RM - Tip - PSA Monitoring

PSA Monitoring
May, 2002

NPM is seeing a disturbing increase in the number of claims associated with a delay in diagnosis of prostate cancer. Based upon our own claims experience, there appear to be two primary issues at play:

(1) Most claims have one significant factor in common. They involve changing PSA test values in which the physician takes no action.

(2) Changing PSA test results are often charted, but somehow are missed by the physician, and PSA monitoring that generally would occur does not.

SUGGESTED RISK MANAGEMENT MEASURES FOR THE PRACTITIONER

(1) Make yourself aware of the current guidelines for PSA monitoring and treatment. In cases where you choose to consider age-adjusted values, be consistent not only in your practice, but also preferably among all physicians and allied health practitioners in your group.

(2) Carefully document discussions that take place with patients who choose to not have PSA testing done and, if it can be ascertained, the patient’s reasoning. If applicable, document all of your efforts to encourage testing.

You already know you and your office staff carry the responsibility of knowing the status of your patients’ health maintenance testing and whether they follow through. Everyone is grappling with this issue. Here are some pointers that may prove helpful to your PSA tracking efforts.

PSA OFFICE SYSTEM BASICS

It is important that clinic leadership and all clinic staff understand the entire process used to monitor PSA values, which includes:

The initial patient visit
The medical decisions made that lead to testing
Performing the test
Receiving the result
Communicating the result and plan for follow-up action to the patient. Follow-up plans can include anything from periodic testing to initiating referrals.

When referrals are initiated, make certain that your office and the referral physician’s office communicate effectively regarding follow-up responsibilities and coordination of care. Bottom line: Do not assume that the referral physician is assuming long-term responsibility for your patients. Have your patients promptly return to your office once consultations have been completed.

Carefully re-examine the systems that are currently being used by your organization for ordering and tracking test results.

Make certain that reporting, communicating, and tracking test results is virtually a fail-proof system and that all clinic team members possess in-depth knowledge regarding the clinic’s underlying systems. Most team members will have good ideas on how to establish or improve the system best suited to your organization’s unique operating environment.

Keep the PSA - or any lab work - tracking simple.

Maintain continuity by having specific individuals responsible for various steps in the tracking process. Make certain that every staff member in the organization is familiar with the process and whom he or she can turn to if a problem should arise.

Keep in mind that interruptions and involving multiple individuals significantly increases the likelihood that errors will be made. Whenever working with test results stay focused upon the task at hand.

EXAMPLE OF FITTING PSA TRACKING INTO EXISTING PROCEDURES

A clinic uses carbonless copies they receive from the lab. One carbon is used as a tracking tool. It is placed alphabetically in an accordion file. This might best be done by the physician, MA, or whoever helps the patient get their test scheduled. When the report returns to the clinic, it enters a signature system where the physician orders any actions to be taken. Before the test results are filed, the designated individual checks it for the physician’s sign-off on the test result (usually initials) and then disposes of the carbon that was originally placed in the file. The remaining carbons get follow-ups according to the clinic’s established procedures.

NEED HELP?

Contact our Risk Management Department. We will gladly discuss ways to institute a workable test reporting and tracking system for your office.