Carter Kelly A, Dawson Brian C, Brewer Kori, Lawson Luan
Department of Emergency Medicine, The Brody School of Medicine, East Carolina University Greenville, NC, USA.
Acad Emerg Med. 2009 May;16(5):423-8. doi: 10.1111/j.1553-2712.2009.00373.x. Epub 2009 Mar 24.
The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient.
The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second- and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre- and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate.
The evaluation and management (E/M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second- or third-year resident was 282.82 USD, which increased to 301.94 USD in the second phase (p = 0.0004).
The educational intervention positively affected resident documentation resulting in greater RVUs/hour and greater billing performance in the study emergency department (ED).
急诊医学（EM）就业市场越来越关注基于激励的报销方式，这种方式主要基于相对价值单位（RVU），并与患者护理记录直接相关。以往研究表明，有必要改善住院医师在记录方面的教育。作者开展了一项针对计费和记录实践的重点教育干预措施，以满足这一已确定的需求。本研究的假设是，这种教育干预将导致急诊医学住院医师产生的RVU数量增加，以及每位患者的平均计费金额增加。
作者采用了准实验研究设计。教育干预措施包括为急诊医学住院医师举办一场关于记录和计费的1小时讲座、每两周一期的时事通讯，以及计费部门针对具体病例的反馈。记录了所有二年级和三年级住院医师在教育干预前3个月和干预后3个月期间每位患者产生的RVU和费用。根据情况，使用学生t检验和重复测量方差分析对干预前后的数据进行比较。
研究各阶段申报的评估和管理（E/M）图表级别存在显著差异（p < 0.0001）。每小时产生的RVU总数从第一阶段的3.17增加到第二阶段的3.71（p = 0.0001）。在最初的3个月阶段，二年级或三年级住院医师诊治的每位患者的平均计费金额为282.82美元，在第二阶段增加到301.94美元（p = 0.0004）。
教育干预对住院医师的记录产生了积极影响，在研究的急诊科（ED）中，每小时产生了更多的RVU，计费表现也更好。
