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Independent consultants have reviewed 4,600 medical records from 30 health centers on behalf of the Västra Götaland region. Of the 30, 14 are now being sanctioned, of which five are private and nine are public, with reduced compensation. This is after health centers systematically recorded irrelevant diagnoses in patients.
For example, it looks like this:
A patient contacts a health center in western Sweden to renew his prescription for medications for a deficiency of thyroid hormone, called hypothyroidism. When the prescription is renewed, the health center also records that the patient has hip osteoarthritis, shortness of breath, high blood pressure and lung disease, as well as four additional diagnoses.
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According to the Västra Götaland region guidelines, only hypothyroidism was relevant when the drug was renewed. The fact that eight more diagnoses were given meant, according to the review, that the health center received higher compensation than it should have received.
Marie Gustavfson, head of the in-depth follow-up and care selection unit in the Västra Götaland region, says that knowledge about how diagnoses should be recorded has increased in health centers after the review.
Photo: Västra Götaland region
Basically acting it’s about justice, says Marie Gustavfson, head of the Care Choice and In-Depth Follow-up Unit in the Västra Götaland region.
– If some units do not report correctly and correctly, there is a great risk that they will receive too high compensation, at the expense of others, he says.
The Västra Götaland region is one of the Swedish regions that uses the ACG system to determine how much compensation a health center receives for receiving a certain patient. The system means that the compensation will be greater if the patient has several diagnoses, since it is later judged that it requires more resources from the reception.
The system has been criticized, among other things, because it is not always clear which diagnoses are relevant at what point of care. In the review, employees of certain health centers claim that individual doctors have had a habit of writing a large number of diagnoses when in contact with patients.
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But there is even employees who say managers encouraged them to record a large number of diagnoses.
“I think it is wrong that employees are punished for doing what managers say,” says an employee of one of the health centers who is criticized in the review.
Another employee says that as long as compensation is tied to the number of diagnoses, there will be incentives to record more.
“For us, it’s about surviving to be able to run your health center,” says the person.
The 14 health centers that have violated the guidelines will now receive compensation for the next 20 months, starting in January 2020. The amounts range from SEK 40,000 to 10 percent of the health center’s total compensation.
