Eighty-four percent of the vast majority that said clinical documentation needs improvement reported that staff and clinician satisfaction has waned. Clinician efficiency and productivity has dipped (82%), clinician work-life balance has deteriorated (81%), reimbursement has slowed (60%), and compliance has faltered (59%). Nearly all (97%) of surveyed hospices indicated that clinicians document after hours, 94% sent papers back to clinicians for correction and 64% have had rejected Medicare claims.
Many providers that are concerned about surviving an audit are providing quality care and doing the right thing, but they don't have the proper infrastructure, said Mark Silberman, a partner at the law firm Benesch. It doesn't necessarily mean there is malfeasance, he said.
"There is no doubt that there are some people who are taking advantage of system, but the people who are concerned about their ability to survive an audit are the providers who have focused on providing quality patient care," Silberman said. "They may be doing what the government wants, but the burden of evidencing it may be more than they can bear."
It's often a problem of the analytic-driven audit process, he said. The audits aren't designed to target organizations that are necessarily breaking the law, Silberman said, but often focus on companies that look and act like the ones that have already been caught.
Most hospice providers aren't equipped with the proper tools to retrieve the data requested in audits, according to the survey. Many still rely on a paper documents and compiling everything can cost at least tens of thousands of dollars.
Only 31% surveyed said they use hospice-oriented software for intake/referral, scheduling, clinical documentation, quality and billing. Sixty-two percent said that a lack of proper documentation reduces time clinicians spend with patients, and 54% said it reduces the quality of personalized care that clinicians can provide.
But spending money on new technology and boosting compliance doesn't increase reimbursement levels, Silberman said.
"Fixing the problem could directly be in contrast to our best interest—improving patient care," he said.
Mending a fragmented clinical documentation process requires taking a close look at the organization's underlying problems, said Josh Pickus, CEO of Optima Healthcare Solutions.
"Addressing this vulnerability requires evaluating how technology, best practices and other approaches can reduce risk," he said.
If the government can better communicate its expectations on what providers should be able to produce and in what format, it would give conscientious providers the ability to get out in front of it, Silberman said.
"The audit process as it currently exists has unintended punitive consequences for good providers to verify that they are good providers," he said.
