Impact of Early Educational Intervention on Coding for First‐year Emergency Medicine Residents

Bang, Sunny; Bahl, Amit

doi:10.1002/aet2.10102

Cited by 10 publications

(11 citation statements)

References 10 publications

(10 reference statements)

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“…15,16 Another recent study found that resident education of billing practices significantly increased RVU billable by resident encounters. 17 Taken together, this body of literature suggests that educational interventions such as ours can have a quantifiable effect on ED revenue and future EP documentation practices.…”

Section: Discussionmentioning

confidence: 75%

Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound

Schnittke

Damewood

2019

WestJEM

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IntroductionEmergency medicine residency programs have rigorous point-of-care ultrasound (POCUS) curricula. However, this training does not always readily translate to routine use in clinical decision-making. This study sought to identify and overcome barriers that could prevent resident physicians from performing POCUS during clinical shifts.MethodsThis was a two-step process improvement study. First, a survey was deployed to all residents of a three-year academic residency program to identify barriers to clinical use of POCUS. This survey identified the perceived lack of a uniform documenting protocol as the most important barrier to performing POCUS on shift. Second, as an intervention to overcome this barrier, a streamlined documentation protocol was developed and presented to residents. The primary outcome was the number of patients who had POCUS used in medical decision-making one year before and after intervention. Secondary outcomes were the level of training of residents performing exams and whether faculty overseeing exams were trained through an ultrasound fellowship program.ResultsPOCUS use by residents increased from 82 to 223 patients before and after the intervention, respectively. Per resident, this translates to an absolute increase from 2.2 (95% confidence intervall [CI], 1.4, 3) to 5.8 (95% CI, 4, 7.6) or 3.6 (95% CI, 1.8, 5.4) exams/resident over the study period. We observed no significant difference in the proportions of scans attributable to the resident level of training (χ2 = 0.5, p = 0.47). The proportion of exams by non-ultrasound fellowship trained faculty increased significantly more compared to fellowship trained faculty (χ2 = 19, p<0.0001); however, both ultrasound fellowship trained and non-ultrasound fellowship trained faculty increased the absolute number of exams performed.ConclusionA key perceived barrier to resident-performed POCUS is unfamiliarity with documenting ultrasounds for medical decision-making. Educating residents in person about a POCUS documentation protocol may help overcome this barrier. Incorporating resident input and motivation into POCUS incentivization may increase utilization. Future studies in optimizing POCUS on shift will need to focus on streamlining documentation, addressing time constraints, and faculty support for resident-performed POCUS.

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Section: Discussionmentioning

confidence: 75%

Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound

Schnittke

Damewood

2019

WestJEM

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“…Some studies have identified that the inability to receive ultrasound expenses serves as a barrier to the use of POCUS [14,16]. In addition, some studies have shown that the frequency of ultrasound use has increased since the introduction of reimbursement claims or education on billing practices [19,27,28]. Adhikari et al identified that educational intervention in the billing process increased the number of POCUS scans billed by 180% [28].…”

Section: Discussionmentioning

confidence: 99%

Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis

Kang

Park

et al. 2022

Medicina

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Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions—expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p < 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.

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“…Table 1 summarizes Kern's framework, outlines key aspects of our curricular design, and includes supporting educational evidence. Based upon results of a few studies 3,6,7 , charting and coding education during residency is well received and has the potential to improve con dence and performance…”

Section: Curricular Designmentioning

confidence: 99%

“…skills. 2,3,4,5 While institutions have used multiple pedagogical approaches, the best method for teaching charting and coding is unknown. 6,7 To address the lack of a standardized charting and coding educational method at our institution, we incorporated charting and coding skills in our health policy curriculum.…”

Section: Introductionmentioning

confidence: 99%

A Team-Based Learning Approach to Reimbursement and Billing Education for Emergency Medicine Residents

Turner

Haddock

Andrabi

et al. 2022

Preprint

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Objective: We developed a curriculum to improve resident knowledge and comfort in charting and coding during emergency medicine (EM) encounters. Our tool kit includes simulated charts and assessments in a team-based learning (TBL) format. Settings: The curriculum was delivered at one an academic institution’s emergency medicine program. Participants: Thirty-one residents and 18 faculty and APP learners attended the TBL reimbursement workshop. Primary and secondary measures: Learners perceived knowledge and comfort in charting and coding Results: The response to the TBL exercise was overwhelmingly positive, with an increase in learner’s comfort with understanding and placing the 6 different evaluation and management Current Procedural Terminology codes commonly used in EM significantly increasing. The learners also had a significant increase in distinguishing between new (e.g., alternative payment systems) and older (e.g., fee-for-service) payment systems had a significant 30-point increase (p<0.001). Conclusions: This study demonstrates that TBL can successfully be used as part of EM residency curriculum to teach charting and coding skills. Our TBL exercise demonstrated significant gains in self-rated knowledge for the three learning objectives pertaining to EM reimbursement.

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Impact of Early Educational Intervention on Coding for First‐year Emergency Medicine Residents

Abstract: The focused longitudinal educational interventions resulted in improved billing performances, reflected by better documentation, in the intervention group versus the control group.

Cited by 10 publications

References 10 publications

Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound

Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound

Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis

A Team-Based Learning Approach to Reimbursement and Billing Education for Emergency Medicine Residents

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