Secondary Logo

Journal Logo

Acute Pain Management Efficiency Improves with Point-of-Care Handheld Electronic Billing System

Fahy, Brenda G. MD, FCCM

doi: 10.1213/ane.0b013e318193fe01
Economics, Education, and Policy: Technical Communication
Free
SDC

BACKGROUND: Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service.

METHODS: Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec).

RESULTS: The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P < 0.001). The days in accounts receivable trended downward from 59.9 to 51.1 (P = 0.031). The average number of charge lag days decreased significantly with month (P = 0.0002). The net collection rate increased from 37.4% pre-elec to 40.3% post-elec (P < 0.001). The return on investment was 1.18 fold (118%).

CONCLUSIONS: Implementation of POC electronic billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.

IMPLICATIONS: The implementation of a handheld point-of-care electronic billing system improved business efficiency for an acute pain management service with an improved collection rate, decrease in charge lag days and a positive return on investment.

From the Department of Anesthesiology, University of Kentucky, Lexington, Kentucky.

Accepted for publication October 29, 2008.

The author has no financial relationships to disclose with the billing software, MDeverywhere, or other products such as Palm discussed in this study.

Address correspondence and reprint requests to Brenda G. Fahy, MD, FCCM, Department of Anesthesiology, 800 Rose St. N-263, Lexington, KY 40536-0293. Address e-mail to bgfahy2@email.uky.edu.

A handheld point-of-care (POC) electronic billing system using a personal digital assistant (PDA) was implemented to replace a paper-based system for acute pain management service (APMS) billing. A Medline search did not reveal any APMS handheld coding and billing. PDA medical billing usage in other specialties remains low with 4% of pediatricians using PDAs for billing.1 Handheld billing improves charge capture2 and coding accuracy for long-term care.3

Back to Top | Article Outline

METHODS

This study was reviewed by the IRB and qualified as an exempt study; no consent was required. APMS anesthesiologists at the University of Kentucky received MDeverywhere (MDeverywhere, Long Island, NY) software training on a PDA for approximately 1 wk before any data collection. None had prior experience with handheld electronic billing. PDAs were carried by the APMS anesthesiologists while performing services enabling POC billing. All billing data were then downloaded and synchronized between the PDA, the desktop computer, and the central billing center. The handheld billing process is detailed in Figure 1.

Figure 1

Figure 1

Before the PDA, APMS anesthesiologists used a preprinted daily paper charge form for each patient which was hand-delivered to the administrative staff for entry into the Signature (Siemens Corporation, Boca Raton, FL) billing system. Data entry included case identification number, service date, patient and service location, provider number, diagnoses, referring physicians, and acute pain billing codes with modifiers. Patient services were captured only if entered on these forms.

Back to Top | Article Outline

Data Collection

Data were examined for a 12-mo period before PDA billing implementation (pre-elec) and compared to the same length of time after its implementation (post-elec), including most frequent charges (Table 1) and charge data (Table 2). Financial billing terminology definitions can be found in Table 3.

Table 1

Table 1

Table 2

Table 2

Table 3

Table 3

For each time period, the following were calculated and analyzed with an unpaired t-test: charge lag, days in accounts receivable (Table 2), net collection rate and bill production time (Table 4). Total number of timely denials (Table 4) for each period was analyzed using a z-test. The percentage of bills posted for each time period within 1 mo and for longer time periods (31–59, 60–89, and >90 days) were analyzed with a Fisher's exact test (Table 5). To account for trends over time, average days from service to billing per month were regressed on time within each period (pre-elec and post-elec) and then the slopes of the regressions were compared between periods using a t-test. A P value of <0.05 was considered significant. The return on investment to the anesthesiology department (Table 6) and costs to the enterprise for purchase and implementation of the system (Table 7) were calculated.

Table 4

Table 4

Table 5

Table 5

Table 6

Table 6

Table 7

Table 7

Back to Top | Article Outline

RESULTS

After handheld electronic implementation, the charge lag decreased while days in accounts receivable trended downward (Table 2); timely denials decreased while net collection rate increased (Table 4). More charges were submitted within 1 mo of service (Table 5) and bill production time was minimal requiring less time post-elec (Table 4).

The slopes of the time trends for the average number of days from service to billing were significantly different between the periods (P = 0.0002) with a positive slope for the pre-elec period and a negative slope for the post-elec period. Hence with adoption of handheld billing, the average number of days from service to billing began to decrease significantly with each month rather than increase. The return on investment to the anesthesiology department was 1.18 times (Table 6).

Back to Top | Article Outline

DISCUSSION

Implementation of a POC electronic billing using PDAs for an APMS to replace a paper-based billing system had a positive impact financially, and handheld PDA billing improved physician workflow. This approach for billing and coding has likely wide applicability as 55% of physicians4 and 70% of trainees,5 including anesthesiology residents documenting training,6 use PDAs or similar devices. PDAs have been used to capture preoperative assessment data with anesthesiology information management systems integration.7 Future possibilities include using a PDA to link surgical procedure and other pertinent data with APMS billing.

A limitation with our process was a desktop computer terminal requiring cradles for synchronization. A wireless network could transfer data rapidly and conveniently avoiding a desktop computer synchronization thus streamlining the billing process. Current charge capture software programs can use wireless transmission while maintaining security along the wireless pathway. As newer technologies become available, including the secure wireless data transfer to a PDA, integration with other systems becomes a reality and handheld devices may become routine in medical care.

Back to Top | Article Outline

ACKNOWLEDGMENTS

The 6-mo preliminary data were accepted for abstract presentation at the ASA Annual Meeting in San Francisco, October 2007.

Thanks to Emily Topmiller for her assistance in preparation of this manuscript and Dr. Richard Kryscio and Jaime Johnson for their assistance with data analysis.

Back to Top | Article Outline

REFERENCE

1. Carroll AE, Christakis DA. Pediatricians' use of and attitudes about personal digital assistants. Pediatrics 2004;113:238–42
2. Blackman J, Gorman P, Lohensohn R, Kraemer D, Svingen S. The usefulness of handheld computers in a surgical group practice. Proc AMIA Symp 1999;686–90
3. Handler SM, Hsieh VC, Nace DA, Sciulli L, Fridsma DB, Studenski SA. Development and evaluation of a charge capture program for long-term care providers. J Am Med Dir Assoc 2004;5:337–41
4. Breen T. Doctors use handheld technology to save time, improve care. Seattle Post-Intelligencer/Associated Press; August, 2007. Available online at: http://www.healthdecisions.org/HealthIT/News/default.aspx?doc_id=130814
5. Kho A, Henderson LE, Dressler DD, Kripalani S. Use of handheld computers in medical education. J Gen Intern Med 2006;21:531–7
6. Hammond EJ, Sweeney BP. Electronic data collection by trainee anaesthetists using palm top computers. Eur J Anaesthesiol 2000;17:91–8
7. Fuchs C, Quinzio L, Benson M, Michel A, Röhrig R, Quinzio B, Hempelmann G. Integration of a handheld based anaesthesia rounding system into an anaesthesia information management system. Int J Med Inform 2006;75:553–63
© 2009 International Anesthesia Research Society