A preview of Daren Smith’s presentation on “Achieving CMS and Accreditation Success: The Role Your EHR Should Play,” providing insight and guidance concerning CMS and accreditation surveys and the value of ASC software.
In mid-July, I'll be presenting a webinar on "Achieving CMS and Accreditation Success: The Role Your EHR Should Play." I hope you'll join me on the program!
As the title suggests, I'll be discussing how an electronic health record (EHR) system helps surgery centers achieve successful Centers for Medicare & Medicaid Services (CMS) and accreditation surveys. I plan to summarize how ASC software broadly assists with surveys and then dive into a number of specific areas and standards common to CMS and the various surgery center accreditation organizations.
To give you a preview of the program, here are five of the ways we've seen an ASC EHR help with CMS and accreditation success.
1. Chart completion
One of the biggest benefits of using an ASC EHR concerns chart completion. Such software provides the ability for "non-human eyes" to examine every chart and inform or alert a center to any required items that were omitted. In some situations, the ASC software can even prevent a user from moving on to other activities until the required work is completed.
Chart completion tends to be a significant area of focus for surveyors. You'll regularly hear an ASC administrator speak of a survey where charts were audited. The surveyor pulls 10 charts and finds that two were missing a required item, such as documented time-out in the operating room or a surgeon's signature. Charts are viewed as legal representation of the surgical experience, so it's not surprising to see an ASC get dinged for incomplete charts.
If you use an ASC EHR, you'll want to ensure you have set up the appropriate alerts and stops so your charts are always 100% completed and you do not need to physically click through every piece of the chart to make sure it's completed appropriately.
2. History and physical examination (H&P)
A common requirement that ASCs used to get dinged for quite frequently and some still do concerns the age of history and physical examinations (H&P). H&Ps are generally expected to be no greater than 30 days old. Certain policies and states still have this requirement in place, so it remains a hot topic. An ASC EHR can usually be set up to flag when a patient's H&P is older than 30 days, allowing the surgery center to secure a more current examination before it proceeds with surgery.
3. Advanced directives
CMS and all the accreditation organizations want ASCs to ask patients about advanced directives. While surgery centers often do not always comply with advanced directives because of the type of care that's provided, ASCs must still ask patients about advanced directives and document that this conversation occurred.
Once again, ASC software should be configurable in such a way that the EHR prompts a center to ask patients if they have an advanced directive and document when this question is asked and the answer that is provided. This setup adds an appropriate "gate," if you will, that will need to be opened by asking that question before a user can navigate into the rest of the patient's chart.
4. QAPI studies
A topic we regularly hear about from our ASC client sites concerns the quality of their quality assurance and performance improvement (QAPI) studies. What's great about an ASC EHR is that it provides a center with a discrete data system. Every piece of data put into the software is searchable and reportable.
Some ASCs get cited quite often on their QAPI studies. The reason: They aren't of good quality. In other words, a surveyor believes the studies do not look deep enough into an area, they're not statistically significant, and/or they're not a worthwhile study topic in the first place.
How does this happen? If you don't use ASC software, completing a QAPI study can take a fair amount of work. After all, if you need to manually pull 50 paper charts and go page by page through each one to find the single question you want to answer, that is a lot of work and time investment. But if you can just click, click, click and pull out a report listing the 15 patients who provided a specific answer to a particular question, that's a much different workload and effort required to produce the study.
We see a lot of ASCs not looking for studies that are going to be the most impactful but rather looking for what are going to be the easiest studies. With an EHR, surgery centers can get both in one fell swoop.
5. Data manipulation
Something we hear more and more from surveyors is how much they appreciate that ASC software and the data it captures cannot easily be manipulated. In contrast, paper can easily be manipulated. You can never really tell when something was documented and signed off. Surveyors are increasingly appreciating the transparency they get from an ASC EHR. We've even received input from some accreditors that they want would like even greater transparency of activity in the system.
We're also seeing more surveyors becoming comfortable interacting with an EHR. Increasingly, ASCs don't need to print off charts. They can simply guide the surveyor to where charts and other pieces of information live in a system so the surveyor can review this on a screen.
Learn How to Improve Your ASC's Accreditation Success
I hope you found this article helpful! I invite you to join me on July 14, from 3-4 PM ET, for my webinar, "Achieving CMS and Accreditation Success: The Role Your EHR Should Play." Besides coming away with insight and guidance concerning CMS and accreditation surveys and the value of ASC software, you can also earn continuing education. This program has been approved for 1.0 hours of AEU credit by BASC Provider #1125. Learn more and register here!