Background: Point-of-care ultrasound (POCUS) is associated with superior diagnostic accuracy compared to physical examination in evaluating for cutaneous abscesses. It also increases the safety of incision and drainage (I&D) procedures. The development of formal ultrasound workflow solutions in emergency departments (EDs) has helped standardize POCUS as a billable procedure. However, it remains unclear whether ED providers are using POCUS sufficiently, whether they are following the proper workflow, and how billing and revenue systems are thereby affected. Our study sought to investigate the frequency with which emergency physicians (EPs) use POCUS for potential abscesses and to determine whether the proper electronic medical record (EMR) workflow is followed. We also sought to quantify the billing and revenue associated.
Methods: We retrospectively reviewed all Epic EMRs containing the diagnosis of “abscess,” “boil,” or “cyst” in the 2016 calendar year in the Mount Sinai Hospital ED (n=2240). We excluded those abscesses in which: POCUS would not reasonably be performed, the abscess was already draining significantly, advanced imaging was performed, or a consultant was involved in the medical decision-making. The following binary data points were collected: Was a POCUS performed, ordered in Epic, interpreted in Epic, and saved in the SoftLink server? Also, was the POCUS procedure billed out to the payer, and was the revenue collected?
Results: There were 710 abscesses (31.7%) that met inclusion criteria. Of these, 283 (39.8%) POCUS were performed, 213 (30.0%) were ordered, 198 (27.8%) were interpreted, and 180 (25.3%) were saved in SoftLink. There were 120 POCUS billed (16.9%) at an average amount of $151.98. Of these, there were 66 payments collected (9.3%) at an average amount of $29.90, for a total revenue of $1,973.53. If the proper workflow and bill collection had been implemented for all 283 POCUS, the revenue would have been $8,461.70. If POCUS had been performed with the proper workflow and bill collection for all 710 abscesses, the maximal potential revenue would have been $21,230.40.
Conclusion: EPs are using POCUS to evaluate cutaneous abscesses in a suboptimal number of cases. EPs are also not sufficiently documenting POCUS through the proper EMR workflow. This may result in the loss of revenue for the ED.