Sunday, March 11, 2012

Let's Make a Deal

It's a beautiful Sunday morning and I'm sitting in front of a computer, partly because I feel rejuvenated after slowing my blog-pace a bit, and partly out of a sense of obligation to post something on this blog.

In blogging, if you don't write, you die. It's a simple as that.

Not that you have to post much, but if it doesn't have relevance, you'll die, too. So here I am, trying to find something relevant, when I stumble upon an article from earlier this week from AMA Medical News entitled: "HHS seeks physician comments on meaningful use rules."

* sigh *

In the article, a member of the Department of Health and Human Services (HHS) likens the rules for Meaningful Use, Part 2 (MU-II) to a game show:
Steven Posnack likens the rule-making process and importance of public comments to the TV show "American Idol." "Every once in a while, the fan favorite is voted off because everyone thought they were safe and so they don't vote for them," said Posnack, director of federal policy for the Office of the National Coordinator for Health Information Technology. In the rule-making world, he said, good policy can be eliminated because people don't express their satisfaction with what they like. This is why the Dept. of Health and Human Services' Centers for Medicare & Medicaid Services and the ONC hope people in the health information technology world -- including physicians -- will take the time to read the proposed stage 2 meaningful use rules and express their opinions, both good and bad.
Like doctors have any say in this, really. It's the law now. We weren't asked to be involved (really) with this to computer thing to begin with, so to come to us this late in the process seems like an afterthought. We should comment now? (Like they'll reprogram things based on what we say? I'm not seeing it.)

The reality for doctors is this: we see that hospitals have hired legions of personnel, practice managers, IT specialists, and consultants to creatively implement the law - a law written on losely-outlined imperatives which are all closely tied to the threat of withholding payments from the government should anyone dare to do anything different. We are promised "efficiencies." We are promised the value for care that the software patch will provide. But we soon see that entire workflows are being reconstructed by computer programmers with absolutely no appreciation for what WE feel and do that is important to patient care. Rather, it's all about what documentation will be required to meet the demands of MU-II to earn governmental monetary Brownie points.

Ask any doctor today what most of their group meeting are spent discussing and I would venture to say most would say that much of their meetings are spent discussing the new software upgrade coming around the corner that will lay the groundwork for qualifying for juicy government handouts for implementing MU-II. Most of MU-II is about constructing a way to handle bundled payments. As if doctors care about bundles. We care about the details, the history, we care about communication with our patients rather than a screen. We care about outcomes and costs, none of which we're allowed to see. These are the things that affect our patients, not meaningful use rules.

So it is no wonder Mr. Posnack likens the rule making process and importance of comments to the TV show "American Idol." After all, he's required by law to make us play his game.  It's supposed to be fun!

But as doctors see these increasingly complex computer games consume more and more of their precious time with patients and see their compensation tied to chart completion rather than patient care, the game has already lost its luster.

Yeah, time to get outside.



Anonymous said...

Great post.

MU-II has mandates to participate in registries/databases. Guess who owns the registry. Can you say the ACC? While ACC leadership has encouraged the takeover of our practices by the hospitals, they have also been positioning their registries as government mandates. It pays to have friends in high places.

Your practice which is based upon an EMR will be interrogated every night while you sleep. It is called Operation PINNACLE. The government will pay ACC for this information. For example, is the patient with a dx of CAD on ASA, beta blocker, ACE I, etc. Or, is your patient with afib on inferior treatment with coumadin vs. superior treatment with Pradaxa/Xarelto?

Imagine the possibilities. Soon the ACC will be independent of the cardiologists it suppossedly represents. Much like the AMA leases CPT to the government which allows them their independence from those demanding doctors. Of course, they are now more dependent upon the government than their supposed constituency. Just dress those bureaucrats in white coats and send them to the White House.

Now Wes, stop looking behind the curtain and get back to work so we can mine your data to justify our outrageous salaries.

vanderleun said...

Ah yes, this is why I can't get an answer about continuing Plavix within three days when I call my cardiologist on clinic day.

And yet, and yet, I would be willing to be that a vast majority of doctors impacted by the growth of government bullshit for cash crapola in the last few years freely voted FOR the party and the president that have given them these programs and other coming programs that are going to be much, much worse.

Margaret Polaneczky, MD (aka TBTAM) said...

If you want another thankless task to do, check out your page on CMS Physician compare website for erros. Mine had me affiliated with Albany Medical Center, a place I've never even visited. I notified them, but the site says it can tak UP TO 6 MONTHS to correct errors.

For our docs, they are already reporting on the site if you are reporting PQRS indicators and if you've passed.

Anonymous said...

I just learned from the CMS site that Internal Medicine doesn't exist and that Family Medicine and General Practice are the same thing.

Where you pick type of physician, Internal Medicine is not an option. I guess they pick 'Primary Care,General Medicine, and Family Medicine'. Never mind that one of those doesn't exist except to insuraance companies, one is a 1 year internship, one is a 3 year residency, and none of them are internal medicine.

I was unable to look myself up. The site lagged out.