Introducing the OpNote Consultants: Dr. Deanna Attai Part 2 of 2

February 19, 2010 at 10:35 am 6 comments

While creating our surgical reporting product, the OpNote, we at mTuitive have been working with many highly skilled surgeons.  These surgeons are from a diverse group of specialties and backgrounds and help to shape the future and efficacy of the OpNote.  We’re introducing these consultants to all of you in the coming weeks.

Dr. Deanna Attai is an accomplished breast surgeon certified in General Surgery by the American Board of Surgeons in 1997.  Dr. Attai is also a Fellow of the American College of Surgeons, certified in Breast Ultrasound and is an instructor in Breast Ultrasound Education for the American College of Surgeons.  She is affiliated with Providence St. Joseph Medical Center in Burbank, CA and runs the Center for Breast Care, Inc.  For more information on Dr. Attai, the Center for Breast Care, Inc. and breast health awareness, please visit her website.  Dr. Attai and I recently spoke over the phone regarding her background in surgery, interest in electronic reporting and why it is so important for surgeon to be aware of medical coding.

Click here for Part 1!

How much do you think could be gained from structured data?  I’m defining “structured data” as capturing a point of data that can be graphed or used for research later.  We at mTuitive put a lot of value into it – do you think a lot of other physicians do?

I’m not sure if a lot of other physicians would – but they should.  That’s how things are going: you need to pull out your cancer staging for some of the stuff that I’m doing with American Society of Breast Surgeons (ASBS) and we’ve got this quality initiative program where you’re entering in some of your data.  Everybody’s going towards quality reporting; it’s going to be part of board certification requirements; it’s going to eventually be part of Medicare and other insurance participation [programs].

Are they looking for quality or for data research purposes?  You can’t always anticipate how the data will be used in the future or what you’ll need.

People need to be told just how important it is.  You’re not just dictating your operative report so you have something in the hospital chart – everybody’s looking at this stuff now.  Whether it’s the insurance companies, patients, hospital billing, or [the Joint Commission] – everybody’s looking at it.

A lot of physicians don’t understand how important it is but they are going to be told very quickly.  Those that do understand will get it, and I think a lot of hospital administrators will understand – now it’s just getting the docs to buy into it, as we don’t like to change.

How do you feel about standardization of content in the operative report?  Right now Joint Commission has some requirements, but there’s not a lot stating what has to be in the operative report.

My dictations are probably twice as long as they need to be.  But I’ve done a lot of peer review – both in the hospital setting and in my malpractice company – and where you get in trouble, as a doctor, is by not documenting.

Yeah, it seems like it’s a lot of “sin by omission.”

Exactly.  So if you didn’t say it or didn’t chart it – it didn’t happen.  I tend to be very detailed in my documentation, both in the office and in the hospital.

The problem is who is going to decide what needs to be in those reports? Will it be [the Joint Commission] or Medicare or something else?  This is where some of my interest in the OpNote came in because I’m also involved in this project with ASBS regarding quality indicators. Medicare has said there are a couple of quality indicators that need to be fulfilled for surgery.  All but one of them doesn’t apply to surgery – they’re just not applicable at all.

What the leadership of ASBS basically said in a summary was that we’re going to be forced to follow certain rules and to do certain reporting – whether we want to or not.  We should be the ones saying “in breast surgery, this is what constitutes quality indicators.”  So we’ve developed a pilot project where you enter all of your surgeries (and also all your core biopsies that you do in the office as well), and report on some very basic quality indicators.  It was good enough that the American Board of Surgery now recognizes that.

One of the things you need for recertification now is proof that you participated in a quality indicator reporting system (of some sort).  And this [ASBS] program has been recognized as one of the systems that is acceptable.

It’s not that much different with [operative reports] or any other hospital documentation.  [Doctors are] being told what we need to put in there, but it’s partly our responsibility as doctors to speak up and say “you guys are actually looking at the wrong thing.  These are the things that are really important and should define either quality or whatever else you’re looking for.”

Any nightmare stories from the old transcription/reporting process.

Hospital billing is horrendous.  I don’t know how they do it.  I’ve gone down to hospital coding departments to sign off my chart, and I’ve seen the codes that they are billing my surgery and I’ve had to replace the CPT code they put in there.  How can you guys not know that the lumpectomy is this CPT – I mean, a lot of doctors don’t know that, either, but the coders…that’s their job!

The problem is they can only code based on what [the doctor] actually writes.  So there’s education needed on both parts.  Doctors are not used to coding – we don’t really get taught in medical school or in residency.  The only time we really get taught is if, in residency, you happen to do some rotations in a private practice setting.  And then you are certainly going to learn about billing and coding.  Most residencies, though, are in academic centers – they don’t teach anything about billing and coding.

I get it – I understand that if I don’t write certain things, nobody’s going to get paid.  But some of these doctors don’t understand that.  And I think that’s because [doctors] just haven’t been educated.

And hospital billing and coding, it is absolutely horrendous.  They don’t understand properly – they don’t know how to follow up on claims.  I mean, I would’ve been out of business a long time ago if I had someone doing my billing like it’s done at the hospital.  Stuff doesn’t get followed up…it’s just insane.

There’s a lot of education needed there…I don’t think the hospital administrators always realize how bad it is.  Sometimes it’s just a personnel problem – you don’t have enough people to do the job.  The hospital isn’t necessarily the bad guy; they’re just trying to make a buck as well.

I do think a lot of education is needed on the doctor side of things.  The docs need to understand more about how this all works.  The better our documentation is, the better job [hospitals] will do figuring out what we mean and what’s the appropriate reimbursement for it.

I’ve always done my own coding because, at the end of the day, I’ll be the one going to jail for Fraud, not my billers.  But there are a lot of doctors that don’t do their own coding.  They just do their [report] and send it off to the biller, and their biller has to decide what level CPT and the ICDs are.

So again, there’s just a lot of education needed on the doctor side.  And you got to teach it in medical school.  Once you’re out of medical school…forget it.  If you haven’t learned it, it’s very hard to drill in new stuff.

Thanks so much for all your time!

No problem!

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Entry filed under: Compliance, EMR, OpNote Consultants, Standardization, Synoptic Reporting. Tags: , , , , , , , , , , , , , .

Introducing the OpNote Consultants: Dr. Deanna Attai Part 1 of 2 Introducing the OpNote Consultants: Dr. John Mattson

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