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EPtalk by Dr. Jayne 2/8/24

February 8, 2024 Dr. Jayne 3 Comments

I appreciate the fact that my health system of choice promptly shares visit notes with its patients. I’m less appreciative, however, of the fact that some physicians continue to refuse to follow documentation best practices, which have been designed for patient safety and improved patient experience.

As always, I dutifully completed the electronic check-in process well in advance, verifying my insurance coverage and ensuring that my pharmacy was up to date. When bringing me back to the exam room, the first thing the medical assistant asked for was my pharmacy information. She didn’t log into the EHR using the workstation in the room, but was instead working from a sheet of paper.

It would be one thing if the paper had my information printed and she was simply verifying, but this didn’t seem to be the case since she asked me to provide the address and phone number. I politely declined, stating that I had just updated them in the EHR the day prior.

I’ve been to this office many times before, and the physician has never used the EHR in the room. She uses a scribe and is good at verbalizing the exam so that the scribe can capture it. However, the practice continues to use templated documentation that doesn’t reflect the work that was done during the visit. My most current documented a “comprehensive Review of Systems” which was not performed and included a reference to “see scanned document completed by patient” which doesn’t exist, since I certainly didn’t complete one. I wonder if the physician understands that documenting work that wasn’t actually done is fraud.

As always, I noted my concerns when the inevitable Press Ganey survey arrived, so hopefully someone will see it and take action. In the mean time, I’ve decided to leave the practice, not only due to this, but due to poor appointment availability and annoyances with the billing processes, such as refusing to collect your co-pay at the time of service, leading to more work on my part down the road. This practice is crying out for process improvement work, but it’s unlikely that will commence any time soon.

From Public Health Nerd: “Re: the recent Senate hearing on social media’s impact on youth mental health. Here’s some data for your consideration.” The statistics provided included a dramatic increase in teens who report “persistent feelings of sadness or hopelessness,” especially among girls. There has also been an increase in diagnoses of depression and increased suicide rates among teens. Although rates of social media use correlate with these changes, it’s difficult to prove causation, especially considering all the other changes happening at the same time, including community violence, rising income disparities, racial tensions, global conflict, and high-conflict political processes. More studies are definitely needed.

From Coffee Klatch: “Re: return to office programs. Keep up the good work exposing them as the power grab that they are. If companies want people to come to the office without complaint, they need to make it a place people want to visit. Nearly all of my colleagues use travel mugs, which don’t fit into the new coffee makers that our company purchased. I tried to bring a ‘shortie’ travel mug, but it was too wide. We all end up using paper cups to transfer coffee to our mugs. So much for the company’s commitment to sustainability initiatives, since we’re creating more greenhouse gases driving to the office and now using a bunch of paper cups we didn’t need before.” I’m sure some people thing this is a small thing, but it’s just one more example of how decision makers who are out of touch with their workforce are contributing to employee resentment and potential turnover.

I’m sure no one was surprised to hear the news of Amazon’s planned job cuts at its One Medical and Amazon Pharmacy units announced earlier this week. Executives who may have had lesser degrees of healthcare experience prior to entering our industry often find out quickly that it’s much harder to get those big wins and revenue bumps than they were used to with their previous employers. Amazon promises to continue to hire providers for frontline care delivery, but it looks like they’re primarily focused on building their midlevel provider workforce rather than hiring physicians.

I’ve had several patients follow up with my practice in recent months after receiving interesting diagnoses from online practitioners who conducted asynchronous evaluations that resulted in what was ultimately a misdiagnosis. Sometimes a picture is worth a thousand words, but other times you really need to have a conversation with the patient to fully understand what is going on. Our society puts the responsibility of making sure their provider is high quality largely on the patient, which is hard to do when you’re placed in an anonymous queue and have no idea who you are going to see until they are actually participating in your care.

Last week was Groundhog Day, when many in the US traditionally look towards a rotund woodland mammal for predictions on upcoming weather. Since reaching a point in my career when I have the flexibility to provide behind-the-scenes medical support for events and gatherings, I tend to keep an eye out for how that plays into any large happening.

This year, officials predicted that up to 30,000 people might try to see the venerable Punxsutawney Phil, gathering in the cold dark morning at Gobbler’s Knob, Pennsylvania. Planners had approximately 20 professionals from five emergency response organizations standing by. In the past, problems have included hypothermia (not unexpected in years when the wind chill has been well below zero), cuts and scrapes, medical emergencies from patients who didn’t take their medications due to the early start of the event, falls, and even the occasional heart attack. There have also been issues with intoxication, even given the typical 4 a.m. arrival for some attendees. I guess it’s never too early to get the party started when groundhogs are involved. Props to Allegheny Health Network and Punxsutawney Area Hospital for their onsite support.

Does your area have a local groundhog, and what was its prediction? Leave a comment or email me.

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Currently there are "3 comments" on this Article:

  1. “My most current documented a “comprehensive Review of Systems” which was not performed and included a reference to “see scanned document completed by patient” which doesn’t exist, since I certainly didn’t complete one. I wonder if the physician understands that documenting work that wasn’t actually done is fraud.”

    I don’t know, or understand the reasoning behind that. But I wonder how much of that is:
    A. Claiming to do what the payer wants in order to get higher reimbursements
    –A.1 Because the clinic administration has told them to
    –A.2 Because the clinician just wants to avoid conversations with record auditors
    B. Overuse of templates, because — time
    C. Failure to review the scribes work
    D. Something else

    I did a note review not long ago and found that the variance between clinicians and clinics was there. In that there were some clinics that used the same templates repeatedly with little modification and that some individual clinicians did the same but others within the clinic did not. It was a quick review and not comprehensive so I won’t draw conclusions about the industry at large — only the few sites I sampled.

    That review also noted that there was a large prevalence of identical ICD-10 codes for the same condition set. So type II had very few ICD-10 although there are numerous E11.x codes in the code set. I don’t know how much of that is ‘saved preference lists’ or people getting tired of trying to find something that is more precise.

  2. I would suggest that the problem with “…mugs, which don’t fit into the new coffee makers…” isn’t so much that fact that they don’t fit.

    The much greater problem is when such problems don’t get resolved. Staff notice the lingering problems and it reflects badly upon management.

    Now honestly? An issue with a coffee maker isn’t going to affect much. But if the problem with the mugs and coffee is representative of a broader lack of oversight, involvement, and competence, then it really starts to look bad.

    And one has to ask: How difficult is it to get a decent coffee maker? It’s not difficult at all. Coffee is one of the most consumed beverages on Earth! There are literally thousands of decent coffee makers on the market.

  3. General Beauregard Lee predicted an early spring in my neck of the woods. I doubt there was a large emergency personnel presence outside of his “mansion” at the Dauset Trails Nature Center. In addition to Beau and Phil, there are Staten Island Chuck in New York and Buckeye Chuck in Ohio, according to this US News article, which also relates the holiday’s connection to Candlemas. Who knew?

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