So what can hospitals learn from their colleagues in demonstration states? "It's a wake up call for better documentation and coding," says Rosenstein. "It is illegal to retrospectively go back and change any of the charts, so hospitals are stuck, and whatever the auditors pull out and review that is what you are under pressure to, if appropriate appeal."
Moving forward, he says, it is all about physician education. "The physician is the one who writes in the chart that supports documentation." Of course how to bring physicians on board for anything has turned into a full-time role on most hospital management teams. Rosenstein says it's important to appeal to their concern for quality and reputation rather than the bottom line. "Physicians don't really care about the hospital losing a dollar or saving a dollar, but quality rankings and reputation stimulates their interest." Hospitals must also enhance processes like coding and case management that help physicians to be more compliant.
At the same time, Rosenstein says he is sharing RAC and other VHA data with hospital CFOs. "We are on the quality side but there is really big financial impact of what this data means, and so it is making a case that we need more resources to make this happen," he says, such as technology and personnel.
Hospitals that have been audited are beginning to understand the full reality of the RAC process, the consequences of decisions made today, and hopefully even the best strategies for appeals. Still, with RAC being so new, some hospitals, and rightfully so, are in reactive mode, struggling to educate their boards, physicians, staff, and coders. Perhaps before hospitals can even begin to address educational needs, they must—as Rosenstein recommends—break down barriers, bureaucracy, and tradition.