D. Jeffcoach1, T. La Charite1, P. B. Barlow1, C. Powell1, M. Phillips1, M. Goldman1 1University Of Tennessee Medical Center – Knoxville,Surgery,Knoxville, TN, USA
Introduction:
Surgical resident education has become more complex. Challenges include meeting the Next Accreditation System education milestones, the national implementation of the Patient Protection and Affordable Care Act (PPACA), and decreasing resident education funding. In addition, physician reimbursement for surgical procedures has declined over the last decade. To address these concerns we developed a training intervention focused on improving patient documentation. We hypothesize that implementing an individualized targeted clinical documentation intergrety intervention for surgical residents would improve documentation patterns. Success was defined as an increase in geometric mean length of stay, case mix index and reimbursement.
Methods:
With IRB approval a prospective case control study was performed using an individualized targeted intervention. Charts were reviewed for all patients discharged from four surgical services over a one month period. Patient demographics, length of stay (LOS), geometric mean length of stay (GMLOS), case mix index (CMI) and reimbursement was collected. All general surgery residents underwent a personalized thirty-minute intervention reviewing the quality of their documentation using current medical documentation practices. After the intervention a subsequent sample of surgical patients were evaluated using the same endpoints.
Results:
All general surgical residents participated in the study (n = 29). In the pre-intervention group there were 396 patient encounters and 328 in the post-intervention group. Baseline comparisons were made using Mann-Whitney U and chi-square tests of independence. The proportion of patients representing each service was not statistically different between months. Actual LOS remained constant between groups (4.0, IQR 5.0 vs. 4.00, IQR 5.00; p=0.970). Independent t-tests on primary endpoints found that the disparity between GMLOS and the patient’s actual LOS was narrowed by nearly a full day in the post-intervention month (M = 1.09, SD = 8.17) compared to the pre-intervention month (M = 1.90, SD = 6.69), p=0.134. CMI also increased (CMI=2.25, SD=1.94 vs. CMI=2.47, SD=2.32; p=0.165), as did reimbursement, $11,834 (SD=$12,744) vs. $12,790 (SD=$14,108), p=0.333.
Conclusion:
While reimbursement increased nearly $1,000 per case, GMLOS increased by one day, and the overall CMI increased, statistical significance was confounded by the wide variance amongst surgical patients. These parameters are vital to hospital fiscal solvency and we consider any improvement a success. In addition to improved resident awareness of accurate documentation, we were able to use this data to negotiate increases in resident complement funded by our hospital. This approach is valuable to both prepare residents for successful practice as well as validate their financial benefit to hospital systems as resources for resident education continue to decrease.