Thursday, February 28, 2008

Pre-Accreditation Jitters, is your ASC infected?

PAJ occurs on a regular basis in ambulatory surgery centers throughout America.

Most administrative personnel anticipate the onset of PAJ months in advance. The pre-accreditation jitters can have a devastating impact on workplace stress, staff morale, employee health, and productivity. 









While the folks in IT departments have no trouble understanding the classic GIGO formula (garbage in, garbage out), the risk management committees, administrators, physicians doing the peer review seem to suffer from an occupational blind spot. If medical transcribers can easily identify the chronic conditions, which provoke PAJ, why can’t those of us so close to the core do the same? Why can’t the pre-accreditation jitters be avoided?









Come April 15th, will the news media have their cameras out as taxpayers rush to the post office to file their returns before the midnight deadline? Planning a story about people who wait until the last minute to do their taxes is a no-brainer for news editors. What about the millions of people who file their tax returns on time because they were doing what they should have done all along?

Whether running a surgery center or a restaurant, they pay their employer’s taxes on time. Their W-2 forms are delivered to employees and their 1099 forms appear in contractor’s mailboxes on time. Not only do these people understand the responsibility to store and maintain data so that they are ready to print W-2 and 1099 forms by mid-January, they also know that other people are expecting these forms to arrive on time in order to prepare their taxes and avoid any penalties for late filings.

 Suppose we compare maintaining a patient’s medical record to handling a company’s accounting functions? In the financial world, data has to be clean. How can you plan a budget without sufficiently solid data to forecast income and expenses? How many people in your accounts payable department are allowed to issue blank checks? There isn’t an ASC in this country that doesn’t have at least one doctor whose dictated reports contain enough blanks to look like a piece of Swiss cheese. Or, a handful of surgery center staff that is notorious procrastinators. When people don’t know how much of a mess has been made – or don’t care – there’s good reason for the person in the hot seat (usually the Administrator and/or the Medical Director of the ASC) to get a bad case of the pre-accreditation jitters. Suddenly, there is a heightened awareness of the need for quality control in transcription.

As the pressure starts to build and employees are asked to work longer hours, management’s expectations become more and more unreasonable. 
While working in the outpatient arena, my friends and I used to compare the long-term health of large dysfunctional nonprofit institutions to that of problem drinkers. Is there a corollary between a surgery center’s pre-accreditation jitters and an alcoholic’s delirium tremens? 
The people at the bottom of the ladder are not fools. Nurses know which doctors make sloppy, illegible entries into patients’ charts or simply don’t chart a post-op note at all. But, as PAJ sets in suddenly on the eleventh hour before accreditation, miraculously dictated then transcribed reports appear. Medical transcribers know which doctors are continually contradicting themselves while dictating because they’re lost in space, dictating so fast that they can’t help but make errors, or are simply too exhausted to pay attention to what they’re doing or saying. Accountants know who’s been doing a responsible job of tracking expenses. It is unheard of for someone to address the physician or staff about their sloppiness in work habits and force them to sober up and learn the proper technique in documenting coherent entries into the medical record. That might require people to risk losing their jobs by accusing a doctor/alcoholic figure of not doing his work properly and being a hazard to those around him. Even worse, it might mean that in a medical peer review, doctors might actually have to accuse their colleagues of being incompetent and whose poor work habits continually jeopardize the accuracy of their patients’ medical records.

Surgery Center Administrators decide that by outsourcing transcription to India they can get faster turnaround with a lower price per line. With new advances in Internet technology, entrepreneurs trumpet claims that they have solved all the problems of creating and maintaining an electronic medical record. 







Larry Abernathy, the President of Digital Voice, Incorporated, claims that “Philips speech recognition technology is being married to our dictation system, to give birth to DVI Speech Power. Without changing physicians’ dictation behavior, we can run their DVI Voice Power dictations through the speech engine, produce a draft text report, and then provide this text – along with a synchronized voice playback – to a ‘medical editor.’ We anticipate dramatic improvements in productivity since correcting a small number of mistakes will be considerably faster for your transcriptionists than transcribing the entire document. 







Abernathy’s statement blithely ignores the fact that fast key stroking is not the issue, which keeps bringing medical transcriptionists to their knees. The problem is the incoherent statements spewing forth from the mouths of the dictators with absolutely no intention of improving the quality of their dictation. When was the last time the medical staff at your ASC diagnosed with the PAJ? Isn’t it about time, we join forces to construct a unity in legibility, quality, and consistency?

Don’t let your ASC be subjected to the infectiousness of PAJ, insistently ensure that all participants of your ASC is up on all their vaccines and that any Antibiotics needed are given way in advance to prevent this industry wide break-out of the Pre-Accreditation Jitters.

“Assisting the clients at doing it right from the very beginning” is our mission statement. Troy Lair, CEO and Principal Consultant of The Compliance Doctor, LLC. A Los Angeles Based Consulting Company that serves the nation in accreditation and licensure.

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