Poor recordkeeping can interfere with compliance, bottom line

Poor recordkeeping can interfere with compliance, bottom line

Jul 01, 2003

Are you losing 20 percent of your gross revenue?

If you're not using a travel sheet (speed sheet, circle sheet, charge out sheet) for every inpatient and outpatient visit, it is a scientific fact that you are losing up to 20 percent of your charges.

Tracking a patient with a travel sheet during a visit will help eliminate missed charges and will allow the staff to take the proper steps to ensure patient care is met.
The claims that it can be put into the computer faster or the technician types in the information as the doctor speaks are nice attempts to become a "paperless" practice, but even paperless practices will capture missing charges if they use a temporary paper travel sheet. The most common reason for missed charges is a failure to complete records in the exam room. The common excuses of: "I need to think," and "I have clients waiting," or "It's rude to write in front of the client" lead to inefficiency and poor communication with your team. Providing complete and accurate medical records serve as the foundation for your staff to work effectively and leads to efficient appointment scheduling. It really doesn't matter if we are talking about an inpatient or outpatient visit. If the medical records are not completed by the doctor(s) and nurse(s), a number of charges are missed. Veterinary Practice Consultants has developed a successful program where client relations staff (receptionists) are rewarded for any missing charges they find before the client leaves. The program has the client relations staff do this by comparing the travel sheet to the medical records and to the charges already entered into the computer.

When Dr. Tom Catanzaro, a veterinary practice management consultant, introduced this program into my practice, we routinely wrote bonus checks to several receptionists for several hundred dollars a month. Did I point out that it was pure net? If the client walks out without ever being charged, it's gone! So every missed dollar the receptionist finds and adds to the bill is pure net. So I'd share it with her!

Getting started Our medical records system includes a patient data sheet (Table 1). The top portion is a computer back-up for practices with paper records that allows doctors and nurses to double check the wellness status of every pet in the household. Sure the front office staff is supposed to do it every time, but they are busy answering phones and dealing with clients, so at times, they miss a few. The technicians, assistants and doctors all have a chance to help out and catch missing reminders, vaccines, lab tests and other follow-ups. We use a two-part program that picks up missing pets and missing clients. Another part of the program is to have the client relations staff and the other members of the veterinary team screen every pet in every household on every visit. Implementing a third reminder into the system that requires a phone call to clients who haven't responded to wellness care (exam, vaccine, therapeutic monitoring) can be combined with these two functions generating $100,000 to $150,000 per year in the average practice.

Table 1: patient data sheet
The lower right corner of the patient data sheet is used to increase client compliance with chronic medications and reduce work for the client relations staff (Table 1). Using short-hand under the prescription refills heading allows the doctor to approve refills for six months to a year after appropriate therapeutic monitoring has been accomplished.

Example: Rx Thyroxine 0.6 mg BID #120 HHHhhh

This entry allows your client relations staff to fill this prescription three more times before any more testing is due. When the next to the last box is checked, the technician will inform the client that one refill is left and schedule the pet for the appropriate bloodwork before a new prescription is needed. This occurs even before the reminder goes out.

By merely reviewing the patient data sheet, any team member, including a doctor, can check the wellness status of a pet on the checkerboard square. This, of course, should be customized for your practice. They can also look at the master problem list for a quick historical summary and which problems have been resolved or which need follow-up care. Finally, any team member can immediately assess the status of chronic medication refills. An added benefit is using pink and blue forms to designate the sex of the animal so no mistakes are made when talking with the client.

Whether you use a POMR, SOAP, HEAP, or some other version of alphabet soup, our box system will speed up your data entry and allow you to get your records done in a timely manner. Add a 12-system exam sticker and your medical records can be complete before you leave the exam room or discharge a patient. The sticker allows you to check off all the normal systems. In today's society if you didn't write it, you didn't do it! Gone are the days when if you didn't write it down, it was presumed normal. Today, if you don't write it down, it is presumed you didn't look at it! These templates can be put into computer systems as well. The shorthand is actually really simple. A box [ ] equals a need.

Example: CBC [TH]

Chem Panel [ ]

X-ray abdm [ ]

Technicians place their initials in the box. This informs the entire staff who completed which procedure. To exit the exam room, the doctor just needs a diagnostic and/or treatment plan like the one previously outlined. Obviously, the doctor's assessment and treatment plan will follow the diagnostics. The other abbreviations are for follow-up.

"W" means that if you ask a client about cleaning his Yorkie's teeth again, he'll go elsewhere. He then smiles and shows that he is missing multiple teeth!