Why public reporting is meaningless

Recently I've been working through some required learning modules for clinical documentation and coding. Most physicians know that the wording used in progress notes and discharge summaries can modify the DRG payment and greatly impact the hospital's reimbursement. What may be less well appreciated is that these little documentation tweaks can also impact severity adjustment which in turn affects the physician's rating in public reporting sites. I was recently reminded that with a little creative writing just changing a word here and there, the provider can radically impact how a patient encounter looks to outsiders. For example, the same patient could be portrayed as a stable medical patient on the ward, or, with a few little tweaks and the help of your clinical documentation specialist, a critically ill patient in the ICU. The language you use in your chart documentation makes all the difference in your public reporting profile regardless of how good a doctor you are. Physicians, particularly hospitalists, are encouraged to develop this skill because the hospital's livelihood depends on it. Enhancement of the doctor's public reporting profile is a side benefit and has nothing to with his or her skill or effectiveness as a clinician. A physician who is well versed in this creative chart documentation may even push the envelope of fraud but the regulating authorities will likely never know. Having observed these things over the last few years I've become increasingly skeptical of the value of public reporting, yet many of our hospitalist leaders who have a strong focus on health care policy continue to drink this Kool-Aid and serve it up to others.