In the latest episode of our podcast, we asked our HIM expert Keith Olenik, VP, Revenue Cycle Services: are there any best practices at the organizational level to combat delayed test results? Read his analysis below:
There are some EHR vendors that have taken notice of what’s happening at the federal level or are working with the government and their providers. Some organizations do a much better job with implementation and utilization of EHRs than others. They’re not all created equal, just like every EHR vendor isn’t created equal, or even the implementation team from the same EHR vendor. So there’s variations across the board. This is why organizations really need to look at what the government has out there and take advantage of every resource document that’s available. In the end, organizations need to have conversations with their physicians and establish what’s going to work best for them and for the physicians.
In addition to looking at the lab results and how the treatment is handled, there is a coding perspective. Coding ties into research, which ties into quality, which then ties into outcomes and, ultimately, reimbursement. There are significant issues when test results come in that change the diagnosis from what was done at the point of discharge. Codes are assigned at discharge and they’re based on the documentation that was available at that point. Coders cannot make assumptions when they see this lab result come in later and assign a different code. They need to get physician buy in. There’s documentation out there about that process and the regulatory requirements for how coding and the changes in diagnoses are done.
But, this does cause concern with physicians as they feel that they’re potentially at risk. For example, there is a patient who has left the hospital and was diagnosed with pneumonia. A lung biopsy was completed prior to their discharge showing cancer. That pathology report came in after the patient had gone home. Whose responsibility is it to now report that the patient has lung cancer? It’s important to assign responsibility to changing that diagnosis and changing documentation. There are guidelines out there from the American Hospital Association and from coding clinics that coders can follow. Physicians can rest assured that they can make those changes in documentation and not feel like they’re altering it, but they need to follow appropriate procedures.
Additionally, there is a little bit of sensitivity given the new ways patients are being notified of lab results, diagnostic test results and communications in general. We’re using portals and APIs on phones. There is a variety of ways that patients now have access to their information. Patient engagement is critical — including making sure that they understand test results. There’s also the risk that when a lab result comes back, it goes out to the portal or to their phone, and the doctor hasn’t called them and the patient is looking at a diagnosis. How do we educate consumers to make them aware that we’re doing this so that they have access to information, but then how do they engage with the physician so that we don’t have the physicians feeling that they don’t want patients to have this information and they hold it back?
There is a lot of work that needs to be done on patient engagement, patient experience, utilization of portal notifications and communication, but at the end of the day, we’re going to get the lab results to the patients and the providers in a more timely fashion.
For Keith’s top six strategies to take action on TPADs, listen to our latest episode of “Get to the Point.”