Friday, July 26, 2013

Results

A difference?
All of us in EMS grow to realize more and more that it’s not about just what we do, but that what we do makes a difference.

We can all remember our earliest days in EMS.

None of us really had a clue. So, much about our experience was about the “stuff” of EMS. EMS, then, was about the thrill of the response, the sound of the siren, the lights and even about the fear that we all felt deep down when we doubted that all that training was really going to translate into the ability to save a life.

But as time went on and your skills became second nature, you realized that it really wasn’t about all that other stuff and now it becomes about the eventual outcome.

Do I make a difference?

Documenting treatment
When it comes to documentation, the eventual outcome is important. However, we typically read a lot about the treatment that took place during the ambulance run, but sometimes not so much about the outcome of that treatment.

We theorize that this is because most of us have been fairly well coached to create Patient Care Reports that fully spell out what we found and then what we did to treat our patient.

We’re very good at documenting that we followed protocol. We’re fairly careful to note that we colored inside the lines and practiced well within the boundaries of our scope of practice.

Of course that’s important.

The average PCR we review here at Enhanced does a pretty good job of documenting the patient’s condition and need for EMS, the actions taken by the responding crew and in most cases important numbers are added to paint the picture (ie. vital signs, assessments including pain ratings and basic diagnostic readings such as pulse ox values, pain ratings, etc.)

The “Close-the-Loop” part
However, we find that many of us fall short in documenting the results, or the outcomes of our efforts.

We read many PCR’s that have done a fairly good job at capturing what’s going on with the patient or at least what the patient says is going on. Those PCR’s, for the most part, include full assessment findings, treatment action items and basic demographics including the point of pick-up, drop-off and documentation of the loaded mileage total traveled by the ambulance while transporting the patient.

The next important part of our documentation in the PCR must be the “Close-the-Loop” part of the scenario. This is the part that tells the story about how our patient reacted either neutrally, positively or negatively to the treatments we provided during the treatment and eventual transport of our patients.

The answer to the question, “Were my treatments effective or ineffective in making a difference for this patient?” is very important and should be included in the written narrative we prepare as part of our PCR.

This is really part of the documentation of our reassessment of our patient and also fits well into the timeline area of the PCR.

Don’t miss the results
You respond to a 60-year-old male patient complaining of chest pain rated as an “8” on a severity scale of 1-10. The patient has shortness of breath, some slight nausea and fairly significant sub-sternal chest pain that radiates down his left arm.

Our EMT-P instructs his partner EMT-B to administer oxygen 15 liters of oxygen via non-re-breather mask while the EMT-P quickly applies the cardiac monitor and assesses basic vitals. The patient is found to be initially hypertensive and a quick 12-lead EKG shows some abnormalities.

The patient is given baby aspirin to chew, IV therapy is established and our EMT-P administers a sublingual nitro tablet to the patient.

In many PCR’s we read this is about where the documentation ends, not counting the basics like mileage recording and pick-up and drop-off location.

Be sure to take your PCR one step further.

Once treatment has been established, now record the effect of said treatment.

For example, “Soon after initiating oxygen administration, the patient’s respirations slowed from 30 bpm to 24 bpm and the patient’s breathing became non-labored. Following the administration of sublingual nitroglycerin, the patient rated his chest pain as a “6” and he stated that his nausea had subsided. The patient appeared to be less anxious at this point.”

Establishing medical necessity
Remember your PCR must establish medical necessity and justify the need for your EMS services.

It’s clear in the above scenario that our patient’s life would have been in danger had it not been for the activation of EMS.

He most likely was in the midst of a life-threatening cardiac event.

The patient, while probably able to ambulate would not have been able to have been safely transported in any other vehicle other than an ambulance that included important equipment and supplies and trained individuals to adequately mitigate the acutely emergent nature of his condition.

EMS was the only prudent option and there is wide justification for payment of those services, after the fact.

You just made the ultimate case for payment of this claim and you definitively backed up that claim by noting that your efforts made a difference… probably saving your patient’s life.

“Coach Enhanced”
EMS is a team effort. Today we play the role of Coach.

It’s the kind of support we provide to our clients on a regular basis. We live, eat, sleep and breathe documentation and compliance. It’s what Enhanced is all about.

If you’re not getting this kind of coaching on a regular basis from your in-house billing office or from your outsourcing contractor, maybe it’s time to check out Enhanced.

Business Development Manager, Chuck Humphrey is waiting for you to contact him. Chuck’s just a phone call (800-369-7544, Ext. 108) or an e-mail (chumphrey@enhancedms.com) from providing your organization with this same type of support.

Join the Enhanced team. Call Chuck today!
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