# Report Cards for Providers



## rblake68 (Feb 18, 2019)

Hello!

I am a coding quality auditor for a very large dermatology billing and coding LLC. I can provide providers feedback when I audit them by reviewing audited claims and error rates however, I am looking to do something a little different. I want to set up a provider "report card" that would be issued to our providers bi-annually to give them a better perspective on what they are doing wrong a what they are doing right. For example: categories could be ROS and provider would receive an A, B, C, D, or F just like a regular report card and then their comments (like when next to the "F'" in math, there is a comment that says "your kids needs to work on self control" or WHATEVER) would say something like "frequently overuses ROS that is not pertinent to CC in order to bill higher codes", ETC. So my question is: have any of you ever done anything like this? I am REALLY hoping to find a template of some sort so that I do not have to build this project from scratch. Any idea? Thanks, guys!


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## CatchTheWind (Feb 28, 2019)

Are you sure the providers are not going to be offended by being "graded"?


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## rblake68 (Feb 28, 2019)

*Possibly*



CatchTheWind said:


> Are you sure the providers are not going to be offended by being "graded"?



Hi! It certainly is possible that they would be offended, I considered that before making the decision to do it. I decided that the purpose served is greater than doctor egos. For example, any provider with a "D" in ROS and a comment next to the grade that says "frequently uses non pertinent ROS in order to obtain a 99214" will be offended and they should be...by themselves. A provider with an "A" is not going to be offended because they have nothing to worry about and will toss this paper on their desk and never look at it again. The idea for report cards comes from the following:
1. Providers have been begging for more feedback.
2. When providers are given detailed reports on their performance, or any document at all about their performance that requires them to read more than a half page, they do not read it.
3. I want them to have a visual. A doctor that has been warned for a year about abusing ROS needs to see what that looks like in comparison to the providers that are practicing appropriately. 

I have already made the decision to do this so I am really just looking to see if anyone is able to provide me with assistance on making it happen.


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## TThivierge (Feb 28, 2019)

*Grading Physicians*

Hi RB

I WOULD NOT DO THIS GRADING METHOD.... you are playing with fire!  Physicians are very funny and protective of their clinical decisions. Just get with them face to face meet in their office and show them errors. Give them a handout etc.  

Lady T


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## thomas7331 (Mar 1, 2019)

I agree that you should avoid this kind of approach, or at least find a way to make it as inoffensive as possible, as I think a 'report card' is likely to create friction and hard feelings on both sides, and ultimately be counterproductive - please take it from someone who has tried this and experience the negative outcomes.  Telling a provider they are 'abusing' anything is certain to create a bad reaction - leave that kind of feedback to the provider's boss - it will only serve to shut you out of any productive interaction with that provider.  Getting feedback to providers is a good thing, but it works best when it is a collaborative process where coders and providers can learn from each other, not a process whereby a coder passes judgment on a provider's documentation.  

A presentation I attended at a conference a few years back made a good suggestion that rather than presenting providers with their 'errors', it works well to identify them as 'variance', or places where the coder and the provider have come up with different codes.  This can be a starting point for discussion and learning.  The decision as to whether or not the code choice is an error can emerge through that discussion, with the provider having the opportunity to offer their input first, rather than just being subjected to the coder's decision without opportunity for rebuttal.  

Another approach that a practice used that I heard about at a conference was a point system based on the severity of errors.  Rather than just penalizing a provider for the number of coding errors, this practiced categorized errors by how serious they were, so that minor errors with no financial impact might just get one point, whereas more serious errors such as missing signatures or code levels that were off by a two or more levels that would result in a larger financial discrepancy in an audit might get two or three points.  This approach also helps to reduce the negativity for providers of just being told they were wrong, and gives a nuance to help them understand the impact of a potential error.  

It sounds like you have already decided on your approach, but perhaps these are a couple of ideas that may be helpful.  Whatever you end up doing, though, I would just urge you to do this in as respectful a manner as you can.  Remember that the coding profession exists to provide a service to the medical profession and you want to always show that you are there to try to help them.  If you set yourself up as their judge or their adversary, you will ultimately lose their respect and cooperation.


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## rblake68 (Mar 1, 2019)

*I am not a coder*



thomas7331 said:


> I agree that you should avoid this kind of approach, or at least find a way to make it as inoffensive as possible, as I think a 'report card' is likely to create friction and hard feelings on both sides, and ultimately be counterproductive - please take it from someone who has tried this and experience the negative outcomes.  Telling a provider they are 'abusing' anything is certain to create a bad reaction - leave that kind of feedback to the provider's boss - it will only serve to shut you out of any productive interaction with that provider.  Getting feedback to providers is a good thing, but it works best when it is a collaborative process where coders and providers can learn from each other, not a process whereby a coder passes judgment on a provider's documentation.
> 
> A presentation I attended at a conference a few years back made a good suggestion that rather than presenting providers with their 'errors', it works well to identify them as 'variance', or places where the coder and the provider have come up with different codes.  This can be a starting point for discussion and learning.  The decision as to whether or not the code choice is an error can emerge through that discussion, with the provider having the opportunity to offer their input first, rather than just being subjected to the coder's decision without opportunity for rebuttal.
> 
> ...



Hi there,

While I completely understand where you are coming from, allow me to clarify my position. I am not a coder. I am my company's QA auditor and I work for the compliance department. It is my job to keep us out of jail. I totally agree that the doctor's boss should be the one to manage this, but in my case, the provider's bosses are also a part of the problem. What you mentioned about what you learned at the conference is helpful but not completely applicable to what we are dealing with right now. I am not coming down on providers and shaming them for coding errors..this is about doctors that know the errors they are making and are doing so with this knowledge for their own gain. I know that they know this and are doing it intentionally because it is my job to know and research these things. These providers have to answer to compliance above anyone else. I think that everyone responding is assuming that we have never talked to our providers about these issues or tried to help them resolve the errors. This is NOT the case. That's why I said I have already made up my mind to do this and am only looking for anyone that can help make it happen. While I appreciate everyone's input, no one can be aware of measures that we have already taken to try and avoid having to do something like this so the responses saying "don't do it" aren't really helpful to what I am trying to accomplish if you know what I mean.


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## rblake68 (Mar 1, 2019)

*Playing with Fire*



TThivierge said:


> Hi RB
> 
> I WOULD NOT DO THIS GRADING METHOD.... you are playing with fire!  Physicians are very funny and protective of their clinical decisions. Just get with them face to face meet in their office and show them errors. Give them a handout etc.
> 
> Lady T



Thanks but we have already done that. The company I work for employs 350 providers across the United States so face to face meetings are not always possible and they do not read handouts, we have learned this the hard way.


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## TThivierge (Mar 1, 2019)

*Grading Physician with improving CDI*

Hi RB
I understand your situation now. So I  would  pull 10 or 20 med records  of each physician in their type of treatment they completed with errors. Show them the errors of notations then how to add better phrase  or better dx code .  Ensure your coders are aware of improvement or if they see errors to inform you too. Display the errors to them and use your grading system but if too complex they may not like it.  At one hospital I worked at coders ntice errors and sent to QA to address. This was very helpful too.

Good luck!

Lady T
PS I had one doc who drew pictures of skin treatments instead of documentation with sentence and adjectives... ...horrible!!!


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## KellyLR (Mar 9, 2019)

*Don't Grade Providers*

You risk losing all credibility with administrative and providers by doing this.


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## TiffanyK (Mar 23, 2019)

This is not criticism because we all must do what we feel is needed. I highly agree that report cards for providers are not a good idea. The Provider is our Boss ultimately, not the other way around. Our job is to find a way to communicate effectively to the Providers. If you start giving a report card out you will be building a wall between you and your providers and then they really will not listen. We all deserve respect, especially our Providers. We have had a similar issue in our company. The providers did not like the auditor and she no longer works for the company. This is just a heads up. I would never give my boss a report card. This would be interesting to see how this worked in your company. I would love the feedback. Again, I say this is not criticism. I think it is great that in our profession we can all come together and give feedback.


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## rblake68 (Apr 24, 2019)

*Hi*



TiffanyK said:


> This is not criticism because we all must do what we feel is needed. I highly agree that report cards for providers are not a good idea. The Provider is our Boss ultimately, not the other way around. Our job is to find a way to communicate effectively to the Providers. If you start giving a report card out you will be building a wall between you and your providers and then they really will not listen. We all deserve respect, especially our Providers. We have had a similar issue in our company. The providers did not like the auditor and she no longer works for the company. This is just a heads up. I would never give my boss a report card. This would be interesting to see how this worked in your company. I would love the feedback. Again, I say this is not criticism. I think it is great that in our profession we can all come together and give feedback.



Hello,

Again, my situation is different. The provider is not my boss. I work for a corporate company that employs these doctors. They work for us, not the other way around. I am in the COMPLIANCE dept not the coding dept. I am getting lots of answers that are not relevant to my situation. I am not a coder and the doctors are not my bosses! They are accountable to my department! I appreciate every ones input but NO one attempted to answer my questions and instead I got a bunch of people trying to talk me out of my decision when they are making assumptions such as the provider being my boss and me not making other efforts before coming to the decision to do a report card. I would NEVER give my BOSS a report card, that would be ridiculous. I feel like I gave all the info needed for people to answer my question but important facts were ignored and I got no helpful info at all. 
I already figured this out on my own and we are rolling out report cards this month, I'll let you all know how it goes.


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## Pathos (Apr 24, 2019)

rblake68 said:


> Hello,
> 
> Again, my situation is different. The provider is not my boss. I work for a corporate company that employs these doctors. They work for us, not the other way around. I am in the COMPLIANCE dept not the coding dept. I am getting lots of answers that are not relevant to my situation. I am not a coder and the doctors are not my bosses! They are accountable to my department! I appreciate every ones input but NO one attempted to answer my questions and instead I got a bunch of people trying to talk me out of my decision when they are making assumptions such as the provider being my boss and me not making other efforts before coming to the decision to do a report card. I would NEVER give my BOSS a report card, that would be ridiculous. I feel like I gave all the info needed for people to answer my question but important facts were ignored and I got no helpful info at all.
> I already figured this out on my own and we are rolling out report cards this month, I'll let you all know how it goes.



Rblake68,

You have to remember that when you come to a coder forum, and ask coders for advice you will most likely get a coder answer. Sounds like you are in a unique situation that most coders here are not, which is probably clear based on the responses you are getting. I understand the frustration of not getting the answer you are hoping for, however I am sensing something beyond frustration from you which might come off as form of arrogance. 

As a coder I have seen corporate folks come by with flashy tools and ideas that in their mind appears to be a great idea, however these ideas and tools are often not translated as truly helpful and just adds another layer of frustration and pressure for providers who already have so many other things to worry about and other requirements. I think this is why you are getting so many words of caution from the rest of us coders, some who have seen what I have seen also, and have experienced the failure of such promotions. We are not here to bash you or knock you down, but instead trying to show the provider's angle on the idea.

While the idea of a report card in general might not be a bad idea, I fear that it will not be received positively from an already overburdened audience. If your tools and ideas were to make your providers work easier and more efficient, then the likelihood of a warmer reception will increase. Is there a positive incentive for these providers for getting this report card?

As a senior coder/provider educator, part of my job is to foresee or predict the response of any provider when presenting feedback, and try to find solutions that can satisfy both needs of the provider and coding/compliance instead of being one-sided. I have found more positive success when I can adjust my materials that make all parties feel it's a win-win situation.

So to answer your request directly here (apart from my advice above), no I do not have a template to offer you because of I agree with my fellow coders. I am not seeing the benefit of these report cards at all, unless you can make a strong spin that will get everyone on-board with your product. I know this is still not the answer you're looking for, but I am hoping you will give some thought to your approach and material. This is meant as constructive and not destructive at all.

Best of luck!


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## kseebeck (May 7, 2021)

rblake68 said:


> *Hi*
> 
> 
> 
> ...



I'm sorry that this trend was not helpful for you. I understand where you are coming from as I work in Compliance as well.
I was wondering if you had time to talk about your experience providing audit reports to the clinicians.


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