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EPtalk by Dr. Jayne 10/13/16

October 13, 2016 Dr. Jayne No Comments

Several of my clients applied for the CMS Comprehensive Primary Care Plus initiative. One reached out to me after receiving a letter from CMS that required a response in an extremely short time frame. It sounds like practices that offer services other than just straight primary care may have been flagged in the application process to provide additional information. CMS was concerned about whether they could isolate their primary care providers and data if they were selected to participate in the program.

I understand the need to make sure applicants can meet the requirements, but the short turnaround time and unexpectedness of the letter created a lot of stress for my client. We were able to gather the required information for the response, but it was a good example to remind them that if they’re selected, they will be even more at the beck and call of CMS.

Speaking of CMS, a friend of mine who works for a vendor mentioned her concerns about the Social Security Number Removal Initiative. This is a big deal for people who are worried about identity theft since Medicare patients have long been identified with their Social Security Numbers. During 2019, Medicare will issue new identification cards to all beneficiaries. This also means that vendors have to adjust their systems to accommodate the new numbers while preserving the old numbers for historical purposes, rebilling, etc. Depending on the timeframe for mailing the new cards and what portion of a practice’s payer mix is made of Medicare patients, we could see some serious check-in delays and billing issues. I’m not sure if contractors have been selected to deliver the cards, but I hope it goes better than Healthcare.gov did.


Pet peeve of the week: I had mentioned previously that people who try to share Web addresses verbally (unless they’re really short, like “Amazon.com” or “CMS.gov”) drive me crazy. I was on a conference call this week where the panelist not only read enormous Web addresses aloud, but also didn’t know the difference between slash and backslash. I hope the people who were on audio-only connections wait for the slide deck to be distributed before they try to reach any of those sites.

The Wall Street Journal a piece this week about physicians “deprescribing” when patients are taking too many medications or risky combinations. For all the pressures on physicians and other healthcare providers to cut costs, this is an often overlooked solution.

There are many cultural factors at play with individuals preferring to take a pill to making the effort to change their habits and lifestyle. Patients don’t want to believe that they have a virus that will take 10 to 14 days to run its course — they want it cured now. Some of our love of pharmaceuticals is also generational, with older patients who came of age with the advent of penicillin and other lifesaving medications believing that pharmaceutical advances are heaven sent.

Unfortunately, there are too many people who are overmedicated. My grandparents, who are almost 90 years old, are on multiple medications for diabetes prescribed by a physician who advocates tight blood sugar control even in their age group and even with newer literature saying this might not be a good idea. It doesn’t make sense medically and they could certainly benefit from a reduced prescription bill each month, but they don’t believe in questioning their doctor.


Speaking of technology advances, there have been tremendous strides in caring for premature infants over the last several decades. A friend of mine who works for Proctor & Gamble clued me in to the recent release of a new diaper for micro-preemies who often weigh in close to 500g. That’s roughly one pound. Years ago I laughed when my friend, who is a mechanical engineer, took his job at P&G right out of school and told me enthusiastically, “You would never believe what goes into a diaper.” Having changed quite a few, I thought that was funny at the time.

It’s definitely true of the new release. The P-3 diaper is three sizes smaller than the regular newborn size and was created after three years and 10,000 hours of research, including input from over 100 neonatal intensive care unit nurses. Sometimes it’s good to be reminded that often technology and innovation brings us new problems that we never even thought of and that require solutions that are outside of our expertise.

Pet peeve, part 2: I was on a call this week waiting for key attendees to arrive. One participant announced that another would be “at least 30, maybe 40” minutes late for the meeting, which was only scheduled for an hour. I appreciate that the delayed participant called someone to say she was going to be late, but since she was the CIO and this was an executive briefing, it would have been helpful for her to indicate whether she wanted us to go ahead without her, wait for her, or reschedule. Instead, we were left guessing and trying to reach her by phone, which went straight to voice mail.

From Nurse Engineer: “Thanks for the heads up on the Healthcare Data Analytics course (Free!!) through OHSU. I am through four modules and thoroughly enjoying the class. I went into informatics way before it was chic – so far it has been a good review with very timeline information. I hope to complete the course next week before work travel interferes.” I appreciate the way they have it formatted. You can either watch the videos or read from a transcript, which allows people who learn in different ways to leverage the content in the way that most meets their needs. It also lets students make progress while traveling on flights with abysmal Wi-Fi.


One of the joys of being a consultant is experiencing life in different parts of the country. Sometimes that involves trying new foods (cheese curds anyone? Nashville hot chicken?) and sometimes it involves trying to translate the local vernacular. My Texas client shocked me this week by mentioning that in their city, “You can’t swing a dead cat without hitting a barbecue place.” I must have had a horrified expression on my face because they asked me if I was OK while I sat there trying to figure out if I really just heard what I thought I heard or whether I was on Candid Camera or being set up by PETA or something like that. I’ve traveled a lot but somehow missed that phrase before now. There are various theories on its origin and my client spent the next ten minutes schooling me on other colorful expressions they felt I needed to know. My thoughts go out to any cats, real or imaginary, who might have been swung.

What’s your favorite local or regional expression? Email me.

Email Dr. Jayne.

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