When reviewing this table, Dr. Simon may get a little uncomfortable because she codes only 2% of follow-up visits at the highest level, but the group as a whole uses the highest code 17% of the time. And, she codes 88% of discharges at the high level, compared with 44% for the group as a whole. She is also out of step with her partners in highest initial consult and the middle initial observation codes. This information will probably make her receptive to peer-to-peer learning from her partners and may motivate her to review some of the coding rules.
Dr. Simon and Dr. Garfunkel are out of step with the group in how often they use the code for the middle level initial observation visit. This group needs to investigate whether these two doctors are coding these visits correctly, and everyone else is in error, or vice versa.
It is important to point out that the goal of the report isn’t to get each doctor to simply mirror the distribution of the group’s overall coding pattern. There might be cases in which the outlier doctor is coding correctly and everyone else is wrong. So the group average can’t be accepted as correct, and any significant discrepancies between one or two doctors and the group as a whole should be reviewed and discussed.
While a coding comparison table like this isn’t enough to ensure proper coding, it is a useful tool for highlighting the areas most in need of attention. I know of cases in which hospitalists who practiced together for several years had no idea their coding patterns were so dramatically different until they created a report like this. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. This column represents his views and is not intended to reflect an official position of SHM.