In a couple of recent articles that are not connected, there is an underlying connection. One, in "For the Record" discusses The Hazards of Note Bloat and the unintended consequences of having a lot of information that doesn't truly say much about the complexity of the patient's condition, not to mention that it is "difficult to view, notes lengthen and errors accumulate." But wait, aren't EHRs supposed to reduce errors? The article goes on to explain how narrative (dictation/transcription) notes have been reduced, but not completely eliminated. It also discusses speech recognition and its implementation this month. The next article talks about the value of outsourcing as a cost-savings process to reduce costs and how this is happening in a big way in Canada. This model has been shown again and again to be cost effective and many hospitals across the US have already embraced this practice to help reduce costs.
In yet another article, 3 major healthcare groups were identified as having caught the financial flu and are not doing particularly well at this time.
In reviewing the 3 unrelated articles, it became apparent that there may be a myopic view of how to balance reducing costs with optimal EHR utilization. Consider this. EHRs are here to stay. We need them and the value they bring to healthcare overall. What we don't need is documentation that doesn't improve the quality of the patient encounter. We need streamlined, content-rich, not bloated notes that drone on endlessly with what the previous note stated. We need to optimally enable physicians so they have the time to see a growing patient population, not spend endless hours doing their own data entry. We also must get the level of detailed specificity now that will be needed as the ICD-10 date edges ever closer. Healthcare organizations must be fiscally healthy enough to provide care and continue to be viable as baby boomers get to Medicare age. So yes, they do absolutely need to cut costs in the right places but keep those that enhance their revenue capabilities.
Here's the conundrum in summary. If healthcare organizations and hospitals focus only on reducing costs at the expense of eliminating medical transcription/editing, they are using a tunnel vision approach that will reduce costs but will simultaneously fail to optimize reimbursement. Complete, detailed documention renders optimal coding, which leads to appropriate and optimal reimbursement. If this process becomes muddy through "note bloat" or abbreviated input from extremely busy clinicians, the revenue cycle process may breakdown and the endless cycle of trying to reduce costs and not optimize documentation will continue.
Stop the broken cycle of cost-cutting measures as the only option. It's time to see the bigger opportunity and realize the value gained in the outsourced model of quality dictation/transcription and speech editing process to capture all the details needed for ICD-10 today. This can get healthcare organizations over the financial flu and on the road to recovery. By adopting a practice of excellent documentation practices, these 3 unrelated items can become related in a way for long-term success with the EHR and improve patient outcomes as one of the most important goals.
