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17-07-2011 | Article

Emergency department residents lose revenue through downcodes


Free abstract

MedWire News: In emergency departments, patient charts that are documented primarily by residents in training as opposed to other staff are more likely to have insufficient information and thus be 'downcoded' and reimbursed at a lower level of service, study results show.

This downcode rate resulted in substantial loss of revenue, note study authors Moshe Weizberg and co-workers from Staten Island University Hospital, New York, USA, who comment: "Residents may be leaving the confines of the academic world unprepared, as much of reimbursement is based on documentation skills."

Thorough and accurate documentation in the medical record is important as it communicates information to other care providers, provides medico-legal protection, and it is critical to emergency department reimbursement.

Weizberg et al reviewed the charts of all patients presenting to the adult emergency department during a 2-week period. They recorded the incidence of downcodes and dollars lost to downcodes.

They compared these outcomes in three groups: patients seen primarily by emergency medicine residents (n=212), patients seen primarily by a physician assistant (n=683), and patients seen primarily by an attending emergency physician (n=437).

Patient acuities were similar in all groups, and they were well matched for age, gender, percentage of patients admitted to the hospital, and percentage of patients admitted to the intensive care unit.

There were 12 (5.7%) downcodes in the resident group, compared with 10 (1.5%) downcodes in the assistant group, and 17 (3.9%) downcodes in the attending group.

The mean revenue lost per patient seen was US$3.21 (€2.24) in the resident group; $0.91 (€0.63) in the physician assistant group; and $2.23 (€1.56) in the attending group.

Weizberg et al note that if the loss in the resident group was projected over 52 weeks, this would result in a loss of approximately $17,693 (€12,338) per year.

"Leaving a residency program without a clear understanding of the impact of poor documentation on reimbursement is a failure of the residency program to prepare their graduates for real-world emergency medicine practice," Weizberg et al in the Journal of Emergency Medicine.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

Andrew Czyzewski