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EPtalk by Dr. Jayne 7/9/15

July 9, 2015 Dr. Jayne 2 Comments

Lots of chatter about the NYSE crash in both the IT and physician spheres today. Despite assurances by the US Department of Homeland Security that hacking was not a factor, conspiracy theories are running rampant. Couple the apparent technology failure with the financial crisis in Greece and a stock market slide in China and people are feeling unsettled. Physicians are starting to fear hackers as much as they fear inquiries by Medicare Recovery Audit Contractors.

I’m closely following the #DataIndependenceDay movement and Mr. H’s efforts to get his health records. I wrote in May about a friend who had knee surgery. She has requested her records to no avail, although she did get a refund check from the hospital. A call to the patient accounting department failed to yield an explanation. Since the amount she paid upfront for the surgery was actually less than what her insurance carrier identified as the patient responsibility amount, the refund doesn’t make much sense.

We’ve been having a good time reviewing the various “explanation of benefits” notices during our biweekly girls’ night in (kind of like girls’ night out, but without the need for one of us to be the designated driver). If the accuracy of her medical records is anything like the accuracy of the billing documentation, she’s in real trouble. She’s been overbilled twice, both from the initial injury. The first time was for an upfront physical therapy co-pay when the provider was contracted to deliver services with no patient responsibility. The second time was for radiology services through the emergency department. When she called to protest the bill, they claimed they had no knowledge of her insurance information even though both the hospital and the contracted emergency physicians seemed to be able to figure out how to bill her insurance carrier.

The most surprising part of the billing situation is that some of her providers have failed to submit bills at all despite it being some time since services were provided. I guess they’ve either never heard of a timely filing deadline or they really don’t need the money. In addition to being unable to get her medical records, she has also found it impossible to get itemized bills from any of the providers. Although her insurance statements list line item charges and adjustments, there are no CPT codes or descriptions to use in trying to figure out exactly what procedures were performed.

So far the winner of the billing game is the physical therapy provider, who submits bills every other week and then immediately bills the patient after receiving their electronic remittance advice. Usually she receives the bill for the patient portion within a day or two of receiving her insurance explanation of benefits. The bill has detailed explanations of the services provided. They offer online bill payment with a no-nonsense interface that gets the job done in seconds. It’s clear that they have their revenue cycle under tight control. Then again, I’d have it under control too if I was only being paid 10-15 percent of the amount I was billing.

Back to the data independence movement. The initiative is not just about patients having access to their data, but for families to be able to participate and collaborate where needed. Another way that families really need to participate and collaborate is advance care planning. Medicare recently announced plans to make such counseling a covered service starting January 1. Whether it’s billable or not, physician counseling on end-of-life issues can be helpful, especially in the context of a long-term physician-patient relationship. Often physicians are too rushed to include the discussion in routine office visits.

There is a large amount of data on the tremendous cost of end-of-life care. Often procedures are done that not only fail to prolong life, but may actually increase suffering. There have been multiple articles on how physicians die compared to the general public. I created my own advance directive at the end of my intern year after watching bad things happen to otherwise healthy young people.

I’d like to encourage everyone to consider talking to their family members about how they would want to receive care in the event of a catastrophic injury or a terminal illness. After the discussion, it’s important to get those wishes documented and provide copies to the appropriate people.

Do you have an advance directive or health care power of attorney? Email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. Thought this might spur some thoughts for a future column.

    Study finds online symptom checkers often give wrong diagnoses
    Kaiser Health News (7/10, Bebinger) reports that a study from Harvard Medical School found that “symptom checkers,” in which users can enter information and receive a suggested diagnosis, “are accurate only about half of the time.” According to the article, the study examined 23 sites including the Mayo Clinic, WebMD, and DocResponse, and found that “one third listed the correct diagnosis as the first option for patients,” while half “had the right diagnosis among their top three results, and 58 percent listed it in their top 20 suggestions.”
    NPR (7/10, Whitehead) reports that the study, published in the BMJ on Wednesday, involved giving each website “45 standard patient vignettes with symptoms consistent with medical conditions ranging from acute liver failure and meningitis to mononucleosis and a simple bee sting.” The study found that while results were 80 percent accurate in recommending medical care in emergency situations, the checkers were “overly cautious” with more routine illnesses.

  2. This is the “big, hairy unspoken problem” with any kind of Clinical Decision Support (holy grail of the EMR?)… “…If the accuracy of her medical records is anything like the accuracy of the billing documentation, she’s in real trouble…” And clinicians know this – that’s why it’s always really scary (and generally a “bad” idea) to remove the clinical component from most workflows…

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