Feeling the Squeeze: Treatment Quality and the Electronic Health Record
Is treatment quality dropping because of requirements to use the Electronic Health Record (EHR)?
Professionals who hang their own shingle already know that you gotta do the paperwork. If they don't keep their assessments, treatment plans and notes up to date, they may not be able to bill a consumer's insurance. Another reason to keep up with the paperwork is that in these documents lie solutions to mental health and addictions problems.
Those working exclusively for agencies may resist spending the time on the paperwork, and that hurts billing, which hurts the paycheck and the organization they work for. Since it's a key to the paycheck, why do some professionals persist, buying into this old problem and have trouble keeping up with the paperwork?
Lately I've been working with a moderately resistant staff that has taken a while to acclimate to using the EHR. After months of work, the professionals are writing the notes to chronicle short, significant activities with consumers that were not previously required. Consumers' records are up to date and include the new documentation requirements, and billing is on target.
The objective for performance in this particular clinic was determined by analyzing what needed to be done to reach the revenue that would enable the clinic to survive. We discovered a couple interesting things.
All the work was being done before the mandate to record the notes in the EHR became critical (in this case, the progress note triggers a record to the billing system to bill for the consumer's treatment). Staff felt they didn't have time to write the notes for these short sessions. They felt the longer sessions were where the meat of treatment was found and really the important thing to document. Were morsels of these shorter sessions ever lost? Who knows. The fact is, they are not lost now.
Prior to the requirement to use the EHR's progress note to kick off the bill for the session, you might have seen professionals reading the paper or balancing their checkbook in their downtime. No more.
The other day a friend I've been working with on this project told me she was pleased with staff's performance in getting the notes done, and the charges for this work they've always performed with consumers, but never been paid for.
There may be a downside.
This clinic, like a lot of clinics, tries to engender a "family atmosphere". The staff members are all caring professionals, well trained in helping people. My friend's fear is that their attention to this aspect of the clinic identity is slipping, and consumer treatment may decline in quality. Staff is focused on survival of the clinic. They feel that without writing a ton more short notes to generate more revenue, their jobs may be in jeopardy. So, the solution to this is to broaden attention to include consumer treatment, while still writing a ton more notes. A management issue that may be a constant companion for a while.
To put it simply, this is just a matter of getting used to a new way of doing business. Right now, it may be true that the staff is taking the paperwork and billing quite seriously, perhaps too seriously. I said earlier they are "caring professionals". As such, they can't help but help the consumer.
My guess is it just takes time and attention to the details.