ER and OR levels
Every hospital has their own approach to determining levels of care in the emergency room and the operating room. Given the differences among hospitals, it is not surprising to find that some approaches are more successful at recognizing resource allocation than others. So the question every hospital leader needs to ask is, do your ER and OR levels actually work?
Do you have a process in place for assigning ER and OR levels?
Once established, most hospitals review their process for assigning levels of care infrequently. This means that any error or omission in their design will continue to trouble the hospital for years.
The same holds true for hospitals that use EHR points systems. These points systems do not always work properly for vital signs, medications, x-rays, labs, diagnostic imaging, and education.
These are the types of issues that a review can detect – and correct.
Determining if your levels are effective.
To determine the effectiveness of your levels or points, it matters who conducts the review. If the review is led by the revenue cycle team, it will not be able to flag anything other than billing or coding errors. This is not due to a lack of diligence on the part of the revenue cycle team. Rather, it is because only a clinician is capable of seeing where levels of care or points systems are incorrect.
Consider the difference in a young man presenting with chest pain. While he may be having a heart attack, he is also likely to present a far less complicated care scenario than a man in his 80s. That difference in time and resources can lead to a considerable amount of care not being properly charged. And that means revenue is being left on the table.
In some cases, hospitals charge differently for a service depending on which level it is assigned to. This variability can affect the hospital’s ability to say what the price of the service actually is. With the current push for price transparency, clarity is the goal.
A better approach
Hospitals can benefit from bringing in a clinician who also has revenue cycle expertise to review their levels of care or point systems. This dual expertise makes it possible to catch services where levels or points may be underestimating the care provided. These are details that professionals skilled only in revenue cycle management could not detect. That is the way to ensure that your ER and OR levels and points are working the way you need.
Photo by Eran Menashri on Unsplash