Friday, February 15, 2008

Getting Played

I'm very upset with my employer right now.

First, in a previous post, I talked about what happens when mistakes are made when receiving payments for services from the U.S. Government. It's not pretty; the Office of the Inspector General gets involved and even if mistakes are accidental they will make you pay. It's that simple. That was the case with Rockingham; it was a billing error where our BLS trucks were transporting patients for whatever reason, and some of their calls were being mapped to ALS billing codes for payment purposes to either Medicare or Medicaid or both. It was an error that was caught and brought to our company's attention. The problems were resolved, but we still had to pay double damages to the Government to the tune of just under a million dollars, and the company had to enter into what is known as a "Corporate Integrity Agreement", or a CIA, with the OIG. One of the conditions of the CIA is that all employees have to be trained in the purpose of a CIA and what it means as well as the conditions that employees have to follow to comply with this agreement. It's a fairly lengthy and arduous set of conditions, all of which really do make sense, but this is happening because of problems that our billing department had, not our operations arm. This is important, and keep this in mind as you read this post.

Anyway, our management decided that this was an opportunity to tighten up everything around the way business is conducted, including operational matters, like patient care, documentation, etc. That's fine, too - none of that is unreasonable. But read on....

Not long after the first of the year, EK, our training and education guy, approached me to help him work on a presentation he had to give, ostensibly as a part of new employee orientation. At least that was what he told me. It had to do with writing patient care reports, and he asked me if he could use one of mine as an example. I agreed; after all, I like to help people learn. I always have, and if there is anything I am able to do to further anyone's education, I will do it. So I provided him with one of my reports. He told me up front that he likes the way I write PCR's; he told me that they are well-organized and that I provide all of the necessary information to describe the circumstances of the encounter. He told me that I "paint a good picture."

Made me feel pretty good, all things considered. But - there's more.....

So fast forward to this past Wednesday, 2/13/08. I attended this class on the CIA and what things need to be done, etc. During the class, they coveredthe following: Part 1 was what the CIA is and what it means to have to abide by the rules set forth by the OIG, Part 2 was an introduction to new forms and a new company policy regarding the transfer of patient care, and Part 3 was a discussion about documentation. Well, EK presented Part 3, and during the presentation he showed different examples of documentation that were to be considered unacceptable by our billing department. The first two examples were missing parts, like the chief complaint on the first one and vital signs on the second. The third example gets put up as "an example of a thorough report", and - you guessed it - it was the very report that he and I had talked about. But here's where it got torn apart: I use medical terminology in my documentation; I have been for a number of years, at this point. The problem that was pointed out, much to my surprise, is that nobody knew what any of the medical terms meant. For example, I use(d) the term "AA&Ox4" to describe a patient that is Awake, Alert, and Oriented to Person, Place, Time, and Situation. That is a legitimate medical term, but nobody knew what it meant. I used the term "WOB" to describe a patient's respiratory effort. That shows up on charts everywhere and is also a legitimate medical term. I used "RVR" to describe a condition known as Rapid Ventricular Response, which occurs in many patients experiencing Rapid Atrial Fibrillation. These are examples of what was in the report, but they are all legitimate and found in many medical textbooks. In our class, only two other people besides myself knew what those terms meant. Those that didn't know the meaning of some of the terms include the clinical director for the company.

The upshot of all this is that because I was the one that wrote the report I ended up having to identify the terminology, and because of this I was singled out in front a room full of my peers and told that this was not an appropriate way of writing a patient care report. All because of medical terms that our billers don't understand.... When I tried to point out that the billing people should be made responsible to learn these terms, I was told that this wasn't going to happen, and the bottom line is that from now on medical terminology was to be eliminated from patient care reporting. I then tried to make the point that by having to write long-handed reports we would be taking longer to document what we did, thus making our time at the hospital be that much longer, ultimately delaying our availability to be back in service. The response to that statement was that we should be in service once the truck is ready to go; if documentation is delayed there is time at the end of the shift to write it. That, in my view, is not acceptable, especially if you are 2 or 3 reports deep at the end of shift and you end up having to deliver them to the ED's well after you should be off shift. That has happened to me consistently since just after Christmas almost every week....

What made me angry (and I still am angry 2 days later) is not that I was made an example of. I'm angry because I was lied to - I was told that the report I provided was to be used for one thing and was used for something completely different, ultimately at my expense. That really, really bothers me. And I don't know what to do about it. I think that I probably will have to suck it up as I don't have any recourse.

After all was said and done, I was apologized to by both the clinical director and EK. That's nice, but the damage was done.

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NH Mind said...

Several problems here:
1. You appear to have been set up, by your employer, no less. Very poor practice on their part.
2. Your company has completely over reacted, probably a result of poor/weak management. To think a healthcare company won't allow appropriate medical terminology to be used because billing people don't understand it, is farcical. How about training your billing folks. You've got some lousy management running that company, obvious in their failure to properly bill the government and again with the way they are handling the aftermath.
3. A public apology in front of your peers by your training guy and clinical director are in order. Bustin' chops over a beer at the local pub is one thing. Doing it in a professional setting is inappropriate at best.
4. It all goes back to piss poor managers/management. Without change in those ranks, you're company will be back in the papers again with more problems/indiscretions/issues.
5. You've probably got no recourse on this one, other than to work for a better, more professionally managed company. Unfortuneatly, you're kind of limited, based on your line of work, at leaset in Manchester.

Don't let the bastards get you down (I used to know that one in Latin, which always sounded cooler).

AlexD said...


An entire company was shut down (1000 employees) checks bounced, communities lost their ambulance service because of poor management and documentation. Two years ago the company I worked for, Emergystat Ambulance, mandated that there were to be NO abbreviations so all of our Patient Contact Reports had to be written in long hand form. I would purposely write three or more pages, that would teach them. I agree an apology is in order but it was better to be scrutinized by your employer than to be pulled into a legal proceeding by the government. And yes Paramedics are sued daily because of improper documentation.
Good Post


manchmedic said...

Thank you, guys.

I'm feeling better after having written what I did and had a couple of days afterward to let all of the stuff digest.

You are both right; overall, management should handle issues like these in a more professional manner, but medics do indeed get sued on a regular basis, and poor documentation bites them in court. I do everything in my power to avoid the second fact....

At some point in the next 24 hours or so I'll be writing a follow-up.

Anonymous said...

first of all, get the facts straight guys. The billing people had nothing to do with this crap...gee, funny huh Tom M. happened to leave just as this was happening. The billing manager left as well. Dont tell me she was not left as the scapegoat in all of this. I am still there but you know, its worse then ever. Blame your past big shots and your still current one man! They should have gotten fired after all of this. They came out smelling like roses. The manager there violates rules all the time, she is a phoney like you would not believe. YOu, you got the shaft from Eric but then who doesnt!