To facilitate use of the MET, ward staff are given laminated cards describing the teams—essentially who's on them and guidelines for when to call them—Dr. Sharon Kiely, an internist at Allegheny, said at the meeting.
In March, there were 12 calls, 11 of which truly needed an MET; 46% of the nursing units had made calls. By April, there were 30 calls, 28 of which needed an MET. The numbers of calls were the same the following month, but 85% of the nursing units had made calls, Dr. Kiely said. Overall, 66% of the patients were transferred to a higher level of care, 26% were stabilized in their rooms, and the remaining 8% died.
Dr. Kiely said it appeared that the MET concept was well received. During meetings with house staff, almost all had agreed that it made sense, and there had been no complaints from nurses, she added.
Rapid Response Pays, If Billed Correctly
Hospitals that employ rapid response teams are finding that it can be quite profitable—as long as they bill correctly for the services, Dawn Moody, R.N., a senior medical auditor, said at the meeting.
The care delivered by rapid response teams is considered critical care, which requires very different documentation than that provided for traditional evaluation and management, said Ms. Moody, who is in the division of general internal medicine at the University of Pittsburgh Medical Center.
First, it must meet the definition of critical care—the patient must have an illness or injury that impairs one or more vital organ systems to the point where there is a high probability of imminent or life-threatening deterioration of the patient's condition, she said.
The care does not necessarily have to be given in a critical care area, but the physician has to be completely devoted to that patient and not seeing any other patient during the time billed.
Time spent with the patient must be documented very specifically. A good way to do that is to include a note at the end of a patient's file stating that the physician spent 3 hours and 10 minutes managing the case. Physicians can include the time they spend away from the bedside if it is directly related to the patient's care. For instance, dictating or writing notes can be billed, as can time with families, if it is to get a medical history, review a condition, or deliver a prognosis, Ms. Moody said.
There are two current procedural terminology codes used for critical care Evaluation & Management: 99291, which is used for the first 30–74 minutes, and 99292, which is used for each additional 30-minute increment. In western Pennsylvania, the local Medicare carrier reimburses the first 30 minutes of critical care at $201.38, Ms. Moody said. That compares with a level V consult, which is reimbursed at $189. The second unit of critical care and each unit thereafter is reimbursed at $101, she said.
However, certain services can't be billed separately, including the interpretation of cardiac output measurements, chest x-rays, pulse oximetry, blood gases, gastric intubation, temporary transcutaneous pacing, ventilatory management, and vascular access procedures, Ms. Moody said.
There are also fairly strict criteria for critical care delivered in the academic setting. Critical care time can only be reimbursed when the resident and teaching physician both managed the patient together, or if the teaching physician was alone with the patient. Any time the resident spends alone with the patient—without the teaching physician around—can't be billed, she said, and most insurers will pay for only one physician's services per critical care episode.