Smart Pump-Electronic Health Record (EHR) Interoperability with Auto-Documentation is Associated with Increased Submission of Infusion-Therapy Billing Claims at a Community Hospital

BACKGROUND

Smart pump-electronic health record (EHR) interoperability has been demonstrated to reduce adverse events and increase documentation and billing accuracy. However, relatively little is known about the impact of interoperability on infusion therapy billing claims and hospital finances.

OBJECTIVE

Our objective was to evaluate the association between smart pump-EHR interoperability with auto-documentation and current procedural terminology (CPT®)-coded infusion-therapy billing claims submissions.

METHODS

At Penn Medicine Lancaster General Health (Lancaster, PA, USA), infusion-therapy billing data were collected for 158,379 patient days (a visit to the emergency department [ED] or 24 h admission to a non-ED unit) and divided into two groups: 78,241 pre- and 80,138 post-auto-documentation. The count and types of submitted CPT-coded claims were analyzed for ED/non-ED groups, inpatient/outpatient status and non-ED unit where the infusion was administered. Dollar amounts for CPT codes were calculated using Medicare Addendum B 2017. Patient day and CPT code counts were converted to annualized values to facilitate analysis.

RESULTS

Patient days did not increase significantly from pre- to post-auto-documentation, whereas annualized submitted CPT-coded claims increased significantly by 14.5% (p < 0.001). The corresponding billing claim dollar value increased by $US1,147,652 (13.5%). ED patient days increased by 2.0% (p = 0.44), whereas submitted CPT-coded claims increased significantly by 4.0% (p < 0.001) and $US478,980 (7.4%). Non-ED patient days increased by 2.8% (p = 0.2), whereas CPT-coded claims increased significantly by 31.7% (p < 0.001) and $US668,672 (34.0%). The total number of submitted CPT-coded claims increased by 13.4% for inpatients and 12.3% for outpatients.

CONCLUSION

Our findings suggest that auto-documentation of infusion-therapy services may have a positive impact on hospital financial performance, which could help drive adoption of this technology.

Sensitivity and specificity levels of two rapid assays for antibodies to Anaplasma spp. in dogs

Canine anaplasmosis is a tick-borne disease of dogs that results following infection with Anaplasma phagocytophilum or Anaplasma platys. The SNAP 4Dx Plus test (IDEXX Laboratories) and the VetScan Canine Anaplasma Rapid test (Abaxis) are commercial in-house rapid tests for the detection of antibody to these 2 antigenically related Anaplasma species. We evaluated 2 tests using serum and whole blood samples obtained from reference laboratories and veterinary hospitals. Samples were obtained from regions of the country known to be habitats of the primary tick vectors. The A. phagocytophilum sample set comprised 236 dog sera from the northeastern and midwestern United States; the A. platys sample set comprised 179 sera from dogs living in the southwestern United States. An indirect immunofluorescent antibody (IFA) test and an A. platys species-specific ELISA were used as reference assays for the A. phagocytophilum and A. platys samples, respectively. The SNAP test demonstrated significantly higher sensitivity (84.7% for A. phagocytophilum and 83.1% for A. platys), compared to the VetScan test (39.0% for A. phagocytophilum and 57.6% for A. platys). The specificity of the SNAP test (95.8% for A. phagocytophilum and 99.2% for A. platys) was significantly greater than the VetScan test (85.6% for A. phagocytophilum and 82.5% for A. platys). In a separate clinic study, conducted within an A. phagocytophilum-endemic state (Minnesota) using 154 whole blood samples from client-owned dogs, the VetScan test was negative for 22 of 39 SNAP and IFA seropositive samples.