I had to bring in another one.
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.
Spare tires have become TERRIBLE.
What is the matter with those things?
We call them donuts. But this comparison is a disgrace to the donut. Powdered sugar is more durable.
As for a balloon? I’ve seen sturdier ones at a birthday party.
It wasn’t always like that. It used to be a real tire. Then, something happened. And, its function suddenly became atrocious.
Even the jack suffered a similar fate. It became two chopsticks with a plastic twisty piece overnight. Did all of the automobile manufactures just get together and determine it was time to anger their customers?
Maybe. But, if being a part of America’s healthcare system has taught me anything, it’s that madness frequently has even simpler beginnings.
* * *
Shortly before I entered medical school, a change in healthcare delivery was already taking affect. It was called Hospital Medicine.
Don’t let me confuse you. Yes, we already had medicine going on in hospitals. But, this was indeed something new.
Different doctors (called hospitalists) were beginning to take care of you whenever you ended up in the hospital. These hospitalists weren’t your main doctor—the one who you saw frequently in the clinic. They were different. Your main doctor didn’t go to the hospital anymore.
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?”
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.
My satellite clinic is about an hour away. I drive there with my nursing staff each month.
We load up ECG equipment, pacemaker programming machines, and a few other doctoring items in my truck.
I provide services to an area that has no permanent resident doing what I do.
Then, I return home.
Today is one of those days. I arrive back to my main office. It’s after 5pm and officially closed for the evening. I hurry to help my remaining staff return numerous phone calls to patients who had left messages while I was away. I hope to finish up at the office soon. Then, I intend to check on a patient at the hospital before making it home for dinner with my family.
I peer down at a piece of paper on my desk, given to me by one of my staff. It’s a printed email message. Sent by the Centers for Medicare and Medicaid Services (CMS).
The message is arguably from the most descriptive email address on the planet—and I’m not making this up—it’s from DONOTREPLY@CMS.GOV.
It’s rather fitting.
Because they definitely don’t want you to reply. That would be easy for me. Too efficient, perhaps. No, they don’t want a reply. They just want me to DO what they say.
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.
You should know that medical documentation has gone awry. I devoted an entire chapter to this topic in Finding Truth in Transparency, but you really just have no idea. If you’ve been to the hospital or to the doctor’s office even once this year, I’m willing to bet that at least a portion of your medical information is now found somewhere within an electronic medical record (EMR). An EMR is really just some mega-computer that stores your health information. Lots of it. And, I guarantee you that the EMR that contains your medical chart is also full of universally unhelpful medical information. It’s bloated on purpose for medical billing. I’ve used eight different ones in the last 4 years and every one has been the same in this regard. Bloated.