Yeah, it happened. The SGR is finally dead. Hooray! Sort of. I mean, it's great and all that -- we'll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we'll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we'll no longer have to waste our lobbying time and effort ...

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shutterstock_192161366 Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER ...

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I would like to explain why Michael Kirsch's article, "Why the ER admits too many patients," is wrong, in all the myriad ways, in his contention that emergency physicians (EPs) admit too many patients because of improper motivations. Note that I am not going to argue that EPs don't admit too many patients -- that's a legitimate discussion to have and there may be some merit to the ...

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Recently, there was a bit of hue and cry regarding Mayor Bloomberg's report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department. Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians ... “It prevents me from being ...

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Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It's high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle. These stresses, if unmanaged or poorly managed, can ...

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I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I'm sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the ...

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I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:

Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it's not clinically relevant. Such is the Kafkaesque world we live in.) And I ...

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I have a lovely pen. It's a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice. It's a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window ...

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I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify. The point in contention is an interesting one: we know the nation's ERs are overwhelmed and overcrowded. That's old news. ...

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There was an interesting and important article in the New York Times the other day about the gradual increase in the average E/M coding levels used by doctors over the last few years. For the non-docs, med students and ER trainees out there, here is a brief summary of the way physician billing works in the ER. During and after the patient encounter, the physician creates a medical record. ...

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