Electronic or Paper…Some things don’t change

Nowadays, we as physicians must spend at least as much time and attention “treating our charts” as we do treating our patients.

Even when the charts were strictly paper, it was crucial that we write down everything that was done and seen.

Courts have long taken the premise that if it isn’t in the chart, it wasn’t done.  So, if you did an examination or you did a procedure, if it is not located in your progress note, the law states that you did not do it.  Stating that you only write down abnormal findings has not been acceptable as an excuse for more than a decade.

It is no surprise that features of electronic recording, open the physician up to legal vulnerability as well.

As is confirmed by Steven Kern, Esq. in his article Hidden Malpractice Dangers in EMRs, “paragraphs of information can be generated with a few keystrokes or even a checkmark…..describing a comprehensive examination in great detail using predesigned templates.  Lists of negative findings can appear, neatly printed, with the push of a button.”

Using the wrong template will generate a report that is simply not in keeping with your examination or the patient that you are currently documenting.

It is therefore crucial that you know what is in the chart as well as the template; preferably before the patient even leaves the office.

Patients complain that physicians spend more time with the computer than with them but in this litigious society, just with the paper charts, this is not going to change.

As we have learned in the past, one must take the saying to heart “Cover your Assets”

Scale Back to Gain

President Barak Obama has a vision of change but change comes at a price- a steep one.

The country is expected to scale back to pay for his vision:

  • Those who drink high sugar beverages will have to pay a higher amount or scale back drinking them
  • Those who have tax deductions from their earnings will have to pay more taxes
  • Those who have Medicare policies will have to pay more for the coverage 
Democrats, Republicans, private interest groups and lawmakers all have suggestions and all have their own agenda.  “All” is technically not the correct word however.  Because no one, not “all” can agree on any plan to fund the health care reform.
Since the public is being asked to scale back on spending and living expenditures, how about the government scaling back?  Not on policies that concern us as citizens and taxpayers.  How about scaling back on the huge amount of aid that goes to support foreign countries- especially the countries using the money for private coffers that never filter down to the common person in that country?!

Challenges of Employer Mandated Health Care

In the quest for universal health insurance coverage, a proposal was made to mandate employers equaling a given size to offer coverage or assist their employees in paying for the health insurance.

This proposal has many advocates.

Big Pharma finds the plan attractive because it would reap great benefit from it.  Millions of new customers could afford to purchase medications who might not have otherwise afforded them.

The American Medical Association supports the Mandate Proposal because it feels that all people could then afford care, either through employment or through subsidies.

The America’s Health Insurance Plan Lobby supports the proposal because it sees patients as  no longer being  rejected for preexisting conditions and would not be penalized for statistics that put them in higher risk categories.

On the flip side, The U.S. Chamber of Commerce rejects the proposal because it fears the plan puts too much pressure on existing companies.  In trying to meet the mandate, companies will downsize their staff or will declare bankruptcy under the new fiscal demands.

Both sides have valid reasoning.  This highlights the complexity of the problem where there might be more than just two sides, but a third that has not been considered.

How about companies getting tax deductions to fund the employee coverage?  If a business does not have to find the money to cover the staff, less operational costs would keep the company fiscally solvent.

Public Insurance Plan Draws Many Critics

President Obama feels that a public insurance plan would create more competition with improved premium rates for Americans.

On the other hand, with the array of insurance companies offering health care policies now, there already is competition and rates have actually been lowered over the last few years in relation to inflation.

Because the government can use its purchasing power as a weapon to decrease costs from physicians and hospitals, private insurers can be driven from the market place in the future.

Even the American Medical Association, who many physicians feel does not adequately represent them, rejects the plan of a public insurance creating additional pressure or drain to the current Medicare program and stress to physicians and hospitals.

The Chamber of Commerce has come out with a statement rejecting a public plan for fear of dire consequences for employer-sponsored health insurance.

If private insurers were to abandon the market place and there was only one (public) system in place, the administrators of this system could then dictate medical treatment options based on costs as opposed to efficacy or eradication of illness.

When this Orwellian system takes hold, there may be no turning back.

Do we really want this system dictating health policy for us?  It seems like a very scary thought.

Will YOU Be Paying For the Health Care Bill?

Providing health care to every American is a costly panacea that may total more than $1 trillion dollars in ten years. 

Where will all this money come from?

Proposals to support a new plan have been made from three chief sources- The White House, The Senate Finance Committee and The House.

Let’s review each of these. 


The House:

·      Slash Medicare and Medicaid reimbursements to hospitals, drug companies and home health agencies

·      Abolish private plan subsidies for the elderly

·      Limit deductions on charitable contributions and mortgage interests to raise $326 billion in taxes

My criticism of the above:

·      Hospitals and home health agencies are already operating at Hugh deficits and asking them to see indigent patients without proper reimbursements while trying to make their expenses and payrolls are difficult if not unrealistic

·      The elderly are in many cases barely holding on.  For those who are in need of many medications, you will get people who are going to have to decide between food and rent or life-sustaining medications

·      Charities in these economic times are already suffering a great deal and by limiting tax donations to them, you are also going to see less donations which will hurt those that need help the most.

The Senate Finance Committee:

·      Taxing the health benefits provided by employers

·      Remove Medicare sliding scale from states that have higher expenses

·      Cut Medicare payments to teaching hospitals

·      Expect Big Pharma to give greater discounts to state Medicaid programs

·      Demand nonprofit hospitals provide care to indigent patients in exchange for maintaining tax exemptions

My Take:

·      Cutting payments to teaching hospitals may cause major cuts to training residents and medical students or worse, having to eliminate training programs entirely.  At a time when physicians in certain regions will be at a shortage, especially in the primary care arena, decreasing programs for teaching is shortsighted.

·      In the current economy, many families are barely making ends meet and by increasing taxes on benefits may tip the scales into bankruptcy or necessitating that the employee declines the insurance benefit.

The House:

·      Place a tax on sugar-laden beverages, which contribute to national obesity

·      VAT – value-added tax on consumer goods

·      Removing tax deductions to Big Pharma for prescription drug advertising

My 2 Cents:

·      While the idea of trying to thwart people from drinking beverages that may not be healthy for them, the money raised from this is a drop in the bucket to the amount of money that is needed.  Consumers will also fear what food group or grocery item would be next.

·      VAT would affect lower income households

My Proposal:

How about taking the money from funds we give away annually to subsidize other countries?

Doesn’t charity begin at home?

When we are facing fiscal crisis, shouldn’t we be thinking of bailing out the U.S.A. over bailing out the economies of other countries?

After all, if we go under, we won’t be in a position to help out anyone else.

That time, my friends, may be fast approaching!

How to Implement Meaningful Use and What Constitutes It.

A recent press release invites anyone interested to participate in a town call web conference  from the Certification Commission.  It states:

The Certification Commission is planning two Town Call web conferences on June 16 and 17 to gather stakeholder input on new paths to certification of electronic health record (EHR) technologies, with the goal of supporting more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA). Areas to be explored during the Town Calls include the crosswalk from certification to meaningful use, enhancements to current programs, and new and updated programs to make certification more accessible to a wider variety of EHR technologies, including modular, self-developed, and open source applications.

After a brief presentation, participants will be invited to submit questions and comments online. Registration is required for the free Town Calls.

Finally, some answers to what is on everyone’s mind…namely what exactly is meaningful use of the EMRs in order to get reimbursed by the government in purchasing and implementing the system.

Up to date, there have been many more questions than answers.

Now perhaps after the conference and ability to call in questions, we will be able to put our mind to rest.

Still a Man’s World

A report issued from Yale University School of Medicine reveals that female researchers earn 8% less than male counterparts and make up fewer tenured researchers along all surveyed discipline lines. 

Although female scientists do get hired at universities, results show that fewer are applying according to a report from the National Research Council. Analyzing data from 89 universities in math, engineering and science from 2004to 2005, women applying for tenure track get them at higher rates but fewer women try for the positions.

According to co-chair Sally Shaywitz, this study suggests that universities need to offer more support to female researchers, aiding in family obligations.

This blog was written with information supplied by Dan Vergano at U.S.A. Today 6/4/09


Who will Foot the Bill or Will it Come from Liquid Assets

President Obama has been attempting to overhaul the healthcare system with a sense of both urgency and zeal.  In doing so, the administration’s plan is forecasted to set back Americans between $1.2 to $1.5 trillion within the next decade.

The staggering financial bill begs the question- where will be money come from?

In order to fund the new healthcare system,  the Senate Finance Committee suggests placing higher taxes on beer and wine.    A new tax under consideration is on non-diet soda.

If these proposals come to fruition, a great burden will be placed on Middle and lower class Americans by increasing their grocery bills despite President Obama’s assurance that this segment of the population (those earning less than $250,000 annuall) will not see a tax increase.

Those who favor these levies support this decision on the belief  that soda and alcohol are unhealthy for individuals by promoting weight gain.  In reality the new taxes are a way to raise money from a new untapped resource.

However, we need to consider that since soda is not a needed staple of households, consumers will purchase less of this product.  Therefore, one can not depend on this tax to support new programs.

A Rasmussen poll reports that 70% of Americans are against the soda tax, partially because they fear that it sets precedence for taxing other grocery items. 

While the idea behind  reform is to stem the tide of increasing expense for healthcare in the long run, the government needs to take a closer look at where the allocated funds will be coming from in the present and near future. 

  Dick Armey, chairman of FreedomWorks, “which advocates lower taxes and less governmental influence”, supplied the information for this blog.




Response to Are You Getting Patient Referrals

When a new patient transferred into my practice, it was customary to ask why they chose to leave the last office.  The answers they gave might be very surprising to some professionals.

When people are unhappy with the practice, it is not necessarily you. 
Ask yourself- is there easy access to the office? i.e. parking available 
Is your staff friendly? 
Is the initial visit process intimidating or easy to slide through for the patient? 
Do callers get a live person on the phone after the first ring or two or do they have to go through ten automated zithromax online fast delivery button pushes until they are referred to someone ( a sure way to lose that initial caller) 

 Patients automatically refer friends and family when they are happy with the service, office, provider, practice. 

A mere thank you card for the one referring informing them that you recognize the special action they took and that you appreciate it also goes a long way. 

These questions may seem obvious but are not always addressed. 
If you make someone feel special and feel better, they will chat about it amongst their friends- the viral marketing is invaluable.

Wait a Moment Please

According to an article in USA Today by Erin Thompson, there is an increase in length of time to obtain an appointment at a doctor’s office, by as much as several months in urban areas. 

This was supported by a study done by the consulting firm  Merritt Hawkins who surveyed more than eleven hundred medical offices in 15 cities.  They analyzed four specialties: obstetrics/gynecology,cardiology, orthopedic surgery, and dermatology as well as family practices.  An 8.6 day increase was seen in wait times with Boston having the longest wait in the survey and Atlanta with the lowest increase. On average in all cities the wait was 20.5 days.

Phil Miller, the vice president of public relations for Merritt Hawkins feels that the answer to alleviate the wait problem is to train more doctors especially in primary care.

Richard Cooper, professor of medicine at the University of Pennsylvania feels that the supply of doctors have been restricted due to the manner of government spending on education while attempting to increase medical access with a greater number of people being insured.  This will incur a greater demand for physicians.

When asked about the medical care shortage, Heyman, the chairman of the American Medical Association stated that patients historically have reduced access to medical care due to health care program budget cuts to health care professionals.  He feels that Medicaid and Medicare need to be financed in a manner that will work beneficially for both patients and physicians.

However, with the advent of new technology whereby patients are monitored at home for certain ailments like high blood pressure, diabetes, cardiac  and pulmonary disease symptoms and advised via electronic devices, the need for office visits will decline.  This in itself will diminish the pressure on the medical community to be seen.

Those patients who have demonstrated a greater need to be seen through this monitoring of symptoms, laboratory results  and vital signs will find greater availability of office appointments.