I have absolutely no problems with using the database to identify patients that may benefit from "new" concepts. I do this all the time already. In fact, I have been using my EMR for the last 9 years not only to replace a transcription service, but have used it because it provides a searchable database. When Bextra and Vioxx were recalled it took me only a matter of minutes to bring up and call all of my patients who were on them. I routinely identify all diabetics or hypertensives who have not been seen in the office in 6 months or more. Every 6 months I also run a list of all patients who have not been seen in over a year. I can then call those that need follow-p appointments (should they not have already been caught by my PM program's reminder feature).
I do however have serious concerns about insurance companies and other third parties using my database to determine whether I should be paid at a 3rd tier level or a 1st tier level. And, give them an inch and they will take a mile. I have been in medicine long enough to know that insurance companies will not negotiate with you no matter how efficient or wonderful a provider you are. They may let you BELIEVE you have negotiating power but, just the fact you are HAVING to negotiate already gives them the upper hand. Why should you HAVE TO negotiate for fair pay? EXAMPLE: I regularly discuss the importance of patients over 60 being immunized for shingles. I spend a lot of time explaining this to patients. That is good medicine. Humana however will not pay for this unless I administer the vaccine in my office. I have asked until I am blue in the face for Humana to provide me with their reimbursement schedule for the purchasing and the administration of this vaccine in my office ( as a solo practitioner, I cannot afford not to at least break even should I elect to do this for my Humana patients). After almost 6 months of calling, emailing, writing letters and having patients with Humana call I have yet to be given ANY reassurance from them that they will cover my expenses. The only reply patients get is that "the Zostavax is a covered procedure" which simply means the patient will not have to pay anything out of pocket. It does not mean I will be fairly paid. Subsequently, none of my Humana patients have been immunized...that is bad medicine. You CANNOT tie your
care for your patients to what a third party payor is willing to pay for that care!!! Please, it is not a realistic endeavor. Certainly in this day and age we as physicians have a duty to provide quality care and do it as efficiently as possible. But, no matter how efficient we may want to be in order to "please" the payors, we still have that patient with their goofy symptoms or the headache that won't go away as well as the lawyers leaning over our shoulders...Humana does not. Being an "efficient doctor" on paper (or your database) does not mean squat when you are sitting in that courtroom or when you have to tell a parent that, golly, their daughter's headache is being caused by a metastatic melanoma which now is too advanced for treatment. Juries and patients have no concept of "the statistics did not support a decision to get an MRI" or "the patient's insurance company refused to approve the procedure". I don't know about you, but I take it personally when I miss a diagnosis or a patient transfers records because they felt like I did not take enough time to listen to them. Damn the insurance companies! I am sure my stats suck when compared to yours. But I'll put my ability to diagnose and treat and produce a good patient outcome up to yours any day.
Leslie who again hopes no offense was taken by anyone.
