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ECONOMICS, EDUCATION, AND POLICY

Acute Pain Management Efficiency Improves with Point-of-Care Handheld Electronic Billing System

From the Department of Anesthesiology, University of Kentucky, Lexington, Kentucky.

Address correspondence and reprint requests to Brenda G. Fahy, MD, FCCM, Department of Anesthesiology, 800 Rose St. N-263, Lexington, KY 40536-0293. Address e-mail to bgfahy2{at}email.uky.edu.

Abstract

BACKGROUND: Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service.

METHODS: Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec).

RESULTS: The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P < 0.001). The days in accounts receivable trended downward from 59.9 to 51.1 (P = 0.031). The average number of charge lag days decreased significantly with month (P = 0.0002). The net collection rate increased from 37.4% pre-elec to 40.3% post-elec (P < 0.001). The return on investment was 1.18 fold (118%).

CONCLUSIONS: Implementation of POC electronic billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.