Category: Quality Measures in Healthcare (page 1 of 3)

“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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Spare Me The Tire

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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.

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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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Open Letter Response to CMS on MACRA & MIPS

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My recent post appeared to catch the attention of Mr. Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS):

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My article recapped another day of insanity within our healthcare enterprise, and yes, taking a look, Mr. Slavitt, would be greatly appreciated.

Choosing to see, however, is my challenge for you—for as a friend reminded me, you seem to be very good at “feeling our pain.”

But, I must admit, thanks to you, I was contacted by a CMS official overseeing the startup of MACRA.

For those that don’t follow healthcare policy closely, MACRA is our government’s latest medical project. Another soon-to-be-implemented healthcare law with 962 pages of rules, including the most recent method devised to pay physicians, something known as the Merit-Based Incentive Payment System (MIPS).

CMS was seeking my perspective on MACRA and MIPS.

My written response to them—edited only somewhat for brevity—is shared below:

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Enterprise Gone Overboard

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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.

DONOTREPLY.

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.

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Getting What We Pay For

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I arrived with my family. I handed the usher our tickets.

We entered the auditorium. The stage was lit. We were directed to our seats.

We were there to watch an OPAS Junior production—a performing arts play for families and children.

The performance would soon be what we paid for, an enjoyable Sunday afternoon event with my wife and boys.

The actors and actresses did their job. They appealed to us, the audience. They danced, sung songs, provided humor, and so forth. They were there for us that day. And, we were there for them.

We paid for their performance. And, they gave us one.

*   *   *

A compelling strategy has consumed American healthcare. It’s known as pay-for-performance. It’s trying to replace our unknown fee-for-service model, because it seems more logical.

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More Astrological Proclamations From The New York Times

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I made a mistake.

I don’t buy the New York Times. I told you why. But, someone snuck one of their recent articles into my email. And, yes, I read it.

The article was written by a person with well-known hostility toward private practice physicians. That’s fine. He was giving his interpretation of a study.

The study appeared almost one year ago in a medical journal published by the American Medical Association (AMA). The AMA is the same society who last month, in response to increasing prescription medication costs, recommended that we ban all television commercials for pharmaceutical drugs.

Whatever your take is on this one, I don’t really care. I just wasn’t certain opening up more advertising slots for beer commercials and Doritos would be the answer. Of note, the AMA failed to mention any need to ban the dollars they receive from pharmaceutical ads appearing in their own magazines. (Perhaps, that will be a post for another day.)

Regardless, the New York Times article was about a study that evaluated outcomes of heart patients admitted to hospitals during two distinct periods of time: (1) during days of the year when a handful of cardiologists are away from work “learning” at national meetings, and (2) during similar days when they are not.

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To Succeed, You Need More Than Ideas

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To laugh often and much

So begins one of my favorite quotes by Ralph Waldo Emerson. One that will have more meaning shortly. I’ll explain.

The American College of Cardiology (ACC), a medical society of which I’m a member, has launched a new website. It claims to be able to help you select the best hospital for your heart condition.

There are often several options to choose from when deciding the best hospitals to receive care for a heart (cardiac) condition… You can make more informed choices.    –From FindYourHeartaHome.org

Since numerous organizations with almost no knowledge about healthcare delivery have decided to release medical scoring systems under the premise that it will help the public in some way, why shouldn’t the ACC get involved? Great idea. Most of ACC’s members are physicians who will know a thing or two about patient care.

So, I quickly navigated to their new website to see what it was all about.

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You Can’t Take Back What You Are Giving Away

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I’ve played some basketball in my lifetime.

Just small stuff.

I’ve even coached a few games, like my sister’s co-ed basketball team, when she was eight years old. I helped my dad. One of the many things we enjoyed doing together.

I’ll never forget this one game.

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