Home Forums Discussions General Discussion Meaningless Use

OK, I am going to vent a little. Here I am in this large, respectable medical entity, clicking away in an effort to be a good employee. The software will not allow me to add health maintenance items such as bone density scans. I cannot add hepatitis immunization for patients with liver issues or otherwise. I cannot put in ASA, statins, ACEI as meaningful things to do to my diabetic populations. In my mind they are struggling to meet MU2 and, at this rate, IMO will never make it to MU3 although that is where I will be, and God help them when ICD-10 comes rolling in. BUT!!!!!!! They pride themselves in the fact that their EMR is meeting all the meaningless use criteria. And, for the most part, their physicians are practicing way below where they should be.

I saw a 41 year old diabetic today....diabetic for over 10 years and already S/P CABG....who is followed by an endocrinologist here. He was dumbfounded when my nurse asked him to take off his shoes and socks...no one had ever checked his feet before. He has never had a dilated eye exam and never been urged to do so. His LDL is 150 and he is not on maximun-dose statins. A previous CT of the abdomen done for some other reason clearly shows fatty liver but he has never had either his Pneumovax or Hepatitis immunizations. He has never had even a random urine for microalbumin not to mention a 24 hour one. He told me the endocrinologist simply downloads his meter, tells him to lose weight and to come back in 6 months.

Now I wish I could say this was an isolated observation but it is not. I cannot help but wonder how much the time and effort required to document meaningful medicine has done just the opposite and made it meaningless, not to mention dangerous. I am convinced there is not a shortage of primary care physicians....they are all just too busy clicking to take care of their patients.

I had a really hard time admitting to myself that I could no longer sustain my private practice. I felt like a total failure, a business idiot, a maverick running from the drovers into the thicket of thorns. But I now see the only thing I failed at was knowing how to play the game now put before me. Sad thing, though, now that I understand the rules, I am not sure I want to play any more. The endo guy is pulling in a bunch of money, the employer is happy and the MU clicks are being clicked and the epidemiologists have justified their existence. And, like the proverbial lemming we are all standing looking over the cliff. Heaven help us. Hang in there guys!

Leslie,

I can understand totally your frustration. It is extraordinarily distressing to be part of a system in which one is never reimbursed for simply doing the right thing.

The entire MU/"Quality" game strikes me as being a giant game of Whack-A-Mole. As long as anyone feels resentment that they are not appreciated for being moral and professional but for doing "stuff" (whether it be a procedure or clicking all the right boxes, like some sort of rat in an experiment), then the system will continue to be subverted. "OK,", I'd think, "You want to pay me only if I have noted down if a patient is Black Hispanic or White Hispanic, and all the little boxes are filled? OK. that's what you get. That ALL you get."

I maintain that the only way to fix this is to decouple personal income from the specifics of day to day activities. Pay all physicians a flat salary, independent of specialty, no little check boxes, and count on peer pressure to get us to do the right thing. I maintain that the non-financial rewards of doing the right thing will modulate activities once the economic rewards are eliminated. I was really proud when I was accepted to medical school. I think maintaining that pride is a powerful motivator.

I will third that. My biller asked me the other day why we weren't doing MU? I asked her why would we want to do Meaningless Use? (I do not want to offend anyone who decided to. It is a lot of money).

I know CCHIT started it, but for me MU is where the government totally got in the game. I am not sure quite the number, maybe 17% of physicians had EMRs. 17% of physicians wanted to learn and use the new technology. 83% wanted to use paper. I was happy letting it move that way. Then the government had to pay physicians to get EMRs.

Here in Maine, we get bonuses for taking care of MaineCare patients. It's quite a bit of money and pretty much makes it all worthwhile. But, the MC check is much greater than the MU check, and it doesn't involve any clicks or identification of the patient.

David,

Your post didn't have one mention of SQL in it, and yet, once again, I learned a ton from it.

Leslie,


May I suggest not even going there. You made your decision and I have a feeling you will do just fine, no matter what environment you are in.

I may do the same thing one of these days and no one really knows how any of this will play out.

As I recall you are the daughter of a haberdasher, and I suspect not without a few skills running a business.

A while back I was about to ask if you would start seeing my old man, since you two live in the same town, so count yourself lucky, the MU EPIC stuff is nothing compared to what could have been, had you accepted his care.

I know this fly's against what everyone is saying (and I don't like what MU has done either), but the real problem is that they have yet to program a computer to practice medicine (and heaven help us if they do.)

You can legislate that MU must have preventive medicine, but skipping diabetic foot and eye care apparently missed the boat on their radar. It could have been manually added had they cared about quality, but they wanted the lowest common standard that would be easy to pass. So as you say, the epidemiologists and the managers are happy, and the doctors are taking home paychecks.

Some of this has been pushed because not everyone practices good medicine. The solution has not solved the problem, just made it harder to find. Hard to do if you see 40-50 patients a day. But if you really want to make money.....

Jimmie,

I would have been happy to have seen your father! I am sure he would have had plenty to say about medicine in the good old days! And, you are right, I made my decision...or let's say the decision was made for me. Even as frustrating as the practice of medicine has become, it still beats the heck out of selling shirts and underwear to grisly old men! But, come to think about that, if I had stayed in the retail business I would be out of business again for that family-owned venture, one which was around since 1868, also could not withstand the hardships of today's economy and went belly up last year too.

Wendell,

You are right, not everyone practices good medicine. But I cannot help but believe that many are not practicing as good of medicine as they once did simply because the documenting of it is just too damned complicated and time-consuming. And, in order to keep their income up, they have to keep the patients moving along.

Leslie,

I had no idea that your family-owned business went out of business. Nothing like kicking a girl when she is down. Sorry for bringing that up.

I have a feeling you are the kind of doc my dad wishes he had!!!

Maybe we can co-author a book together on this crazy MU stuff!!!!!