Category: Electronic Medical Record

“Mapping” Madness

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I had to bring in another one.

Another company.

I’ve now lost count.

I just know the number of 3rd-parties involved with documenting the medical care I provide exponentially dwarfs the actual people that I have providing it.

The latest company deals with something called “mapping.”

Certified mapping, if you will.

Now, take what I’m about to say with caution, because I’m not here to steer you wrong. But, when it comes to healthcare in this country, the following advice comes from my own experience:

Whenever you learn about someone, or something, or some other entity getting another medical “certification,” run away from them. Go the other direction. For one, it means that you probably won’t be able to afford them. But two, the certified medical system has just gone haywire.

I’ll break it down for you.

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Business As Usual

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It’s business as usual at the office.

Another Fall season is here.

It’s time, once again, to sort through all the madness.

I wish it were “Midnight Madness.” Because, I like college basketball. That’s the name we give to the first formal practice of the season. The one where you get a glimpse of your local team’s talent.

Unfortunately, that’s not what I’m talking about at all. But, there are some similarities.

For example, the madness (I speak of) spans numerous midnights and deals with a practice—albeit a physician operated one.

My office is currently back at it again trying to figure out how we can continue to see Medicare patients. One day soon, we might just give up. But, if you are one of my Medicare patients, don’t call me in panic. Call your congress member instead. Click here if you don’t know who that is.

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Documentation Gone Awry

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I’m obsessed about finding ways to better deliver high-quality and affordable medical care.

And, yes, it obviously starts by eliminating the medical waste that’s preventing it. What’s on the chopping block for today?

Mandated medical documentation.

Follow me around for a single morning. It’s the most obvious waste you will recognize.

Ninety-five percent of it might as well be monkeys typing on a typewriter. No one providing care wants to read any of it. Because it’s not helpful.

There are lots of letters on the page. And, there are lots of pages.

Frequently, it’s an unsolvable puzzle. In fact, I challenge you to find much of anything that really matters inside a patient’s chart anymore.

I guarantee you the insurance companies don’t read any of it. I send them records all the time trying to get studies approved for my patients. They read absolutely none of it.

They just deny the test. Then, I have to call them. Wait on hold. Talk to a nursing supervisor. I just hung up the phone with one a few minutes ago. Do you know what she asked me?

“Doctor, can you tell me the reason you are ordering this test?”

Tell you?

I sent you two-dozen pages of notes. You are looking at them now. Why don’t you read what I send you?

I’ve got my theory on this one.

WE HAVE ALL JUST GIVEN UP.

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Solving Nothing

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American tax payers have spent billions funding our current healthcare computer systems.

“Cash for Clunkers,” he calls it.

“[The legislation] gave $30 billion,” says technology entrepreneur Jonathan Bush, “to buy the very pre-internet systems that all of the doctors and hospitals had already looked at and rejected.”

And, he’s right. We’re using clunkers. Paid for by the U.S.A.

The reason for this is simple. These government subsidized and heavily regulated software systems were never designed for the physician end-user. They were built to satisfy thousands and thousands of pages of federal regulations. And, they’ve essentially achieved two things: (1) to create privilege for some, and (2) to politicize everything for the rest of us.

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The Butterfly Effect on Me

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After reading my latest post about conflicts of interest in healthcare, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful.

Since hostility is never my goal, I thought I’d give it a try.

I read for an entire evening on butterflies–their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother liked them. She lived for nature. Flowers. Birds. Butterflies. She stayed with me once as a child when my parents were out of town. She would literally drive only 10 MPH on the road if anything remotely beautiful were visible out the window. Butterflies included. During her visit that year, I intentionally directed her down the ugliest roads in town so we could get to where we were going more quickly. I know it sounds bad, but that’s what I did.

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Regulate THIS!

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Pharmaceutical drugs cost too much. The new ones are always so expensive.

Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drug-maker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.

The government should regulate things more so we can get it cheaper.

Case in point. One new medication now available to cure a chronic liver disease costs about $84,000 per treatment course. The actual production cost for the company that makes the drug is supposedly around $100. Granted, the company paid $11 billion for the patent rights, and then took a risk that the drug would even get through Food & Drug Administration (FDA) approval. But, ultimately it did, and this year alone, the company will likely receive over $17 billion in revenue from it.

Wow. Then, they likely will make more profits next year.

And, the year after.

Why isn’t the government protecting us from such pharmaceutical price gouging? Where are the regulations? We need them.

Here’s the bitter irony.

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How to Spend Eleven Billion Dollars

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Eleven billion dollars.

Sounds like a lot of money, doesn’t it?

It is. But, I’ll give you even more perspective, Tony Robbins style.

Eleven seconds ago you started reading this page. A few blinks of an eye. But, eleven million seconds? That was a few months back. 127 days to be exact. Can you remember what you were doing then? Eleven million seconds have passed since you did it.

But, when you jump to billions, you’ll begin to see my point. Take eleven billion seconds. How many days ago was that? Not days, really. Try years. I’ll give you a hint. You weren’t born yet. Our country wasn’t even born yet. Eleven billion seconds ago was almost 350 years in the past. It becomes days versus centuries when you go from millions to billions. They are solar systems apart, even when traveling at the speed of light.

So, back to eleven billion dollars.

Remember, as Everett Dirksen once said, “a billion here, a billion there, and pretty soon you’re talking about real money.”

Eleven billion dollars is what the Department of Defense (DoD) is about to spend to revamp their electronic health record (EHR) system. That’s right. Computer software. For medicine.

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Distracting Pilots Landing Planes

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Years ago, I owned a lawn service. I ran the company.

Actually, I was the company. The only worker. Then, a buddy of mine joined up. It became our summer gig for many years.

We prided ourselves on quality. We were good at what we did. And, we were fast, too.

Jump ahead a few years. Okay, more than a few.

I now work in healthcare. And, to be honest, I wish there were more similarities now with what I did back then. I’ll explain.

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Looking for Craftsmen, Finding Red Tape

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I’ve got dozens of peculiarities with my personality. In fact, my wife might say that’s a conservative estimate.

I get frustrated when the collar of my polo shirt curls up in the humidity. I’m amazed that you can’t make a moisture-wicking white undershirt that doesn’t wrinkle, doesn’t fade to light gray with months of washing, and whose logo won’t show through a white dress shirt. If you find one of these, send me a message, and I’ll purchase a dozen.

I don’t buy the “off-brand” bottled water anymore, at least not the kind they sell at my local grocery store. Why? Does it taste different? Not to me. My taste buds are so bland, I probably wouldn’t know if I were drinking salt water. The reason is that 1 in 10 of the off-brand plastic bottles actually upsets me. The bottle upsets me, not the water. The wrapper just won’t stay glued to the plastic bottle long enough for me to finish drinking it. It starts to peal off, and yes, this bothers me. It’s just glue, and you ought to be able to get that right.

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