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2010 Annual Meeting Abstracts

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Optimizing mid-level practitioner charge capture in high acuity surgical ICU’s: Time is money
*Karyn L Butler, *Rebecca Calabrese, *Manish Tandon, Orlando Kirton
Hartford Hospital, Hartford, CT

To determine the impact of a standardized staffing model and critical care documentation tool on charge capture by intensive care unit (ICU) mid-level providers (MLP’s).
Prospective cost-effectiveness and cost-benefit analyses of MLP critical care charges (99291 or 99292) was performed.
Neuro-ICU and cardiac surgery ICU in a level 1, 800 bed hospital. MLP provider to patient ratio was 1:6 with 24 hour surgical intensivist oversight.
ICU Advanced Practice Registered Nurses and Physician Assistants (MLP’s).
A standardized critical care event note (CCN) was developed to simplify documentation and billing of critical care. All MLP’s participated in comprehensive educational sessions on billing compliance and documentation.
Charge capture was collected for three years and comparisons made between the first quarter before (FY 2008), during (FY 2009) and after (FY 2010) implementation. The number of ICU patient days, length of stay and number of beds were collected. Data is expressed as mean ± SEM and was analyzed with t-test; P<0.05 was considered significant.
During the implementation/education phase (FY09), there were no differences in charge capture compared to FY08. First quarter charge capture significantly increased after education and implementation of the CCN (FY 2010) compared to before (FY 2008) implementation ($71,037.98 ± 6944 vs. $46,756.73 ± 6685, P=0.01). The number of ICU admissions, length of stay and number of beds were not different. Salary offset increased from 72% to 86% from FY08 to FY10.
Midlevel providers represent an important component of the critical care services provided to high acuity patients. A standardized staffing model, standardized critical care documentation and comprehensive education on E&M guidelines significantly increased charge capture.

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