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Coding for Clarity: Echocardiography Gains Two New CPT Add-On Codes

Medical Coding News - Tue, 02/14/2017 - 06:51

New technologies need new codes CPT codes describe medical, surgical and diagnostic services and procedures. These codes communicate uniform information about medical services and procedures to healthcare providers, payers, administrators and accrediting bodies. They are also vital as financial and analytical tools. New codes are necessary when novel technologies enter clinical practice, as was the […]

The post Coding for Clarity: Echocardiography Gains Two New CPT Add-On Codes appeared first on MedicalCodingNews.Org.

Categories: Healthcare News

Travel Ban Is Revealing—but Does Not Threaten American Medicine

The Healthcare Blog - Mon, 02/13/2017 - 22:11

A 90-day ban on travel from seven countries has sparked tremendous outpourings of worry or outright opposition by some 33 medical organizations.

“The community is reeling over the order, fearing that it will have devastating repercussions for research and advances in science and medicine,” states an article in Modern Healthcare.

Certainly the order is disrupting the lives of individual physicians who have won coveted positions in American medical institutions and were not already in the U.S. when the order was issued. Also their employers have a gap in the work schedule to fill. War tears people’s lives apart, however innocent they may be. And countries that sponsor terrorism have effectively declared war on the U.S.

But is American medicine so fragile that it can’t survive a 90-day delay in the arrival of physicians, most of them trainees, from Iran, Iraq, Libya, Syria, Yemen, Somalia, and Sudan? After all, every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program through the annual computerized “Match” of graduates with internships.

After another chance through the Supplemental Offer and Acceptance Program, or SOAP, hundreds of seniors are still without a job. This means that they cannot get a license to practice in the U.S., however desperate rural communities or inner-city hospitals are to find a physician, and their four years of rigorous, costly post-college education are wasted. Yet James Madara, CEO of the American Medical Association (AMA), is worried about vacant residency slots, according to a Feb 3 article in MedScape by Robert Lowes.

Entry to medical school is highly competitive, so presumably all the students are well-qualified. Can it be that graduates from Sudan are better trained? Does the U.S. have so few young people capable of and interested in a medical career that we have to depend on a brain drain from countries that are themselves desperately short of physicians?

For all the emphasis on “cultural competence” in American medical schools, and onerous regulations regarding interpreters for non-English speakers, what about familiarity with American culture and ability to communicate effectively with American English speakers? Some foreign-born graduates are doubtless excellent, but many American patients do complain about a communication gap. So why do some big institutions seem to prefer foreigners? Could it be that they want cheap, and above all compliant labor? Physicians here on an employment-related visa dare not object to hospital policy.

Whatever the reasons for them, here are some facts about the American medical work force:

One-fourth of practicing physicians in this country are international medical graduates (IMGs), who are more likely to work in underserved areas, especially in primary care, according to Madara. According to the Accreditation Council for Graduate Medical Education (ACGME), 10,000 IMGs licensed in the United States graduated from medical schools in the seven countries affected by the ban.Immigrants account for 28% of U.S. physicians and surgeons, 40% of medical scientists in manufacturing research and development, and 15% of registered nurses, according to the Institute for Immigration Research at George Mason University. More than 60,000 of the 14 million workers in health-related fields were from the seven countries affected by the ban.

Is medicine, like agriculture, now filled with “jobs that Americans won’t do”? Actually, we have more than enough Americans who love medical work. But some of best doctors are being driven out by endless bureaucratic requirements, including costly “Maintenance of Certification™” programs that line the pockets of self-accredited “experts” but contribute nothing to patient care. They are being replaced (substituted for) by “mid-levels” with far less training. Then there are thousands of independent physicians having to retire or become employees because they can’t afford the regulatory requirements—soon to be greatly worsened by MACRA, the new Medicare payment system. Physician “burnout” is becoming so bad that we lose up to 400 physicians—the equivalent of a large medical school class—to suicide every year.

The U.S. should be a beacon to attract the best and brightest, and it should welcome those who want to become Americans. Unfortunately, the lives of Americans, as well as the opportunities of aspiring foreign-born doctors, are threatened by those who desire to kill Americans and destroy our culture. These must be screened out.

Meanwhile, the reaction of organized medical groups to the travel ban is spotlighting serious problems in American medicine.

Categories: OIG Advisory Opinions

Say You’re Sorry, Donald

The Healthcare Blog - Mon, 02/13/2017 - 22:10

I’ve never met Dr. Suha Abushamma or Dr. Kamal Fadlalla. 

But of all the frustrating stories circulating since President Trump issued an executive order barring immigrants from several predominantly Muslim countries, their travails hit closest to home. 

Both Suha and Kamal are internal medicine resident physicians. From Cleveland Clinic and Brooklyn Interfaith Medical Center, respectively. Like me, they have endured the rigorous calling that is American medical training, including not only graduation from medical school, but also the completion of four board exams, a vigorous interview process, acceptance to a medical residency and ultimately working long hours caring for very sick patients.

In fact, they must have excelled – only the best foreign medical graduates gain entry to medicine residency in America.

Yet what was their reward for such hard work? After President Trump’s travel ban last month, Dr. Abushamma was physically deported to Sudan from John F. Kennedy airport in New York and her work visa was withdrawn. On the same day, Dr. Fadlalla was barred reentry to America after visiting family in Sudan, despite having an active specialty occupation visa.

After several courts challenged the executive order last weekend, both Dr. Abushamma and Dr. Fadlalla were able to return home during the interregnum while the ban is lifted. 

The doctors’ exclusion from the United States was not only an atrocity from a moral perspective, but also from a practical and functional standpoint. When a resident physician is unable to work, there are broader ramifications outside of their immediate absence. 

Who takes care of their clinic patients? Who fills in for them during in-patient rotations on the hospital wards? A rising physician’s personal medical education is not only disturbed, but the residency program may be stretched thin, forcing some physicians to work overtime and potentially violate hour restrictions. 

What’s even more ironic is that since the federal government pays all medical residents’ salaries, President Trump’s administration actually continued to compensate both doctors during their “banishment” despite not permitting them to work. 

Ultimately, the greatest harm falls on the most vulnerable – American patients. A medical resident’s absence creates a domino effect that harms the whole community. 

Luckily, there are fail-safes such as coverage schemes and “sick-pull” lists built into residency programs in order to deal with a resident’s absence, which their hospitals surely utilized.

But despite the heavy publicity received by the two physicians’ cases, the Trump administration was silent and likely ignorant of the potential aftermath of a medical resident’s absence.

At the very least, while the legal details of the travel ban reversal and the justice department’s rebuttals are elucidated, the Trump administration ought to apologize to the doctors and their respective medicine programs for their unjust exclusion from the country. Ideally, the government would go one step further and retroactively pay for their travel expenses.

By its nature, medicine is an inclusive, ecumenical and optimistic calling, the central mission of which is a humane desire to help and heal. Physicians are also lifelong students. The Trump administration ought to bear in mind the sage-like writings of Sir William Osler, a father of modern medicine – “The true student is a citizen of the world, the allegiance of whose soul, at any rate, is too precious to be restricted to any one country.”

Geoffrey Rubin is a cardiology fellow in New York. His commentaries have appeared New England Journal of Medicine, Pulse, JAMA Cardiology and The New York Times.

Categories: OIG Advisory Opinions

Should We Blame Technology For the Growth In Healthcare Spending?

The Healthcare Blog - Mon, 02/13/2017 - 22:09

Should we blame technology for the growth in healthcare spending?  Austin Frakt, a healthcare economist who writes for the New York Times, thinks so.  Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth.

In this piece, Frakt contrasts the contribution of technology to that of the ageing of the population.  Frakt notes that age per se is a poor marker of costs associated with healthcare utilization.  What’s important is the amount of money spent near death.  If you’re 80 years old and healthy, your usage of healthcare services won’t be much more than that of a 40-year-old person.

So far, so good.  But should we accept the proposition that technology is the culprit for healthcare spending growth?  Says Frakt:

Every year you age, health care technology changes — usually for the better, but always at higher cost. Technology change is responsible for at least one-third and as much as two-thirds of per capita health care spending growth.

Frakt’s position is common among mainstream economists who come to their conclusions through the application of complex mathematical models of the economy.  The studies Frakt cites all use statistical analysis to try to disentangle the relationships between a number of interacting cost factors (e.g., demographics, GDP growth, income growth, insurance growth, etc.) before drawing conclusions about the relative contribution of each of these factor.

The models, however, necessitate making assumptions that may not hold true.  Moreover, technology spending is generally not measured directly.  Instead, the models first explain spending on the basis of other measurable factors (e.g., demographics), and then attribute to technology the share of spending that remains “unexplained.”

But if we resist the seduction of quantitative models and, instead, apply common sense reasoning, it becomes apparent that the conclusion that technology per se drives the crisis of out-of-control spending growth is manifestly untenable.

To see this, it is helpful to imagine a simpler context where healthcare spending is decided voluntarily by patients and their families.

In such a context, a company may speculate that a particular technology (say, one that produces artificial limbs), could serve a certain need.  The company then makes an entrepreneurial decision to develop, manufacture and sell artificial limbs on the basis of an estimate of the willingness of patients to pay for the limbs at a price sufficiently high to cover the costs of production and allow for some profit.

The technology company obviously takes a risk.  It may err in its estimation of how patients will value its product: If the asking price is above the one patients are willing to pay, it will incur a loss and may go out of business.  On the other hand, if the asking price is below the level at which patients value artificial limbs, the company will succeed and make a profit.

What is certain, however, is this:  if the company succeeds and patients are willing to pay for the product, healthcare spending will increase, but that will not be viewed as a problem.  If patients voluntarily pay for artificial limbs—or for bionic hearts, xeno-transplanted pancreata, or miracle longevity pills—it is because they value the technology more than the money they have parted with, or else they would keep the money.  Overall welfare is increased, and there is no reason to blame technology.

Admittedly, some patients may later regret their purchase.  But such a regret does not in itself indicate that technology is at fault for the increased spending.  It simply means that those patients miscalculated the value they personally derived from the technology.

This potential for miscalculation is something many mainstream healthcare economists frown upon.  In 1963, Nobel Prize-winner economist Kenneth Arrow gave fresh impetus to the field of healthcare economic theory in a seminal paper calling attention to this potential for miscalculation and attributing it to “product uncertainty:” Because of sickness, and because of the complexity of medical care and technology, patients are unable to make proper value decision.  They can miscalculate in two ways.

First, producers and service providers may take advantage of the situation and obtain a higher price than would otherwise be established under normal “competitive” market mechanisms.  Arrow (and many economists following him) therefore recommend various government regulations to mitigate the effect of this “information asymmetry.” (I have previously shown that the standard assumptions put forth by Arrow and others regarding the effects of information asymmetry in medical care are refuted by historical evidence.)

Second, patients may miscalculate in the other direction and forego technology that could potentially be beneficial to them.  Healthcare economists also find this possibility intolerable and invariably favor government intervention to promote or finance health insurance so as to avoid self-rationing by patients.

The problem with these interventions, apart from their inherent paternalism, is that they do nothing to “bridge” the maligned information gap that can lead patients to miscalculate value.  In fact, they widen it.

In the first instance, the regulation of technology means that regulators substitute their own value for those of patients.  It is regulators who decide what level of evidence and what level of risk is acceptable for a technology to be legalized.  In doing so, they deprive patients from even knowing about certain products.  They thus make the information gap infinitely large.

In the second instance, the provision of health insurance impairs the ability of patients to make proper value decisions since they no longer bear the full cost (or even any cost) of the technology.  Therefore, they are more likely to seek out technology that they might not have purchased at an unhampered market price.

The natural tendency for patients who are shielded from costs to over-utilize healthcare technologies naturally drives the price of technology upwards, so long as the insurer is willing to accommodate this demand.  In most cases, in fact, insurance companies do end up paying for technology.  This goes to show that Frakt and the modeling studies he cites have it exactly backwards: it is increased spending that causes increasingly high technology prices, not the other way around.

Mainstream healthcare economists have long minimized the potential for health insurance to lead to increased spending.  In his same 1963 paper, published 2 years before the enactment of Medicare, Arrow had asserted that

The welfare case for insurance policies of all sorts is overwhelming.  It follows that the government should undertake insurance in those cases where this market, for whatever reasons, has failed to emerge.

Arrow did consider that health insurance might increase demand for healthcare, but he minimized that possibility and left it to future economists to obtain empirical evidence to determine the extent to which so-called “moral hazard” (the tendency for insurance to increase demand) would affect prices in healthcare.  With Arrow’s reassurance, the government embarked on a massive program that has subsidized the demand for not only healthcare technology, but for services and products across the entire healthcare sector.

Because economic analysis is poorly suited for empirical study (since the factors involved change constantly, may not be fully accounted for, and interact with one another), obtaining persuasive evidence for the effect of health insurance on spending has taken decades to materialize.  Recently, however, Amy Finkelstein, a prominent MIT healthcare economist, was able to analyze a large set of historical data on spending patterns before and after the introduction of Medicare.  In regards to the relationship between spending growth and technology, she commented that:

…there is widespread consensus that technological change is the driving force behind the growth in health spending.  But this just kicks the can down the road.  What then drives technological change in medicine?

…[In my recent study] I find evidence that the introduction of Medicare encouraged the adoption of new medical technologies…Now we find that when large-scale insurance changes lead to a big aggregate increase in demand, hospitals have an incentive to adopt new medical technologies.  People will use these technologies because they are not paying for them out-of-pocket…

It therefore looks like insurance, by increasing demand because it lowers the price [to the patient] of medical care, encourages both the adoption of new technologies…and, further down the pipeline, the innovation and development of these new technologies.

In fact, Finkelstein showed that “the introduction of Medicare [caused] …enormous spending effects” and that “the spread of insurance played a very big role in driving health care spending growth over the second half of the twentieth century.”

Whether Finkelstein’s study will eventually persuade other economists, such as Frakt, remains to be seen.  But it is noteworthy that her historical evidence is only confirming what should have been demonstrable by careful reasoning all along: subsidies raise prices and massive subsidies raise prices massively.

So here’s a paradox to conclude with.  Compared to technology, ideas are cheap.  But when bad ideas are concocted into a widely embraced but faulty economic theory, the result can be ruinously expensive.

Categories: OIG Advisory Opinions

Mobile Apps Are Reflecting the Changing Role of the Patient in the Healthcare Ecosystem

The Healthcare Blog - Mon, 02/13/2017 - 20:30


The 4th edition of Trophées de la Santé Mobile took place last week in Paris which showcased the best French healthcare mobile apps in different categories.

The winning apps were clearly showing the changing role of the patient in the healthcare ecosystem. The patient is at the center, more informed, and plays an important role in his or her own health. Since the patient has a better understanding of his or her own health, they can detect a disease earlier, co-create their own treatment with the doctor, and adjust it based on the information being continuously collected through apps or wearables.

The winner of the Grand Trophée for this 2017 edition was Novi-Chek, an app that empowers and informs diabetic patients. Developed by Roche Diabetes Care France, Novi-chek is an app for patients who have recently been diagnosed with Diabetes type 1. It supports them during the 1st month of the disease, explaining what diabetes type 1 actually is, the treatments available, why they need to auto-check their glucose level, and how diabetes will impact their everyday life. The patient can also use the app to set up alarms to check glucose levels or enter useful information to track the diabetes.

Another rising trend in healthcare at the moment is the use of Artificial Intelligence to empower patients. There were 2 different projects on stage using AI at the TSM17: Enovap and Symptocheck.

Symptocheck as the name indicates is a symptom checker that can be used by patients to establish a preliminary status of their condition and answer questions such as: is it an emergency? Is it serious? Do I need to see a doctor? Etc. Symptocheck doesn’t replace a doctor nor does it establish a diagnostic but brings you medical orientation and peace of mind, thanks to a powerful software that uses Artificial Intelligence algorithms to narrow down potential diagnostic orientation based on your symptoms.

Enovap is a smart electronic cigarette that helps smokers reduce their consumption and quit for good. It uses Artificial Intelligence to analyse the smoker’s personal daily consumption, delivers the right amount of nicotine for each use of the e-cigarette and progressively reduces it day after day.

Enovap was the winner of the Journées de l’innovation 2017 in the category Connected Device. The other winner of the Journées de l’innovation in the category Mobile App was Mon Coach Douleur, developed by Takeda. This is another good example of patient empowerment as it targets a very important and undervalued aspect of healthcare: pain management. Patients can report on pain they are experiencing during the treatment on a daily basis and share the results with their doctor. The doctor can then modify the treatment or accommodate that pain. Originally developed for oncology, that app is currently used by other patients with different conditions who find a real value in it.

Those awards were organized by DMD santé, who was founded by Dr Guillaume Marchand and Dr Nicolas Lafferre. DMD santé developed a European certification label for Mobile Apps and Connected Devices, called mHealth Quality, which recognizes your app as safe to use, ethical, compliant and valuable.

Winners Trophées 2017:

  • JNIS Mobile App: Mon Coach Douleur – App to identify and report pain during treatment
  • JNIS Connected Device: Enovap – e-cigarette that uses Artificial Intelligence to help you stop smoking for good
  • Coup de Coeur des Internautes: Ben le Koala – App that teaches kids how to brush their teeth and wash their hands in a fun way
  • App for Professionals: Medpics – App to share and discuss clinical cases between healthcare professionals
  • App for consumers/Patients: Doctisia – Apps that helps you organize your medical data end prepare appointments with your doctor.
  • Followup App: Qalyo – App to store, follow up and manage your health data
  • Grand Trophée: Novi-Chek – App to support patients who have recently been diagnosed with diabetes Type 1.

Congratulations to all the winners of the 4th edition of Trophées de la santé mobile. Looking forward to the 5th edition!

Aline manages the business development in Europe for Health 2.0.

Categories: OIG Advisory Opinions

An Open Letter to Kaiser Permanente Northern California

The Healthcare Blog - Mon, 02/13/2017 - 13:29

I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible.

The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send the file.

The emotional and human reason I want to talk with Darryn Carter–and I think it’s appropriate to share this reason too, given that you are a care provider–is that I believe I received bad care at Kaiser, and yet no one at Kaiser has ever listened to what I have to say about it, despite months of my trying to tell someone. My concern and frustration, which is so strong that it drove me to spend a Saturday writing this letter, is not primarily about the bad care I believe I received but rather the wholehearted dismissal that your organization has levied through an unnavigable bureaucracy. This dismissal has kept me up nights, sometimes crying, sometimes fuming, sometimes brooding, always feeling that special type of indignity reserved for a patient with a care provider who blatantly and systematically refuses to care.

Over the two months that I have tried to contact you, there have been some weeks where I have contacted your team ten times via phone and email. I started by using your web messaging portal, day after day, week after week. For many weeks, “web services consultants” responded that Darryn would call me in three to five business days (see a sampling of messages below). I started calling your help desk, where well-meaning junior associates would promise the same, a callback in 2-5 business days. I heard in their voices a genuine desire to help, earnestly dialing out to Darryn Carter, getting back on the line to let me know that they were unable to reach Darryn, or find Darryn’s direct line, or connect me with a manager, but that they had left a voicemail and would send a message, and I should expect to hear back in 3-5 business days.

Other weeks, like these recent ones, I have done nothing, have not tried to contact anyone from your organization. How could I continue? The few actions I know to take as a patient who needs help and information have proven not just ineffective but painful, like thrusting myself at a brick wall again and again hoping it will break.

So here is another in a long and exhausting parade of attempts to get a response from a person at Kaiser who will listen and speak to me like the person I am, a person who is hurt and dissatisfied but reasonable. I have two requests, and I will spend the rest of this letter providing more context and evidence around these.

  1. I want someone from Kaiser who knows about my case to speak with me on the phone about what happened, how the case was reviewed, and how the decision was made. In short, I want recognition. 

    The sad thing is that, really, this is all I have wanted all along. One phone call months ago could have put this whole thing to rest.

  2. Given some evidence that my case manager, Darryn Carter, is not a current employee at Kaiser, I want confirmation that Darryn Carter is in fact a Kaiser employee, and that he or she was employed by Kaiser at the time my case was reviewed.

    The side effect of my many calls and emails to your organization has been to learn that Darryn Carter is unreachable by any reasonable action. As of this writing, he or she does not exist in the phone directory at the number to which I am continuously directed (925-737-4873), and also does not exist in the searchable Kaiser directory that my primary care doctor uses. There may be a reasonable explanation for this–I would like to know it.

You can stop reading here and get in touch with me to respond to these requests. Or, you can read on to learn the basic details of my case.

On a Sunday in July, I cut open my right middle finger in the kitchen–blood puddles on the floor, that kind of thing. My boyfriend rushed me to the Kaiser Emergency Room on Geary Street, where I was efficiently moved through the administrivia and into an exam room surrounded by a curtain that easily let the stories of those around me pass through. For 30 minutes or so my boyfriend and I sat, listening to the man next to us describe an excruciating episode of back pain, wondering what he looked like, listening to the doctor ask probing questions exploring validity of his pain, delicately investigating whether he was angling for opioids.

A nurse came in to clean my wound, and an attending came in on a round to check in.

“Doctor X will be in soon,” she said, “and if he gets tied in with other things, I’ll sew you right up.

I wish I had understood the nature of the situation at that moment and had the wherewithal to ask her right then if she could please be the one to sew me up. I didn’t realize I was waiting for a resident, and that July is when the new residents start in the ER. Later, someone told me that patients are legally allowed to ask for an attending rather than a resident to provide care. Now I know.

Dr. X arrived after some time. He is tall and Caucasian with big features and thinning hair, like a TV show doctor. He made some small talk and put me at ease. I recognized his voice as the one from the conversation about back pain, and admired his delicate handling of that situation, for which I had a front row seat.

Doctor X began laying out the tools for the stitches. I watched him put on his gloves, lay out two sheets of sterile paper in front of him, and place a series of metal and plastic objects on top of the paper. His actions were noticeably deliberate, his movement notably slow, his gaze notably fixed on his hands. I had a sense of the actions being unnatural to him. An ER doctor is in the business of rushed care, and this plodding seemed odd. But I dismissed it as probably just his style.

Dr. X started on the stitches, with the attending nowhere in sight. It wasn’t until halfway through the job that I noticed his hands were shaking. I desperately wanted to point it out to my boyfriend, who was sitting next to me, but I was silenced by a stronger desire to be polite. That wasn’t my place. Plus, I told myself, stitches are an easy, straightforward procedure. If there’s anything a frightened new doctor should do, it’s probably this. So I waited it out.

When the stitches were done, the attending swept through and looked at them.

“Oh my goodness!” She exclaimed, “those are beautiful!” She used the overly expressive voice of a kindergarten teacher.

“You are an artist!” She continued, “those are the best stitches I have ever seen!” For reasons that you already understand, this statement was more concerning than comforting.

“I’m going to glue the very top of the cut, where there are no stitches” Dr. X said.

“Ok!” said the attending doctor, and she left.

This is what happened next, which I have been trying to discuss with someone at Kaiser for two months:

Dr. X retrieved a glue bottle.

He unscrewed the cap, and aimed it at the top of my finger. He shook it a few times. No glue came out.

He brought the glue bottle back up to his face and examined it. He peeled off some additional layer covering the opening of the bottle, (I learned later that surgical glue bottles have a layer of foam to help apply the glue precisely.) Once the foam was removed, he aimed the bottle back at my finger, and turned it over. The glue, which was a thin liquid, emptied immediately and entirely onto my finger, covering the whole cut and much of the rest of the finger, and dripping down my bloody hand. It dried in an instant, hardening around the stitches and the blood to form a knarly, prosthetic-looking bloody sheath around a big section of my finger and hand. Then Dr. X left and a nurse came in to wrap it up.

Once it was wrapped, the attending came by and saw some of the glued blood on my hand. She quickly asked the nurse with a furrowed brow to please wipe that off.

When I took off the wrapping three days later, I unveiled a finger that was covered in blood and had infectious-looking lumps up and down the cut. I returned to Kaiser twice. During my visits, nurses called in NPs who called in doctors for second and third opinions. The question at hand was: What is causing this unusual Frankenstein finger? Is this an infection? Is this glue?

When I went to get the stitches out, the nurse didn’t know how to approach the project. All my stitches were firmly glued in place. She called in an NP to give me a digital block, to re-anesthetize my hand like Dr. X had during the initial stitching.

“Do you see this a lot?” I asked. The NP answered delicately,

“We do really try to avoid putting glue over stitches, for this reason.”

Even after the stitches were out, I went back to Kaiser again for a glue-related inquiry. One part of the cut had a strange looking growth. The NP who saw me thought it might be a type painful overgrowth of the tissue under the skin that bulges out of a wound. It certainly was painful to touch. He showed me photos and for ten minutes we discussed possible next steps to deal with the complication. In the end, the Medical Director came in and concluded: strange, but just glue.

The only person at Kaiser to whom I have had the opportunity to tell this story was a first line bureaucrat on your crisis management team whose job it was to fill in a rigid form. After telling her my story, she said,

“So you are looking for reimbursement for the charges related to this episode?” I told her that reimbursement would be nice, but more than that, I am looking to speak with the doctors involved, to explore what happened and hear their side, to get an apology if one is warranted, and to prevent something similar from happening to someone else.

“Ok Ma’am. So I’m putting down that you would like a reimbursement for the charges surrounding this incident.”

“There’s that,” I repeated, “but more importantly I’d like to have a human conversation with the people involved here.”

“Um ok. I have recorded your request for reimbursement of charges.”

She told me that my case would get pushed up to a senior case manager, and that person would call me with questions to further explore the case. I figured that when that person called, then I’d really dig in. I had photos and additional details, and all kinds of thoughts to share, which were too far reaching for the crisis form during that first call and the form-filler whose performance may have been contingent on how many patients she processes per day–I don’t know. Surely that senior crisis manager would have a more nuanced conversation with me.

The next and last communication from Kaiser on this was a rejection letter I received in the mail about a month later.

I remember when I read it sitting in the living room, on a sunny Sunday afternoon. The letter had been buried in a pile of mail for that past few days, and I was systematically going through the pile, expecting this to be another meaningless or redundant survey or notification from Kaiser, which came in multiple times a week. After reading it twice, I heaved one big sob as the wind was knocked out of me, held my breath for a moment to try and stop more from coming, and broke down crying into my arm. My boyfriend came in and found me with the letter crumpled in my hands. I looked at him ragefully and said, how could they. The strength of my anger surprised even me. But I suppose we only have our one body and mind, and I had paid Kaiser to be the protector of my body and mind, and this letter, to me, represented a deep disregard for both.

Anyone who has ever been on the phone with Comcast knows what happens next. Here is a small sampling of the written responses from your staff on this issue, to give you a taste. This was also accompanied by many phone calls with well-meaning but powerless phone operators.

I know my case is trivial compared to some. The mistake made in my care, if any, is very far from the horrors of medical mistakes that result in life changing disabilities or death.

Even so, I felt this letter was important to write, because if you are this good at blocking communication from a concerned, persistent, and reasonable patient, I can only imagine the nameless many who can’t advocate for themselves and have been long buried.

Please respond. I don’t know what else to try.


Rachel Katz

Categories: OIG Advisory Opinions

Healthcare Reform Can Create Confusion Over Compliance for Providers

Medical Coding News - Mon, 02/13/2017 - 07:58

In 2016, the federal government recovered more than $3.3 billion in healthcare fraud judgments and settlements. On Monday, TeamHealth agreed to pay $60 million to settle allegations that a company it acquired, IPC Healthcare “knowingly and systematically encouraged false billings by its hospitalists.” The settlement is the latest in a string of False Claims Act […]

The post Healthcare Reform Can Create Confusion Over Compliance for Providers appeared first on MedicalCodingNews.Org.

Categories: Healthcare News