Getting members of a physician group to agree on the terminology used to document care is essential, and has an impact on communication within the practice as well as reimbursement.
A year after making that change, the rate of documentation in the practice had increased to 82.33%, and by the second of quarter of 2017 it had reached 99.33%. “This is a concrete example of how by agreeing to agree and changing our culture we were able to achieve measurable improvement,” he said.
In other example involving the IRIS Registry, the practice’s performance for optic nerve evaluation in primary open-angle glaucoma was 45.97% when first calculated, compared with the registry average of 72.32%. The blame was pointed at the software— “it must be a glitch”—since the scribes and physicians were certain data were being correctly documented.
Motivated by their seeming “failure” at performing so far below average, the physicians began to investigate. They found that their EHR system did not recognize their documentation of an optic nerve evaluation, for purposes of the IRIS Registry, when the cup-to-disc ratio had not been entered following an exam performed with optical coherence tomography. Despite all the other data from the analysis, lack of that number meant no credit in the numerator.
Now that this omission has been corrected, the practice has a 78.64% score for optic nerve evaluation. When the performance data for a practice is not up to the expected standard, another way to investigate the problem is by examining the data for provider variation, Dr. Colloton said. If the data show that certain providers are performing well below average, it opens the door to conversations about how to deliver a higher level of care.
Changing EHR for the better
“We have been able to use the tools the IRIS Registry has given us to encourage our doctors to agree to agree, and that can be a tricky thing to accomplish,” Dr. Colloton said. “The IRIS Registry serves as a tool to help us clarify our communication with our doctors and improve on an already positive office culture while demonstrating measurable improvement in performance.”
Edward L. Colloton, MD
P: 309/662-7700 E: [email protected]
This article was adapted from Dr. Colloton’s presentation at the 2017 meeting of the American Academy of Ophthalmology. He did not report any financial disclosures. Cohesive, uniform terminology can also improve practice reimbursement percentages.