A look into KPIs: A recipe for open encounters

To close an open encounter, the following ingredients are required: one completed progress note, one chief complaint, a diagnosis, and a physician level of service. Combine all four in EPIC and you're ready to post charges.

“Open encounters can cause delays in billing because whenever you’re following an EPIC ambulatory workflow, an open encounter can keep charges from posting, keeping the charge in a pending status,” says Bruce Preston, CPC, director of revenue integrity at Grady Health System in Atlanta.

Grady Health System began monitoring the key performance indicator (KPI) of open encounters just over three years ago. According to Preston, open encounters are often caused when providers put off their documentation due to a busy schedule of patients.

The challenge is having the provider accurately recall the patient account post-encounter. This is an issue on both the hospital and compliance side.

“For the hospital billing side, we really need all those elements in place in order to bill, because if there’s no documentation there, then legally the visit never happened,” says Preston. “It could be a compliance issue, too. Because if you let the missing documentation linger a month, how are you going to remember what you did on that patient a month down the road?”

Grady measures this KPI in terms of the raw number of open encounters. Then, that number gets broken down by department, by the provider that saw the patient, and how many days the encounter has been open. This information forms an open encounter report. If there’s a high number of open encounters found, Preston and his team then assess the reason for the open encounters, which could include the provider being on vacation or a change in personnel responsible for following up with providers about their open encounters.  

“As a teaching facility, we have a rotating staff of medical students and residents who don’t have access to close an encounter—it’s up to the attending physician. Once resident is gone, they’re gone,” says Preston. The revenue integrity department developed a documentation checklist housed in the HIM department that helps staff verify whether documentation is complete.

The revenue cycle analyst on the revenue strategy team uses a canned EPIC clarity report called Open vs. Closed Encounter Trend Report to create the open encounter ranking. The report takes the number of weekly encounters and breaks it down by provider.

The weekly report is sent out to department leaders and then to clinicians so they can see how they compare to each other. Previously, the ranking was sent out to clinicians quarterly, but Preston has found success in increasing its frequency. “It does matter when they see their name and their department, and whether they’re higher or lower than their peers. No one wants to be ranked number one in terms of the raw number of open encounters,” says Preston.

To advocate for the more frequent schedule, Preston had weekly meetings with administration leadership at Grady’s two medical schools in Atlanta, Morehouse School of Medicine and Emory School of Medicine. Once Preston explained the issue and the impacts, he found leadership were receptive in getting their doctors to close encounters in a timelier manner.

Preston’s goal for 2016 was to reduce Gray’s number of open encounters. Due to the increased reporting method and weekly administrative meetings, the open encounter rate decreased 70% from 2015 to 2016.

To read more about KPIs, check out the January 2018 issue of the NAHRI Journal, where revenue cycle professionals share six steps to successfully establish, track, and maintain KPIs.