Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Relax documentation requirements during the COVID-19 pandemic

P. Dileep Kumar, MD, MBA
Conditions
March 27, 2020
Share
Tweet
Share

The Centers for Medicare & Medicaid Services announced several measures guiding the care of patients during the current COVID-19 pandemic. Another important action that will immensely help the health care workers at the forefront is to reduce the documentation requirements for all patients. Health care workers should be unshackled from endless documentation, freeing up their time and resources to take care of the increasing number of patients. CMS, insurance carriers, and other regulatory agencies demand a slew of documentation for billing. This results in health care workers spending more time in front of a computer rather than with the patient. Most of these documents are duplicative or add little value to the care of patients, like pertinent negatives. A moratorium on the current billing documentation requirements should last till we are able to control the COVID-19 pandemic. Physicians and nurses should be permitted to document the necessary minimum for billing purposes and regulatory compliance.

An example of the proposed initial hospital history and physical note (level 3 visit) of a typical COVID-19 patient:

A 68-year-old man with a past medical history of COPD and CHF was admitted with cough, shortness of breath and bilateral interstitial pneumonia. COVID -19 test is positive. Patient is being treated with antibiotics, bronchodilators and experimental antiviral medication. He is saturating 92 percent on 4 liters of oxygen.

On examination, vitals are stable. Lungs bilateral rhonchi.

CXR interstitial pneumonia, CBC leukopenia and thrombocytopenia.

Assessment and plan: Acute COVID-19 interstitial pneumonia, continue medications, monitor lytes, guarded prognosis. Risk of death or adverse consequences high.

The complexity of medical decision making could be captured from a few sentences in the assessment and plan section. A follow-up note (level 3 visit) might look like this:

This 68-year-old man admitted with acute COVID-19 and interstitial pneumonia is on bronchodilators, antibiotics and antivirals. Shortness of breath increased today. Oxygen saturation stable.

Examination: stable vitals, persistent rhonchi.

CXR showed slight worsening. Sodium 120.

Plan: Acute COIVD-19 with interstitial pneumonia. Continue current medications and monitoring. No indication of ARDS. Hold off IV steroids. Check for SIADH. Risk of death or adverse consequences remains high.

Nursing documentation can also be simplified along these lines. Currently, nurses document the same data every so often, amounting to cutting and pasting. They should be able to document meaningful information less frequently in the EMR.

Simplifying the documentation will help physicians, such as intensivists, to focus on the care of patients. This will be important in case of an intensivist/physician shortage, which is happening in Italy right now.

ADVERTISEMENT

Hospital billing criteria should also be relaxed during this crisis to ease the pressure on physicians to document extensively. Instead of forcing the hospitals to comb for every minute detail in the chart in an attempt to add several co-morbidities to obtain the correct level of reimbursement, payments could be based on the average DRG payment the institution received for a particular diagnosis during previous years.

Caregivers should be able to share physical examination findings unless there is an acute change in the patient’s condition. A single examination policy will avoid unnecessary close contact with the patient by several providers and also will save on personal protective equipment (PPE). Other initiatives, such as reducing the frequency of checking vitals and finger stick blood sugars and corrective insulin administration, will reduce documentation volume.

These measures should also be applicable to the outpatient setting, where resources can be stretched thin. As always, CMS and other agencies should conduct periodic audits to detect any irregularities or systematic fraud.

These actions will go a long way in helping our health care workers during the current COVID-19 pandemic. We need them to take care of the sickest patients and not to produce voluminous notes.

P. Dileep Kumar is a board-certified practicing hospitalist specializing in internal medicine. Dr. Kumar is actively engaged with professional associations such as the American College of Physicians, Michigan State Medical Society, and the American Medical Association. He has held a variety of leadership roles and has authored more than 100 publications in various medical journals and a book on rabies (Biography of Disease Series). Additionally, he has presented more than 50 papers at various national and international medical conferences. Several of his papers are widely cited in the literature and referenced in various textbooks.

Image credit: Shutterstock.com

Prev

Breaking bad news to patients when they are alone

March 27, 2020 Kevin 0
…
Next

Advice for a pediatrician: the importance of having a grateful heart

March 27, 2020 Kevin 0
…

Tagged as: COVID, Hospital-Based Medicine, Infectious Disease

Post navigation

< Previous Post
Breaking bad news to patients when they are alone
Next Post >
Advice for a pediatrician: the importance of having a grateful heart

ADVERTISEMENT

More by P. Dileep Kumar, MD, MBA

  • AI in health care: the black box of prior authorization

    P. Dileep Kumar, MD, MBA
  • Sweden’s controversial COVID-19 strategy: lessons from higher mortality rates

    P. Dileep Kumar, MD, MBA
  • The collapse of rural health care: Why small-town hospitals are closing

    P. Dileep Kumar, MD, MBA

Related Posts

  • The social determinants of health during the COVID-19 pandemic

    Heather Thompson Buum, MD
  • Malpractice claims from the COVID-19 pandemic: more questions than answers

    Robert E. White, Jr. & The Doctors Company
  • Medical education in the COVID-19 pandemic can’t be ignored

    Casey Hribar and Carolyn S. Quinsey, MD
  • The uncertainty of an international medical graduate during the COVID-19 pandemic

    Juan J. Delgado-Hurtado, MD, MPH
  • The COVID-19 pandemic is a catalyst for reimagining future health care delivery

    Imelda Dacones, MD
  • Reflecting on my experience as a teenage health care worker during the COVID-19 pandemic

    Ananya Raghavan

More in Conditions

  • Could ECMO change where we die and how our organs are donated?

    Deepak Gupta, MD
  • From Civil War tales to iPhones: a family history in contrast

    Richard A. Lawhern, PhD
  • The hidden dangers of over-the-counter weight-loss supplements

    STRIPED, Harvard T.H. Chan School of Public Health
  • How denial of hypertension endangers lives and what doctors can do

    Dr. Aminat O. Akintola
  • How physicians can reclaim resilience through better sleep, nutrition, and exercise

    Kim Downey, PT & Shirish Sachdeva, PT, DPT & Ziya Altug, PT, DPT
  • Who are you outside of the white coat?

    Annia Raja, PhD
  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How to balance clinical duties with building a startup

      Arlen Meyers, MD, MBA | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How to balance clinical duties with building a startup

      Arlen Meyers, MD, MBA | Physician
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Could ECMO change where we die and how our organs are donated?

      Deepak Gupta, MD | Conditions
    • Every medication error is a system failure, not a personal flaw

      Muhammad Abdullah Khan | Meds
    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How to balance clinical duties with building a startup

      Arlen Meyers, MD, MBA | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How to balance clinical duties with building a startup

      Arlen Meyers, MD, MBA | Physician
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Could ECMO change where we die and how our organs are donated?

      Deepak Gupta, MD | Conditions
    • Every medication error is a system failure, not a personal flaw

      Muhammad Abdullah Khan | Meds
    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Relax documentation requirements during the COVID-19 pandemic
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...