Background:

We previously reported on the deployment of a computerized note‐writing system, eNote on our Hospitalist Service.[1] Since its launch in February 2004, over 25,000 Hospitalist notes have been entered via eNote. Since our last report, we also developed a module in eNote for discharge summaries (DSUM Writer).[2] These documentation tools support a variety of research and operational activities, including physician billing. We hypothesized that eNote positively impacts the efficiency of physician billing on our busy Hospitalist Service.

Purpose:

To evaluate the impact on physician billing by an electronic documentation system on a Hospitalist Service at a large, academic medical center.

Setting:

The Hospitalist Service employs 6.5 attending Full‐Time Equivalents distributed as follows: 3 attendings working with 3 PA's, 2 attendings working with 4 residents, and 1.5 FTE's covering a consult service, weekends and vacation. This service has about 3,300 discharges/year not including consult services.

eNote:

eNote is a Web‐based tool for writing admission, follow‐up, consult and discharge notes. Notes are semi‐structured with templated fields in which physicians enter free text. Several aspects of eNote may contribute to billing efficiency:

  • 1.

    Electronic “tie‐ins” to resident notes

  • 2.

    ICD9 coding for billing is embedded in the templates

  • 3.

    Discharge Summaries can be submitted for a bill as a discharge‐day note

Method:

This study was a before‐after, retrospective assessment of outcomes related to the efficiency of physician billing on the Hospitalist Service. Primary outcomes included pre/post means for the number of monthly invoices and charge lag (date of service until bill submitted to payor). Revenue was considered as a secondary outcome.

Summary of Results:

Mean monthly invoices increased 250%. Although on the rise before eNote, mean monthly charge lag decreased 29%. Mean monthly payments increased steadily throughout the study period.

Statement of Conclusions:

Electronic documentation on an academic Hospitalist service can enhance revenue recovery. The before‐after design of our study was limited in its ability to determine causality in the presence of confounders. One factor which may have affected our results was that physicians on the Hospitalist Service were taken off 100% compliance review in mid‐2005. However, anecdotal reports indicate this was in part due to enhanced legibility and completeness of documentation via eNote. Next steps include determining the impact of eNote on charge denials and comprehensiveness of notes.

References:

Stetson PD, Lee PG, Bakken S, Johnson SB, Haas J, Chang J, Shea S. [Abstract] Electronic Clinical Documentation to Support Patient Safety. Society of Hospital Medicine, Annual Meeting 2005 pg 71

Stetson PD, Keselman A, Rappaport D, Van Vleck T, Cooper M, Boyer A, Hripcsak G. [Abstract] Electronic Discharge Summaries. Proceedings of AIMA2005 pg 1121

Author Disclosure Block:

P.D. Stetson, None; P.G. Lee, None; S. Shea, None.