Home Forums Discussions General Discussion Meaningful use

As it has not applied to us, I had not paid much attention to the meaningful use part of the electronic record. I got my first exposure to it last night.

You have GOT to be kidding me.

I have heard over and over that medicine, and especially primary care, is in a pretty demoralized state in most of the US, and I appreciate we breathe a fairly rarified atmosphere in the North, but to submit to this? Is this really what you dreamed of doing with your life when you got your acceptance letter to medical school?

Consider. You hope, maybe, to get paid something like $40,000 if you see a lot of Medicare. Subtract the hardware, software, IT and lost income, and possibly you may see half of that in profit. Divide that by the number of patients you have to see to achieve the billing target. You are getting paid about $1.00 an hour to document worthless information AND subject yourself to any auditor who is told to go find all that fraud and abuse the government KNOWS is out there because the costs of this program far exceed the amount they told the public that it would cost.

I have a better idea. Why not tell them to stuff it, and instead of spending your effort documenting if the patient's favorite language is Chinese, spend your efforts selling magazine subscriptions out of your waiting room? I'm sure you will come out ahead financially, and it will be less demeaning. Remember Annie Landers : "No one can take advantage of you without your permission."

Take a deep breath....
Now, the trick with all this will be to see how we can satisfy MU and not compromise patient care. The secret to quality care is not computers, REC's, MU, etc, etc. As Francis Peabody famously said, "The secret to the care of the patient is to care for the patient." As I'm sitting talking to a patient and struggling with my laptop I have to constantly keep Dr. Peabody's advice in mind.

Well said. I think all of us as physicians will expend the time and effort to adapt to new methods (like EMRs) to benefit our patients. No matter how hard, or how long.

But then, Peabody worked in a different time. There is no doubt that the forces that are gathered to usurp the private relationship between doctor and patient are more powerful and numerous than ever. Meaningful Use, Accountable Care Organizations, Pay For Performance -- these are just the latest weapons of the bureaucrats and clerks to line up their columns of numbers neatly.

My opinion -- they have seriously underestimated us. When the latest house of cards collapses, we'll still be here doing patient care.

Can someone explain to me why the hell i need to print the CCD's for good are? seriously? what the hell is it good for?

maybe you will. If they try to drop the reimbursements rate another 40% (yes they will too try to do that) will you still be doing this?

I'm not surprized more physicians dont apply for jobs at McKinsey.

I mean, I am surprized that more dont apply,.

i mean, paul revere rode to warn the british that my half-nude twitter message was not sent by me....I mean it was...I mean.

I'm not a provider, obviously, but I broke out laughing when I was looking over the slides for meaninful use (I didn't go to that one because my provider did and I figured it was up to him more than me) and the requirements. They touched on MU in other topics, but honestly...the government is just being arbitrary at this point. It'll be like everything else, a pain until it becomes repetition and then acceptable and ignorable as an issue. (Does that make sense?) Just an adjustment period.

Privacy of both the doctor and their habits as a professional and much more importantly all of us as once but no longer Constitutionally protected, bill of rights Americans. Screw MU, I say FU to MU (yeah I guess I'm back...)... I will roast in hell or freeze in it which ever comes first before me, my family no less our patients have their entire medical privacy posted to the WWW for the gov't, carriers, employers and hackers and wackers to steal and use their PROTECTED, health information against them possibly forever.... What part of Protected did they and we not understand or get???

You do understand that Meaningful Use (MU) is the quintessential "Tryanny of Vagueness" employed by those in a position of power.

To wit: The beautiful tie

An illustration of the Tyranny of Vagueness would be for the government to decree that any time an individual visits another he/she must wear a tie. Simple enough, perhaps, we all know what that means. But no, it's decreed that one must wear a "beautiful tie". Aha, now we have tie makers lobbying, experts expounding, and general groveling to qualify for the definition of "beautiful". So it is with EMR. As physicians we generally know what it takes to deliver the best and most efficient care to our patients and indeed what should be recorded for future relevancy to that patient's care. No, that just won't do. We need a beautiful, er, I mean, a meaningful use EMR which spawns a huge cottage industry of commissions, opinion makers, academics, and political courtesans (sic)

All we want is a damn record which is pertinent and readable.

Bob

Who here remembers "Index Cards with one or two sentences at the best recorded by their family doc in the 60's and 70's. My wife wants to return to large format Index Cards with Card sized drawers to file them in....

Paul

I love all of the new board members!! You are sparking great conversations. And, Paul, yes you are back. LOL! I wish we could all get together and "just say No".

Leslie,

Forgive my ignorance, but why can't you say "no" as individuals? We opted out of Medicare, and it was a great decision. When we get those computer generated letters from insurances telling us a patient is non-compliant with medications and asking for a two page response, we just ignore them. In fact, we ignore probably 75% of unsolicited forms, pre-authorizations, and insurance requests for medication changes. The insurance a patient has is not really our concern. If he or she wants to discuss a medication change because it would be cheaper, they make an appointment, and we discuss the pros and cons of that change (not all statins are created equal, and I chose the one I did for a reason.)

I am frankly puzzled and intensely frustrated by the discussions I see of all the time spent by my colleagues here on tasks that are not directly to the practice of medicine. I simply fail to see the imperative in spending my time in the foolish projects of others, just like I ignore the surveys from drug companies that will pay me $5 to fill out a 4 page form. I keep getting the impression that most of the world is talking a different language when it comes to medicine. I say "I practice internal medicine", and you say "I practice Internal Medicine", but what you mean by that and what I mean by that are may be as dissimilar as being a reactor tech on a submarine and being an aircraft mechanic; maybe more so. There is the distinct aura of indentured servitude in your posts. Is this true? Were you sold to an HMO by your residency program when you were not looking? I, at least, can and do just say no when it is not in the best interest of me or my patient. Why doesn't everyone else?

David,

I say "No" all the time. And in fact I probably say it more than most everyone else. I too ignore 95% of requests from insurance companies and other junk requests. But, I cannot envision dropping Medicare. My patients are basically loyal but not that loyal. When the Medicare Advantage programs came out and I did not sign up for the Anthem one, I lost a number of patients. More and more I find the patients are very motivated to save money. At this point if I made such a major change in my practice, I think it would be financial suicide. The patients will go to others who continue to accept it. It needs to be a unified endeavor.

Relative reimbursements obviously differ. In this area, those that do take medicare have set themselves a quota, as these patients are seen at a loss. I initially calculated that our total practice would lose $40,000 a year when we opted out. In fact, our income rose slightly. Asking the patient to pay $35 for an office visit beat what Medicare was paying, and without the games.

Hell what are they paying up there for a level 3 or 4 est patient Office Visit dare I ask then??? I agree we all save lots of money and time (which again is money as only you docs can generate the revenue, not us support people) so taking it down a few bucks is not a loss and possibly even a gain... But $35 bucks even for a short level 3 quick sick visit is a bit small there.... Unless you cost of living is real cheap which I thought your neck of the woods was actually a good amount higher because so much has to be transported in and out long distance via rail, truck and air, and your heating season is extremely long too.... Am I missing something here??? I guess if you saw 4 $35 patients an hour with no loss to the system what so ever, that is $140 bucks straight pre-taxes income, which might not be all that much to sneeze at in reality... sort of like perhaps equal to $160-$200 traditional Hamster Wheel with added staff and billing expenses.... Perhaps??? Is this where you are at and what your model is.... Love to know and discuss further...

Paul

That was a 99213, and is about 25% of usual and customary. It is not possible to meet overhead on 4 level 3 medicare visits a hour (let alone pay the physician) in this area.

Are there resources within Amazing charts for patient education material to be handed out? I am assuming that is something we do outside of AC and click the "patient education given" button.

If you go the the last menu tab (KNOW) on the patient visit screen there are references for educational material and more.

Yes, these are all outside AC. You can import your own files under main page/view/practice documents. This is good both for in office as well as patient material. It helps, of course, that we have printers in most of the rooms.

It isn't about adapting to EMR but the retarded rules put forth to make it meaningful use. .. we are going to be forgetting about our patients and what their real needs are rather then actually getting things done for them..

RE: Educational Resources

don't forget about resources you may already be giving out. We do fingerstick A1Cs and lipids in the office. The machines prints out the result on a label and the staff slaps it on an education handout for patient on either diabetes or cholesterol. This will count (if I remember to check the box).

Ketan, actually I am very happy to have this. We have a ton of different documents and this is a simple way to codify they have been given one. This works for me.

On a separate MU issue, my hospital (which does all my lab work) is dragging their feet on setting up an interface. I'm thinking of using Quest. Has anyone got experience with Quest/AC?

I know lab interface is one of the MU menu set objectives. As I understand it, we just have to meet 5 or 10, so there's no essential need to have the lab interface. Is this how you all understand this MU issue?

I have the Quest interface. They paid for it and setup was pretty easy. Display of results is less than ideal - a lot of scrolling to see everything and like a lot of things in AC, can't look at labs and other screens such as med lists at the same time.

My understanding of the MU is that the lab interface is just one of 10 "menu items" - we have to pick and do any five to qualify. For now.

I echo what SantaBarbaraIM said.
Quest Lab interface is very good. Quest paid for it and sent someone out to install a little program which queries Quest every hour and converts the labs to HL7 format so Amazing Charts can read. You can easily graph things over time. It is one of the optional 5 of 10 items for 2010, but is not hard to implement.

Great, thanks!

How do you record CQM alternates in the AC so the meaningful usage wizard will pick them up as fullfield ?
Seems that no matter how I record all this staff I am still getting red checkmark for those.