Hospital documentation requirements

Abstract

Rise in regulatory documentation requirements have steadily increased the size and heft of hospital charts. In parallel, the coding of hospital charts for reimbursement after patients have been discharged has become so complicated that it has spawned an entire industry of medical coders. We postulate that the weight of the chart and hospital reimbursement might be related. We weighed the hospital charts of 49 patients admitted between December, 1997, and January, 1998, and who spent time in the medical intensive-care unit. Financial data were obtained from the hospital's billing system. Mean age of patients was 57 years (SD 19); 30 were men and 19 women, and type of insurance varied as did diagnosis-related group and procedure codes. The average length of hospital stay was 19 days, hospital charge US$56 662, hospital payment $36369, and chart weight 1·38 kg (SD 1·08). We tested correlations between chart weight, charges, length of stay, and payments, with weight as the independent variable. The results are shown in the table.TableRelation between chart weight, charges, length of stay, and paymentsrr2pHospital stay (days)0·930·86<0·001Hospital charges ($US)0·970·95<0·001Hospital stay ($US)0·720·52<0·001Amount charged and paid can be calculated: charges=($52269 × chart weight) −$15 661; payments=($28 181 × chart weight) −$2865. Open table in a new tab Amount charged and paid can be calculated: charges=($52269 × chart weight) −$15 661; payments=($28 181 × chart weight) −$2865. In the era of electronic records, it will be interesting to find out whether the reimbursement correlates with the quantity of computer memory each chart requires. Apparently, the chart really is worth its weight in gold.