Thursday, November 29, 2012

Doctor Click

Doctors are paid to treat patients, right? 

Back in the old days that was true, but not any more. Now they are paid to enter data.

Let me introduce myself, I’m a professional clicker.  I used to be a member of a highly respected and sought after profession; a doctor.  The modern world of government/insurer managed healthcare has turned me into an efficient clicker, busily documenting everything I do so that I can:
  • Be reimbursed for my services
  • Afford to pay my staff/landlord/utility/self
  • Avoid being prosecuted for fraud by Medicare
  • Avoid lawsuits
  • Communicate with other docs
  • Meet “quality” parameters set by Medicare/insurers

The once noble profession of a physician where time was spent with patients discussing their issues is now replaced by a computer terminal. Face time is now screen time.
We did not create the system/game.  At every step of the way, we have been forced to play by Medicare’s and the insurers’ rules.  Not only have we been forced to play by their rules, we have also been forced to shoulder the expense of buying and learning to use the EMR (electronic medical record) that many of us did not want to use.
Second, the EMR made it easy to record what we never recorded in the past.  It’s hard to exam a person without examining his/her skin.  Acne and blemishes, skin color, texture and warmth are readily apparent.  In years past, only positive findings would have been recorded in my patient’s paper chart.  Now, click, click, click and it’s all recorded electronically.  In the old days, I knew what my notes meant.  Now, the rule is:  If it’s not recorded, you didn’t do it.
Think about that for a moment. You haven't really treated a patient until you have entered data in to a machine.
We are clicking because we are being forced to click.  In 2014, we will be financially penalized for not clicking.  Now, we may be penalized for being too good at clicking.  The government is on a witch hunt looking for fraudulent clickers.  Sometimes, you can’t win.
One more question needs to be answered.  Clicks are data points and are being collected every minute of the day by Medicare and the insurers.  What’s being done with all that data?  That question is the one keeping me awake at night.
Pleasant dreams . . .
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