Health Care – How it’s Broken

FU, FFS

A poem about the painful absurdities of practicing in a fee-for-service model. Published on Doctors’ Day 2023, in celebration of my impending freedom from this broken system. FFS, you atrocityWith wRVUsCruelly concocted by CMSEncoding suffering with ICD-10And compounding it endlesslyWith Z codes for SDOHAnd 7 characters to specifyEpisode of care How I do translateThe sequelae

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Just One Eye

“Don’t worry, doc.  It’s just one eye.  I’ve got two.”

My stomach lurched to hear this statement.  A guy who has done nothing wrong aside from choosing self-employment (and perhaps inheriting less-than-stellar genes) is left with the choice: financial devastation or blindness in one eye.  He works hard, has served the country, didn’t complain to me at all, yet here he is about to be swallowed by the ever widening maw of impossible medical expense.

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The Secret Back Door

Go to a typical primary care practice (like the one I was in for 18 years) and try to find out the cost of anything and you will only get shrugs and obfuscation.  It’s not only that they don’t know what things cost, but the design of the system on which care is built goes out of its way to hide those costs.  Why?  Because it would be infuriating to people to see that their insurance pays 100% more than someone else’s plan and it would be equally mortifying to some physicians to realize just how bad their pay is compared to the docs down the hall.

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Of Drugs and Rectal Pain

Fortunately for this my patient, I was not only able to reunite him with the joys of sitting, but I was able, with a little research, to find him his proctological savior at a low cost.  Unfortunately, most patients don\’t have docs who are economically incentivized to save them money, and most people don\’t realize all of the games played by pharmaceutical companies and pharmacies to routinely perform wallet biopsies, nor do they know how to find the cheapest prices for their medications.

I don\’t know what can be done about this kind of thing aside from increasing awareness. I\’m not real confident in any government solution.  People just need to be smarter shoppers when it comes to their care.  It\’s just a shame that people who are dealing with health problems (even if it is just trouble sitting) have to outsmart the gaming done by those supposedly trying to help them.

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ICD-10 and Inflation of Codes

For those still unaware (perhaps looking through catalogs for gigantic inflatables for president\’s day), ICD-10 is the 10th iteration of the coding taxonomy used for diagnosis in our lovely health care system.  This system replaces ICD-9, which one would expect from a numerological standpoint (although the folks at Microsoft jumped from Windows 8 to Windows 10, so anything is possible).  This change should be cause for great celebration, as  ICD-9 was miserably inconsistent and idiosyncratic, having no codes describing weakness of the arms, while having several for being in a horse-drawn vehicle that was struck by a streetcar.  Really.

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What Can\’t Be Afforded

Until our system can figure out a way to handle this kind of thing, we will pay a big price.  Waiting for problems to become emergencies is a terribly expensive practice.  I\’m not sure I know exactly what needs to be done for this, but it\’s becoming an increasingly common problem.  Some say that a single-payor system will be the remedy, but they ignore the fact that a third-party payor system is what got us in this mess in the first place.  Things are far too expensive because patients don\’t have to pay for them.  That\’s why stress tests, which don\’t actually cost thousands of dollars to do, are so expensive.  That\’s why there is $100 hemorrhoid cream.  That\’s why medications are unreasonably expensive: someone else pays the bill.

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Computerized Epic Failure

Good news: my local hospital has the fanciest, newest, coolest computer system (costing major bucks, of course) and now is routinely sending me \”transition of care\” documents on my patients.

Bad news: they are horrible.

Seriously, we get several of these documents per day and often can\’t figure out what the document is about.  On the bright side, sometimes after taking 10-20 minutes of looking through the 12-14 page document, we do actually gain some useful information.

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