The effect of performance incentives on resident documentation in an emergency medicine residency program

Study objectives: We sought to improve resident medical record documentation in an academic emergency department by using an educational stipend as an incentive. Methods: A stipend for educational expenses and materials was paid to residents for documenting medical records above a specific threshold level according to evaluation and management codes (99281 to 99285) during a 4-month period (December 2002 to March 2003). Comparisons were made with historic documentation levels, and residual effects of the program were measured. Fisherʹs exact test and t tests were used for statistical analysis. Results: Twenty-two residents worked in the department over a 4-month period (42 resident-months). A total of 74% of residents received the educational stipend. Documentation levels increased significantly from 2.86 and 3.04 during the control period to 3.31 during the study period (P<.01). A total of 46% of medical records were documented at 99284 (level 4) or 99285 (level 5) during the study period compared with the 30% (December 2001 to March 2002) and 23% (December 2000 to March 2001; P<.01 for both comparisons). In addition, during the months after the plan when there were no incentives, documentation continued to improve, with 69% documented as levels 4 or 5 from April 2003 to June 2003 (P<.01 for all comparisons). Total payments per patient were $48.05 for the study period and $42.36 and $35.86 for the previous 2 periods (P<.01 for all comparisons). Conclusion: Implementation of a resident incentive program to enhance medical record documentation significantly improved documentation levels and collections and may improve resident interest and education in documentation.