance companies make us jump through so our hospitals get paid would seem just another way to avoid paying for their clients/our patients care. They probably rejoice when we can't get all the paperwork done!
Specializes in ER, Outpatient PACU and School Nursing.
sucks huh?? we have computer charting also. I document where I stuck the patient, when I started the IV/ Med and at the end I need to document again the time I started the IV and for how many minutes.. Its gotten out of hand but required or my chart is incomplete..
deeDawntee, RN
1,579 Posts
Its another way to burden nursing and to put us in the BLAME for a system error. Isn't that easier than figuring out a better system?