PHM Session: Let’s Talk Peer-to-Peer. Inpatient and Observation Status—What Really Matters?
Presenters: Lucinda Lo, MD, Children’s Hospital of Philadelphia, Pa., Amy Sanderson MD, FAAP, Boston Children’s Hospital, Boston, Mass., Daxa Clarke, MD, Phoenix Children’s Hospital, Phoenix, Ariz., and Sheilah Snyder, MD, FAAP, Children’s Hospital of Omaha, Neb.
Presenters started with a brief history of the creation of “observation status” in the 1980s and provided an overview of the different status levels as they exist today. They highlighted that the observation guidelines were initially developed with adult medical care in mind. At times, these can be difficult to translate into pediatrics, which accounts for much of the frustration and confusion pediatric providers must navigate on a day-to-day basis.
Presenters next led attendees through a series of clinical scenarios, asking for the appropriate status assignment, and followed with short role-plays of potential dialogues for subsequent peer-to-peer reviews.
They ended the presentation by discussing clinical documentation improvement (CDI). They emphasized that the role of CDI is to bridge the gap between clinicians and coders by uniting information from various parts of the chart to ensure documentation supports the billing.
- Peer-to-peer reviews are not a judgment on medical decision making, they are for agreeing on status assignments and level of care.
- When performing a peer-to-peer review, providers should:
- Do not take anything personally.
- Know the story, especially the diagnoses, and any related interventions.
- Use institutional resources, such as case management, to determine which status guidelines the patient meets ahead of time.
- Clear and accurate documentation of a patient’s diagnosis and treatment can help avoid peer-to-peer reviews, as missing clinical information is a frequent cause for denials.
- Ultimately, providers are the experts on their patients and are in the best position to advocate on their behalf, as well as on behalf of their institution.
Dr. Bakkum is a second-year pediatric hospital medicine fellow at Akron Children’s Hospital in Akron, Ohio, and is a trainee member of The Hospitalist’s editorial board.