AU Blogspot

In this podcast interview, medical billing consultant, Jennifer Dever, discusses a number of practical guidelines you can follow to avoid the common pitfalls that plague most practitioners.  Now for those of you already working in the medical billing field, I don’t need to tell you how much money incorrect coding alone can cost a practice, a problem that becomes further compounded when there is not a proper detection system in place to identify, analyze, and correct such errors.  The marketplace is more competitive than ever and no practice can afford to absorb losses due to billing error, an unfortunate end when one considers that these errors are ultimately preventable.  Enjoy this podcast and take advantage of the opportunity to learn from others’ mistakes.   

Ryan Rode
Ashworth University

           Thanks to Kevin Trotman for permission to use this Photo.

I wrote a blog entry on this topic yesterday, then deleted it, as it wasn’t very nice. Kevin, MD’s Dr. Pho has covered 75% of what I wanted to say on his blog today (nicely), here; read his blog entry then come back here for the rest of what I wanted to say:

Glenn Beck’s hospital horror story is getting some attention. Apparently, he had a surgical procedure with marked post-op pain. As physicians tried to control his pain with increasing doses of narcotics, he suffered adverse reactions as a result.

This is one of those amazing occurrences in medicine that makes all of us in Emergency Medicine alternately furious and incredulous, the “Just go to the ER” from a physician who knows the patient much better than the EM doc will, knows what outcome they want, what the patient will need, but cannot be bothered with the 10 minutes of administrative time it’d take for the direct admit to happen. This is what Mr. Beck should have had in the first place, and then a lot of his problems / complaints wouldn’t have happened. He didn’t need the ED, he needed his doctors to take care of their patient.

Mr. Beck was operated on that day in the same facility he was sent back to for re-admission, after having clearly been identified by the anesthesiologist on the case as having significant problems with pain control. (more…)

Defensive medicine is indeed a problem. This isn’t the example that tells that story. Oh, and my friend Kevin looks pretty good on TV.

From cbs.com:

“It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room. There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.”

Wow, she walked in and just got a CT scan! Oh, wait, she also got a history and a physical exam, but you wouldn’t know that from the slant of the article.

But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan.“I was pretty flabbergasted,” said Robert Varipapa, himself a physician. Varipapa says his daughter’s pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.

              Thanks to Rick Audet for permission to use this Photo.

Aah, a doctor relative with a retrospectoscope. Stepwise testing works just fine in the clinic, but in the ED we need to do a lotta things in a hurry:

• rule out the horrible thing
• get a diagnosis, or exclude the killer diagnosis
• get the patient out of the ED to make room for the next patient

But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.“It would not have ruled out appendicitis obviously, it would not have ruled, necessarily, out a kidney stone,” said Dr. Bob Powell, ER medical director of Bon Secours St. Mary’s Hospital.Varipapa agrees, but asks why not start simple - and do the CT scan only if necessary?“Well it’s my opinion this is defensive medicine,” Varipapa said.

Well, you may be right that it’s defensive medicine, but that doesn’t make it incorrect, or bad medicine. A better question would be the 6K charge for a CT scan, but bashing the ED is a lot easier. Frankly, this is not a terrific example of defensive medicine, but is a good example of a) the different though processes between clinic and EM doctors, and b) a cautionary tale of current ED costs. Kevin looked very reasonable and professional (and wasn’t wearing his pajamas)! Here’s his CBS video. I recommend it, mostly to see my friend Kevin before he moves to Hollywood.

Dr. Allen
Creator of GruntDoc
Ashworth University Contributing Blogger 

*Allen earned the alias GruntDoc through is his work as a doctor in the USMC infantry and has carried the name through his current work as an Emergency Physician.  Dr. Roberts obtained his MD from Texas Tech University and is board certified in emergency medicine.  In recent years, he has become one of the most popular and respected bloggers on matters related to health care and medicine.  We’re honored to welcome Allen as a member of our contributing bloggers’ network and would like to specially thank him for the opportunity to share his knowledge, skills, and experience with our student community.  To learn more about the life and work of Dr. Allen, visit his outstanding GruntDoc blog.  Thanks Allen!