So just an update on how bad this core measures silliness has gotten:
#1 I got dinged on a patient for not giving beta blockers to an acute MI. The hospital let me know that I was expected to give beta blockers to all AMIs because we lose points on the core measures stats. Now I got pretty steamed on this on and pointed out that in the chart it was well documented that this particular patient was a hypotensive, bradycardic post code in the field patient who was in the ED for 22 minutes before he went to cath. Beta blockers would have killed this patient outright. The auditors said that none of that counted because I "failed to give the indicated medication or specifically document that the (in this case lethal) medication was considered and contraindicated for a recognized and approved contraindication." Of note bradycardia is not an "approved and recognized contraindication" to beta blockers, go figure. The senior director summed up the fiasco by saying that if I had given the Lopressor it never would have come up because the guy would have died and then not been admitted and core measures only applies to admissions.
#2 There's a labor dispute at my hospitals and the union fed the local rag all the core measures stats which look bad but are crap. For example they said we're only giving ASA to 88% of our MI patients. That looks that way because up until 2 months ago the auditors weren't looking at the EMS sheets to see if the ASA was given PTA. Now we are documenting AS given PTA on the ED sheets to make up for that.
#3 We have been informed by our management group to expect reimbursement to be linked to core measures compliance within 2 years. Ug. If they're got to dock me I guess I'll have no choice but to give the Lopressor to the hypotensive bradycardic people. No biggie, I'm already giving Azithro to practically every patient for fear they might get admitted with pneumonia and didn't get abx within the magic 4 hour window.
As a hospital pharmacist, one of my jobs, occasionally, is review charts to monitor & get documentation for just some of these things so the hospital doesn't get dinged. (I hate this part of my job!) In my small personal experience, the snf & mental health units get dinged far more than the ed, but that is for a diffferent forum.
The auditors may be well trained or not so well trained...sometimes, they're nurses & sometimes they're medical records folks. But..often - they don't know what they're looking for. What appeared to be a clear progress note when you wrote it is not so clear when someone is looking at it with the intent to decrease your reimbursment. So...we have to document on stuff, just like what you've noted above so later it doesn't come back to bite us.
JCAHO, IMO is the worst - they generate the most absurd notions of what will influence pt outcomes. However...they control the accreditation & therefore the money.
But...your own group can be proactive, if it affects your reimbursement. I know two physician groups - one an electrophysiology & another an ED group who employs someone to do their own independent audits so they have documentation to protect reimbursement. (Of note..the electrophysiology group also does drug studies, so this person is employed full time with all sorts of QA issues - some dealing with FDA compliance).
As for drug choices....ask your dop to keep Keflin - old, old, drug - everthing's resistant to it, its cheap & ususally won't harm....but won't do any good to a real pneumonia pt.
Or...there's one dose of erythromycin - it also isn't very effective as one dose, cheap, very little incidence of allergic reaction & if they haven't eaten....it might actually give them something to complain about...altho that might complicate your situation a bit
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Oddly enough....we do have streptomycin - we keep it very well hiddend for resistant TB - now if we let you have it...the pharmacy would get dinged!!!
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Good luck & who let out confidential info anyway?????
), the receiving services could save us by keeping pneumonia off the #1 line.
