EDITS Data - Benefits Analysis

There are numerous very tangible benefits to be derived from use of the EDITS Data program:

1. Greatly Improved Hospital Charge Capture
   As noted in the "background" section, one of the early benefits achieved at the first hospital where EDITS Data was installed was markedly improved capture of hospital charges and a large increase in net revenues. The problems associated with charge capture by nurses with regard to consistency and accuracy are universal. CQ Systems has conducted 14 lost charge audits for hospitals considering the implementation of EDITS Data. These audits have consistently demonstrated that hospitals are losing large quantities of charges. In the 14 audits, an average of 35% (range 16-58%) of charts were noted to have charging errors and the average loss per chart audited was $25 (range $7-$55). For an average-size ED with 20,000 visits per year, this equates to approximately $500,000 in lost charges. Depending on the payor mix, this can be expected to result in a net revenue increase to the hospital of $150,000 to $250,000. These audits clearly affirm that it would be the rare hospital that would not benefit substantially from improved charge capture. In addition to improved charge capture, the chart sweeper position relieves nurses of a task that they have been shown to perform poorly in study after study and allows them more time for patient care. The problem of nurse charge capture typically cannot be effectively resolved by focusing efforts on this aspect of their work. The universal nature of this problem, as reflected in the audits performed by CQ Systems and others, and which is intuited by anyone with any degree of ED experience, would indicate that it is a "system" problem requiring a totally different approach.
   
   
2. Consolidation of Data Capture
   In most hospitals, multiple individuals are involved with information capture and coding of each ED record. It is not unusual for the Pharmacy Service to be involved with charge capture related to drugs and, likewise, Central Supply for supply charge capture. Someone else has to enter room charges and chargeable nursing services, while other individuals typically do CPT and ICD-9 coding (often this is done by two individuals -- one on behalf of the hospital and one on behalf of physicians when they bill separately). This fragmented data entry is very slow, inefficient and labor intensive. All of this redundancy is eliminated with use of EDITS Data. One person captures everyone's data and distributes needed elements to the parties who require them in a timely manner.
   
   
3. Department, Staff and Physician Profiling
   In addition to the charge capture and redundancy avoidance benefits of EDITS Data, the software provides the opportunity to profile the performance of the emergency team in an unprecedented manner. The number of detailed, provider-specific reports that can be generated with the available data elements is unparalleled. In addition, the preparation of standard monthly or quarterly management reports, a task formerly requiring hours or even days, (if they could be generated at all) can now be completed in minutes. Also, EDITS Data can be easily used to compare performance data between multiple hospitals in a system or group practice.
   
   
4. Performance Improvement Initiatives
   Emergency department performance improvement traditionally involves the retrospective review of ED charts to ascertain whether a problem exists, implementation of educational endeavors or policy changes to eliminate the problem, and follow-up through subsequent audits to determine if improvement has occurred. All of this work is tedious and time consuming and, in addition, generally involves requesting the Medical Records Department to provide large numbers of records to review. Because user-defined data fields can be added to EDITS Data, the chart sweepers can review charts for any specific performance improvement data as they come through the chart stream and enter this information in addition to the core data. This largely avoids the need to request charts from Medical Records for retrospective review. The goal is to touch the chart once and extract from it all of the needed data - whether it be related to charging, coding, profiling or performance improvement efforts. Because it can analyze multiple data elements from an entire population, EDITS Data eliminates all challenges related to sampling biases and allows an unprecedented ability to address complex, yet important, clinical and managerial issues.
   
   
5. Consolidated Coding and Billing Initiatives
   Should the hospital elect to consider the outsourcing of its ED coding or billing, use of EDITS Data provides the vehicle by which this can be readily facilitated. Since EDITS Data contains all of the informational elements needed for coding and billing for both hospitals and physicians, the electronic uploading of this information to a billing company would greatly facilitate a combined effort. Even if only CPT and ICD-9 coding were combined, benefits would be achieved in that codes generated by the hospital and physician group would not be in conflict - a growing concern in this era of fraud and abuse audits. The EDITS Data program is the ideal solution to the challenges posed by the Medicare Ambulatory Patient Classification (APC)-based Outpatient Prospective Payment System. Specifically, the program is capable of providing hospitals with all of the CPT codes needed to appropriately maximize Medicare payments.
   
   
6. Increased Hospital "Compliance" With Required Coding Standards
   All hospitals are struggling to create and implement compliance plans in order to meet regulatory requirements and to minimize exposure to allegations of "fraud and abuse" from local, state and federal agencies. EDITS Data is designed to promote standardization of coding of physician and hospital components while capturing clinical and management data on all visits. By minimizing the number of personnel applying coding rules, the risks to hospitals and physician groups are minimized.