A Missouri newspaper is accusing University of Missouri (MU) Health Care of providing radiology services to patients without physician orders for those services. University officials, however, say the episode is simply an example of incomplete documentation for a small number of studies.
In an article published online January 15, the Columbia Daily Tribune stated that the university's Women's and Children's Hospital had been "caught" by an internal audit to have provided imaging services to patients without physician orders. The story went on to speculate that the episode could be connected to the resignation in December of radiology department chairman Dr. Ken Rall, who had been convicted of a misdemeanor in the 1980s related to an alleged fraud scheme, according to the newspaper.
At the heart of the Tribune article were two internal audits conducted by the hospital's Office of Corporate Compliance, which, according to the paper, found that "62.5% of random radiological services involving Medicare patients did not have proper physician orders to support the services that were provided."
The first audit, released in December 2010, used billing information for services rendered in September 2010, and included a random sample of 30 Medicare cases for a total of 32 services, according to the document. Of the 32 services provided:
- Two (6.25%) did not have a physician order
- 12 (37.5%) had physician orders that supported the services requested
- 14 (43.75%) had physician orders that didn't specify number or types of views taken
- Four (12.5%) had no physician signature with the order
The second audit, conducted as a follow-up in September 2011, found that only one of 42 services did not have proper documentation of a physician order. Both audits stated that implementation of computerized physician order entry improved documentation in the medical record and that no corrective action was necessary.
The university is disputing the newspaper's allegation that it has been providing radiology services to patients without physician orders, according to Rich Gleba, director of the Office of Communications for UM School of Medicine. Instead, the audits simply revealed that some orders weren't being properly documented.
"The [two] audits reviewed how physician orders for radiology services were being documented in patient medical records," Gleba wrote in an email to AuntMinnie.com. "The first audit showed that 6.25% of cases reviewed did not have a documented order for a radiology service. The second showed that 2% of cases reviewed did not have a documented physician order for a radiology service. There were and are physician orders for all radiology services, of course, but in a few instances those orders were not documented in the medical record."
The Tribune came by its 62.5% figure (the percentage of services that did not have proper physician orders) by subtracting 37.5% (the percentage of services that had correct physician orders) from 100%. But this indicates that MU has been providing radiology services without physician orders for more than half of its procedures, according to Gleba.
"The reality is, all exams had physician orders, but we were unable to locate a record of orders in two out of 32 instances reviewed in an internal audit," Gleba told AuntMinnie.com. "The instances cited in our audits just weren't completely documented -- a situation that was remedied by putting a computerized physician order-entry system into place. Having incomplete documentation of a physician order -- that is, orders missing the number or types of views taken, or not having a signature -- is different from not having one at all."
