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Dumb Healthcare Ideas Of The Week

I’ve collected a few reports from my fellow bloggers that perfectly exemplify healthcare improvement/payment strategies designed by committee.

A nonsensical quality assurance program in Britain, via GruntDoc:

Britain’s nurses are to be rated according to the levels of care and empathy they give to patients under government plans. Health Secretary Alan Johnson told the Guardian newspaper that he wants the performance of every nursing team in England to be scored.

But he ruled out rating individual nurses and also said it would not affect pay.

Ridiculous medical record documentation rules via the Happy Hospitalist:

The E&M rules of documentation state very clearly what type of information is required on follow up cognitive care visits. They state that you need to include things like character, onset, location, duration, what makes it better or worse, associated signs or symptoms.

This is all fine and dandy when you can quantify a complaint (like pain, rash, headache, or weakness). But what do you do when a chief complaint does not involve a qualitative or quantifiable entity? There are no E&M rules that allow exceptions to these circumstances. So you get the following garbage:

Chief Complaint: Hypercalcemia [too much calcium in the blood]

HPI: She presented with hypercalcemia. It is described as chronic, constant, and parathyroid. The symptom is gradual in onset. The symptom started during adulthood. The complaint is moderate. Significant medications include lithium. Important triggers include no known associated factors. The symptom is exacerbated by dehydration.

There is not a single piece of information in that excert that was clinically worth anything. In fact, it reads as if it is computer generated with key word insertion.

Character: Moderate (what does that mean?)

Onset: adult hood (what the hell)

Location: parathyroid (seriously?)

Duration: chronic and constant and gradual in onset.(what a bunch of garbage)

What makes it worse?: nothing and dehydration in the same paragraph, completely contradicting each other.

Imagine how much time was spent entering this worthless information. Not only asking them but entering them into the computer. Imagine multiplying this by 25 times a day. And you wonder why health care is so inefficient. Because we have to ask completely meaningless questions to get paid.

A new way to thwart physician compensation via the Physician Executive:

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

It is a befuddling regulation since, as an employed physician, 100% of my billings have gone to organizations that paid me a salary. Why check my provider identifier with my tax information? They don’t correlate. I can pretty much promise you that they never have and sometimes the discrepancies have been fairly substantial.

I am sure this will be a huge problem for docs in practice who bill under their name and get paid directly. Any discrepancy in any character in the field will ensure non-payment. This is not the kind of thing your laptop spell check will prevent. If this regulation is enforced to the letter, it will assure that services are provided free of charge.

I bet that this billing “error” can also be enforced as fraud and abuse, leading to criminal charges, financial penalties, and time in jail.

This post originally appeared on Dr. Val’s blog at

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