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HIM compliance coordinator shares low delinquency rate secrets

HIM Connection, November 23, 2004

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Few hospitals can rival the rate of Harrison Memorial Hospital in Bremerton, WA, where Kelly L. Meeusen, RHIT, compliance coordinator and privacy officer, can boast a high rate of 3.28% and a low of 0.99%. And that's for a facility with 342 physicians on staff, 15,000 inpatient discharges, 45,000-50,000 outpatient discharges, and an estimated 60,000-70,000 emergency department visits a year.

Medical Records Briefing set out to learn Meeusen's secrets and discovered it had nothing to with high technology and everything to do with "good old-fashioned methods of communication and consistency," he says. Meeusen attributes Harrison's impressive delinquency rate to the following approaches:

• Include everything you analyze in your delinquency rate. "If we analyze it, we count it," he says. By factoring emergency room visits and outpatient discharges into the figure, the total number of records is larger, which helps to lower the percentage. Analyzing cases other than inpatient discharges but not factoring them into your rate "would really skew your statistics."

  Meeusen points out that when he calculates only inpatient discharges, his delinquency rate goes up to 7.66%-still an impressive rate. "If that chart can be counted as incomplete, then it should be counted in your statistics, even if it's just an ER chart needing physician signature," he says.

• Staff an enthusiastic, competent clerk in the record completion area. Harrison's record completion clerk offers physicians a personal touch which helps increase compliance and leads to complimentary letters from doctor's throughout the year, says Meeusen.

  The hospital has a 20-day delinquency cycle, so at the 10-day mark, the clerk sends out a letter and personally calls each physician with incomplete records. "She's even been known to hunt them down in the cafeteria and drag them back with her," says Meeusen. At the 20-day mark, another letter goes out. "When the physicians get that second letter, they're in the same day."

  If a record isn't complete within the 20-day time frame, that physician cannot admit any new patients until it's done. But that threat is rarely carried out. "We haven't suspended a doctor in two years."

• Apply your policy consistently. Harrison's procedure has been consistently applied and enforced, Meeusen says. "I think that makes a big difference because our doctors know exactly what to expect. I've been here 13 years-the system worked the day I came in the door, and it still does. We've never had a delinquency rate over 5%."

• Inspire the physicians. Meeusen finds that physicians are much more likely to work toward compliance when rules and regulations are emplained in terms of improving the continuum of care. For example, physicians want to document allergies to medicine because the next provider will have that information the next time the patient comes in-not because the government rule requires it. "They really hate seeing issues as just another regulation," he says. "If I start talking about compliance, I meet a brick wall."

In addition, Meeusen has actually gotten physicians to compete with each other for a low rate. He distributes the delinquency statistics at each medical staff department meeting. "I break the data down by department so everyone can see where they stand." For example, the anesthesia department will compete with surgery for the lowest collective rate.

This excerpt is adapted from the book Mastering Records Completion 2: More Strategies from Medical Records Briefing.

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