Medical Paperwork

A PricewaterhouseCoopers study for the American Hospital Association chronicled more than 40 layers of paperwork associated with caring for a typical Medicare patient who arrives at an emergency room with a broken hip and receives treatment until recuperation. Some of the findings:

• Roughly 60 minutes of paperwork were performed for every hour of emergency department care, 36 minutes of paperwork for every hour of surgery and acute inpatient care, 30 minutes of paperwork for every hour of skilled nursing care, and 48 minutes of paperwork for every hour of home healthcare.
• “Each time a physician orders a test or a procedure, the physician documents the order in the patient’s record, and the government requires additional documentation to prove the necessity for the test or procedure.”
• “Many forms … must be completed daily by clinical staff to submit to the government to justify the care provided to skilled nursing facility patients.”
• Medicare and Medicaid “rules and instructions” are more than 130,000 pages (three times larger than the IRS code and its associated regulations), and “medical records must be reviewed by at least four people to ensure compliance” with Medicare program requirements.
• “A Medicare patient arriving at the emergency department is required to review and sign eight different forms, just for Medicare.”
• “Each time a patient is discharged, even if only from the acute unit of the hospital to an on-site skilled nursing unit, multiple care providers must write a discharge plan for the patient. This documentation, as long as 30 pages, applies to all patients, regardless of the complexity of care received within the hospital or required post-hospital setting.”
• In addition to regulation by state agencies, local agencies, private accrediting organizations, and insurers, hospitals are regulated by more 30 federal agencies.