Health IT

How much is your doctor worth vs how much your doctor is paid

Guess how much this visit is reimbursed, in this scenario of newly-diagnosed breast cancer:

That’s where my office gets involved. Five or ten faxed pages arrive on my assistant’s desk. She calls the Gynecologist’s office to request additional material, including copies of the mammogram report, the patient’s contact information and insurance data-if the patient is insured.

As it happens, like more than 60% of the women I …

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The real scoop on EMRs

Here is the truth about the so-called “holy grail of medicine”:

Admittedly, other industries have seen large cost savings from computerization, but health care is different. First, the health-care system is hardly a system. It is hundreds of thousands of doctors and thousands of hospitals all practicing medicine their own unique way — and the EMR will not change that. Ideally, the EMR should allow a doctor standing in the …

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Fat Doctor on EMRs

It makes it easier for the charts to pile up:

When we had paper charts, I’d get freaked out if there were 10 on my desk. I’d quickly scribble out bare-bones histories, ROS, PE findings and plans. Now, it’s really easy to get behind very quickly. Part of the problem is the ability to be so darned thorough. I never felt that pressure with paper charts.

Templates are key. …

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Why OB/GYNs are becoming harder to find

Why would you want this job?

Wanted. Part-time. Private practice seeks obstetrician and gynecologist. Forty hours a week, some nights and weekends. Pretax income $70k/yr and falling. Life-altering medical malpractice claims average only 1/3 years. Electronic medical record – partially functioning. Administrative skills required. Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above …

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Are EMRs affecting the doctor-patient relationship?

It seems so. Many EMRs are template-driven, so you have to work within its confines – rather than the other way around. I also was amused at how the doctor immediately announced how much time she had for the visit:

I was surprised, however, to see this new doctor enter the examining room with a computer on a cart. She didn’t greet me or shake my hand. Instead …

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Cosmetic charting

Dr. RW writes about how P4P will lead to an increase in chart games. EMRs already gives notes added verbosity (via templates and cut/paste), leading to an increase in coding. Once P4P comes into play, expect the templates to gear towards P4P goals – at the expense of meaningful clinical information.

TIME.com: VA hospitals are the best

Their EMR is a major reason. Although I don’t think it works this well:

Most private hospitals can only dream of the futuristic medicine Dr. Divya Shroff practices today. Outside an elderly patient’s room, the attending physician gathers her residents around a wireless laptop propped on a mobile cart. Shroff accesses the patient’s entire medical history–a stack of paper in most private hospitals. And instead of trekking to the …

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The wonders of a universal EHR

It’s funny that we’re re-inventing the wheel, when a great EHR is functioning well at the VA:

The centerpiece of that culture is VistA, the VA’s much praised electronic medical-records system. Every office visit, prescription, and medical procedure is recorded in its database, allowing doctors and nurses to update themselves on a patient’s status with just a few keystrokes. In 1995, patient records at VA hospitals were available at …

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Frist on the ER crisis

It all starts with liability reform:

To begin with, we must fix the broken medical liability system that drives doctors out of emergency room practice, increases costs, and contributes to wait times. Some opportunistic trial lawyers, quite simply, have converted our litigation system into a lottery that damages medical care for almost everyone. We should also build more community health centers to provide free or inexpensive care for the uninsured, …

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Deal with it insurers: High-level coding is here to stay

The AAFP sent a letter to insurers stating that appropriate, high-level coding (99214/99215) is here to stay. EMRs are cited as one reason:

The overall aging of the general population coupled with an accompanying increase in chronic health conditions that are treated in the ambulatory care setting rather than in the hospital “result in patients needing more complex care than they did a generation ago,” said Frank.

Other factors …

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EMRs: Where more is less

Doctor comments on JAMA’s recent EMR commentary:

Moreover, EMR encourages everyone to copy-and-paste the notes of everyone else so that notes become the same from author to author as well as from day to day. Even consultants are assimilated into the oneness of the EMR Borg. A cardiology consultant recently copied-and-pasted the intern’s note into his own, even including “consult cardiology in AM” in his recommendations. Perhaps he meant …

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Microsoft’s EMR

Microsoft Word that is. This physician explains how he does it.

How an EHR is slowing visits, and reducing access:

Rollout of the Defense Department’s electronic medical record-keeping system has reduced patient access to many military outpatient clinics and lengthened workdays for many doctors, say physicians and system administrators . . .

. . . Because of appointment backlogs, Nelson said, many parents are bringing children to the center’s emergency room for care. “We are so far behind. … We …

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Innovation in Massachusetts. Universal health care without a single-payer system.

Updates from around the blogosphere –

Mathew Holt:
“Either the insurers will not be regulated, and the market will implode with under-insured replacing the uninsured, and consumers and providers will be equally grumpy as it’ll all have been a head-fake. Or the insurers will be properly regulated in time, and the approach I suggest will be …

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Banning cell phones in hospitals may do more harm than good. “The prohibition against mobile phones in hospitals may do more harm than good, a new report reveals.

Medical facilities prohibit cell phone use, but some doctors already use them. And it turns out they reduce medical errors because communication is more timely, a new study finds.

Mobile phones rarely cause electronic magnetic interference, Yale School of …

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“A perfect storm of medical, legal and personal choice issues.” More on the record high C-section rates:

The increase in primary C-sections and decrease in VBACs continue a trend established in the mid-1990s, the report noted. In 1996, C-sections accounted for just more than 20% of all U.S. births, with primary C-sections constituting about 13% of the surgeries. At the same time, VBACs rose to about 28% of births to …

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Statutes of limitations

Statutes of limitations for malpractice cases in Wisconsin don’t fully address injuries to developmentally disabled children, so a teenager who was injured at birth should still be allowed to sue his health care providers, the state Supreme Court ruled Friday.

(This is, I guess, an established fact in the case).

The case could have broad implications in Wisconsin, where the state’s medical malpractice environment is already in flux because …

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