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.

I enjoy caring for my Medicare-age folks. It’s just that—with each passing year—I question whether I’m still smart enough to figure out how to comply with the insanity that’s required to do so.

For the last 5 years, I’ve played the insanity game.

I’ve done my time.

I’ve hired people to teach me the rules. Hired more people to train the people to teach me the rules again. Because the rules are constantly in flux.

At this very moment I’ve got four different companies working to help me implement what the government is requesting I do. (Of note, the latest proposal is 2398 pages.) I’ve subscribed to email lists and paid dues to professional societies for their support, although I’m canceling the latter group this year. They can spend someone else’s money next time. They just aren’t working out for me.

Interestingly, Washington continues to emphasize through mainstream media that the system is still working great. Evidently the rest of us are tuned-in to a different channel.

I’ve been writing for years about the futility and frustrations of submitting PQRS (so-called medical “quality”) data. It’s basically where I click a bunch of patient boxes on a computer screen all year long, then submit the results to somebody on the Hill trying to guess what needs to be mandated for the “best work” to get done.

I’m currently slated to receive a penalty from the Hill next year. A payment cut for seeing Medicare patients. The irony is that I did what I was supposed to do.

Proving it, of course, to the bureaucracy is what might be the end of me. I’ll explain.

I am required to use a “certified” electronic health record. I do.

I’m required to submit data. I do.

The data is nowhere close to describing anything meaningful I do. Yet, I do it anyway.

And, I will be penalized.

Let me elaborate further.

Fall risk.

That one means I screen you when you come to see me in my clinic. I try to determine if you are at risk of falling, which would obviously be a bad thing. I watch you walk down the hall. Anyway, I get points for checking that box. Doesn’t matter what I do about it.

For the record, I’m not anywhere close to being the world’s expert on gait. I’m not sure that I’ve even had ONE formal hour of training on this matter in my lifetime. (Perhaps, completing ONE will become a checkbox next year.)

But, for this moment, I pretend I’m an expert on gait. I screen you. And, move on. Keep in mind, I’m a heart doctor.

There’s lots of boxes like this.

Dozens of metrics.

Certifiably exciting.

Always created in the name of public welfare. Someone on the Hill thinks certified clicks makes you healthier. I’ve yet to meet anyone off the Hill that seriously believes that.

The reason I’m slated to receive a penalty when seeing Medicare patients next year is not entirely clear. Even the government is confused. Which is why, once again, it’s business as usual at my office.

Everyone is scrambling to figure out why the government’s database has me logged as seeing ZERO Medicare patients last year.

As a side note, if you have Medicare, and I do see you, perhaps you could inform the government of your existence. You can even let them know the standard deviation of their data is apparently plus or minus a thousand or so.

Regardless, for the second year in a row (but apparently for a different reason this time), I’m appealing the government’s decision waged upon me. More paperwork. More hours holding over the phone. More online logins and various submit-more-of-this-and-that buttons.

I’ve already started preparing for next year’s submission process too.

For example, I have a government “certified” EHR, but that’s not enough. Evidently, the certifications have become too onerous for any one single EHR party to comprehend. So, I’ve had to hire another third-party to help me out.

This certified company will extract the data from my “certified” EHR.

Then, I will pay a different third-party (a government “certified” data submission vendor) to—get this—submit it to the government!

You might even think I’ve listed everyone who must be involved. I haven’t.

For one, at this very moment, my office EHR is currently offline. Another third-party is installing more necessary updates.

So, what does all this really mean?

For anyone on planet earth—outside of Washington—it means the system is a joke. It’s failing the front-users, back-users, and end-users.

As for Washington, they say they’ve been hearing us for sometime. They say they’ve been making it simpler with each passing year.

Well, I’ll tell you one thing.

This is the most bizarre journey toward simplification I’ve ever been a part of.

But, I will admit it’s simplified something.

It’s made it so much easier to explain to people why healthcare is so unaffordable.

Every layer you add—government imposed or not—comes at an economic cost. And, the elite will always navigate each new cost better than the less fortunate. Guaranteed.

This is the paradox.

We’ve finally reached a point where the best way to help the least fortunate is to unhook the Hill from the wagon. Otherwise, the healthcare wagon will just tumble right off—and more of the status quo isn’t good for anybody not already at the top.