In the good old days, I always charged a 99213, always looked the patient in the eye for the whole visit, always dictated a short note in less than a minute or two, always could understand my last note and get up to speed in 20 seconds or less, and didn't know there was a better way.
Now in the quest for justifying a 99214, I struggle to see all my established patients on schedule, and really enjoy having new patients so I can relax and just listen and talk. You know, be a real doctor.
Really, the only improvement is in being more thorough with check lists or templates. But, readability and succinct summaries are now unnatural and scant. Actually, the best improvement is being done with the note when the patient and I leave the exam room. I don't want to go back to a stack of charts on my desk!
I try to type several sentences at the beginning before I start clicking, as I don't want to dictate later. I end up with a page and a half of enough facts to make a CMS auditor want to skip my practice.
I think the goal is to combine a section of hyper-variable text with all the pertinent positives and negatives that encourage you to think of less obvious diagnoses.
What I want is a program that allows me to see trends and quickly summarize them. The program knows all of the weights and vital signs enough to graph them, so it could alert you and concatenate a paragraph and make some suggested clinical summary sentences for us to choose or customize quickly. Shouldn't AC alert you and make it easy to document when a patient is below BMI and losing weight for the last three visits, or the blood pressure is high and climbing, or the pressure is low and dropping while the pulse is climbing? AC has the data so why should we have to take 5 minutes trying to make a paragraph about it.
Diabetics could be tracked for at least the glycohemoglobin, osteoporosis for their t-scores, thyroid for their TSH, etc..
The database can be used to document progress in the note, instead of just display it. It could lead to better care,
and a full two page, definitely 99214 note
