Chart All Possible Diagnoses to Improve Hospital Mortality Scores

What we write in the chart will have a direct impact on the DRG

applied to that episode of care, which will in turn affect the expected

length of stay. In addition, the more accurately we reflect the

patient's true condition - including all the patient diagnoses and

comorbidities - the higher the patient's expected mortality will be.

Accurate chart documentation is not gaming the system. It is an

essential piece of the system itself.

As far as ethics goes, intent

plays an important role. The medical literature already suggests that we

enroll patients into hospice too late. If the intent is to identify

hospice-appropriate patients early and to otherwise provide them with

the benefits of hospice longer by early enrollment, I think that is

fine. However, if the intent is to increase your exclusion pool by

recruiting questionable hospice patients and manipulating them into

enrolling into hospice - well then, that sort of speaks for itself,

doesn't it?

Franklin A. Michota, M.D., is the director of

academic affairs in the department of hospital medicine at the Cleveland

Clinic. He reported no relevant conflicts of interest.