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EPtalk by Dr. Jayne 3/9/17

March 9, 2017 Dr. Jayne 3 Comments

I’m still getting back into the swing of things following my recent adventure in healthcare. I’ve enjoyed the relative downtime, although I’m getting a little stir crazy. Hopefully I’ll be cleared for travel early next week so I can keep the good stories coming from the trenches.

In the mean time, I’ve been going through my post-HIMSS and post-hospital mail. A couple of vendors need to get some money back on their marketing efforts: the postcard from eClinicalWorks arrived on Monday after HIMSS had already started, with an invitation to “The Way of Tea” at the Vital Images booth arriving on Tuesday. The grade schooler who picks up my mail when I’m gone does an excellent job sorting and bundling so that I know what mail is the oldest. I can’t wait until he grows up – I see some serious potential as a process improvement specialist.

I’ve been working my way through loads of email. A special thank you to all of you who sent well wishes and good vibes for a speedy recovery. It was nice to have those little rays of sunshine popping into my inbox.

I was glad to have been on sick leave from my clinical position because I was supposed to be working the day the big Amazon Web Services outage hit. Our vendor sent quite a few emails apprising users of the status. They were apparently having a partial outage, where users could document visits but could not see images, forms, and letters. You can have a really great downtime strategy in the office, but you never know how things are going to unfold when an outage hits.

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CMS has finally updated its website with Clinical Quality Measures information for the 2017 performance period. The Meaningful Use domains have been removed and now the measures align with the Quality Payment Program and its Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) tracks. CMS invites people to submit questions about the documentation, but I wouldn’t hold my breath waiting for a response. I’m still waiting for clarification on some Chronic Care Management questions from earlier in the year.

I’ve also had a ringside (couchside?) seat for the release of the American Health Care Act, with plenty of time to digest the back-and-forth commentary from politicians and healthcare leaders. I finally had to step back after a while because it’s going to go on for months as everyone tries to get their piece of the action with the usual wheeling and dealing, negotiations, and amendments.

The so-called “repeal and replace” legislation is only 4 percent the size of the Affordable Care Act (120-odd pages vs. 2,700) so the devil will truly be in the details. I’ve talked to a couple of friends who are OB/GYN physicians and their patients are still terrified about losing coverage for contraception and preventive services. One physician has a patient who is trying to import black market IUD devices from Canada. Apparently they’re made by the same manufacturer that makes them for the US market, but the cost is less than 25 percent of what they go for in the States. That’s a sad commentary on the state of healthcare in the US.

After the Affordable Care Act went into effect, my personal insurance plan was still grandfathered and didn’t have to offer all the mandatory coverage. Late last year, the trustees of the plan voted to un-grandfather and began to offer coverage for things that were previously not covered.

I finally began to pursue a genetic consultation to address some lingering family history concerns. After months of waiting and submitting genograms, results of relatives’ testing, and more, I finally have my appointment with the geneticist next week. Of course, it’s going to be better to know one way or another, but I hope my decision to get tested doesn’t come back to haunt me if there are changes to the protections and coverage for people who know they are at higher risk for serious health issues. (At least I know I’m at zero risk for gallstones or cholecystitis now, so that’s a plus.)

I had a strange experience as a physician this week. I received an email in my consulting business account containing a link to access a summary of care record. It was from a hospital where I haven’t been on staff since before I bought this domain, so I’m not entirely sure how my address came to be linked up to their system. Sure enough, it was a patient discharge record.

I cross-referenced it against my patient panel from the last year I was in a traditional primary care practice and found the patient. I’m not sure if it was a computer glitch or whether she really still considers me to be her primary care physician after all this time, but it was a nice memory. I called the hospital and they weren’t terribly helpful in trying to figure out how it got routed to me as it did, but instructed me to simply discard the message.

Physician readers familiar with “The Match” will cringe at this news story. The cardiothoracic surgery program at New York-Presbyterian / Columbia University failed to submit its resident ranking list, meaning it will not be able to offer residency slots as part of the traditional Match Day next week. Columbia can still fill its program through the Supplemental Offer and Acceptance Program, which makes unfilled slots available for residents who did not match. This could be a boon for students who didn’t get a spot via the actual Match process, but it means that the program will most likely not have access to its top-ranked candidates.

I still remember my own Match Day, and not entirely fondly. Although my placement was a sure thing, I was on the edge of my seat waiting for my turn to open my envelope in front of my entire class. For some, it was a barbaric way to do things as we watched people’s dreams get crushed in between happy Matchers jumping up and down. Schools still have formal Match Day ceremonies where this continues to happen, although applicants can now skip the envelope and find out an hour later via email.

What’s your Match Day memory? Email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. Hey Dr. Jayne, glad to hear you are back in the swing of things! Fighting my own cold and “depression” (How can it be -16F wind chill the second week of March – yuk!). If you are ok sharing, what genetic testing do you/does your caregiver use? I heard Dr. Aubrey Milunsky speak about ten years ago at a conference (“Know your genes!”) and was fascinated, so I went out and bought his book.

  2. Thanks for your insight / thoughts on ACHA — I find myself sharing some snippets of yours often to my personal FB page to try to inject some reality into the debate going on from both sides. As an analyst that thrives on rooting out waste, inconsistencies, and generally helping to ‘reorganize’ healthcare one data element at a time — the lack of public policy for group purchasing of medical devices and medications is absolutely stultifying. None of these things should cost that much and they really don’t in other countries. We have this obsession as a country (IMO) with ‘pull yourself up by your bootstraps’ which works to an extent but health is one of those things where you can’t do the pulling if unhealthy. Dr. Pamela Peele (UPMC) said once at a conference ‘we have compulsory education funded by taxpayers– why not compulsory healthcare?’ Outstanding point– but then I was embarrassed to admit that when I started to research how compulsory education came about, I was shocked by history. Each State had to individually get on board and mandated it on their own (with acceptance of Federal funds). It really put part of the challenge in focus for me– we have 50 different healthcare systems, minimally, and achieving consensus seems farther from possible than ever.

    Also: Regarding the residency Match debacle — WOW! Knowing so many people who have been through that process– just Wow. Thanks for sharing.







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