Hidden somewhere inside each hospital is the person who is responsible for coordinating the submission of the Medicare Cost Report. This is an annual filing that contains information about the hospital’s cost of delivering care. While Medicare currently reimburses hospitals prospectively based on DRGs, accurately and efficiently logging your physicians’ workflows is still a major driver of that reimbursement. Below are two areas that are directly impacted by physician time logs.
Medicare Wage Index (MWI) – The wage index is a compilation of all wages paid for delivering care. The wage number includes all costs from housekeeping to nursing and even physicians. The administrative time spent by physicians on behalf of the hospital weigh into that calculation. Think medical directorships, on-call agreements, co-management agreements, they all have a time component that can be counted in the index.
Now here is the catch: If the person preparing the filing documentation does not have evidence of the time performed by physicians, it cannot be specified and submitted on the cost report and therefore no reimbursement takes place. Payroll is the easy place for the majority of wages. It offers proof of what was paid. Now consider physicians who turn in hand written time logs with subjective notes of the work that was actually performed. These descriptions may or may not match the agreement terms, but each individual entry must be considered to see if it qualifies for reimbursement. Assuming the person preparing can read the time log, care must be taken to only include duties that are considered appropriate. This is a daunting task given mounds of paper, manual entries, and the need to consider these duties in terms of relevance to the contract and to what CMS believes compensable.
Technology solutions are critical to capturing this data in a compliant relevant fashion for ease of submission. This can save hundreds of hours of finance time in preparing the cost report and will ensure all data is captured and not lost in a filing cabinet in the basement.
Graduate Medical Education (GME) – Many organizations have teaching programs. The time spent on teaching programs is reimbursed by Medicare in one of two ways, either in a pass-through method or on a per resident calculation. CMS is serious about medical education and recognizes providing this opportunity to learn slows down the physician who is doing the teaching which in turn has a real cost to the hospital.
Physicians are often tapped to assist with the educational component. These physicians might be employed by the hospital or be independently contracted, but interested in teaching. The hospital often sets up a formal relationship between the hospital and the doctor to provide teaching to the residents. It may cover rounding with residents, spending time in the private office setting with residents or the more formal lecture series.
With either method, the pass-through dollar or per resident approach, CMS will reimburse for time spent teaching. But that time needs to be captured in a fashion that can then be submitted on the cost report. Similarly for the wage index, if your finance team is sorting through filing cabinets trying to read hand written entries, you are leaving money on the table.