Twitter is perfect to document the orthopaedic physical exams
This is a normal occurrence in the post operative notes I see. With bundled surgical payments, it doesn't matter what you write. In fact you don't have to write anything to get paid. A patient could be in the hospital for two weeks after a surgery with complication after complication being managed by the hospitalist and the daily surgical note can be nothing more than
surgical site stable
If I was able to document one and two sentence notes to get paid, I could double, triple, or quadruple the number of patients I see in a day. That's how you cut costs and make health care delivery more efficient. As it stands now, I spend 70% or more of my time documenting worthless information just to get paid and not be accused of fraud via the government mandated E&M coding rules.
They got paid to do the surgery. As you are well aware, they don't get paid again for 90 days after the surgery for any visits or care they provide, unless the patient has to return to the OR. They don't get paid to do anything else. That's what you're there for and that's what you get paid for, everytime you walk in the room and prove you did so by writing it in the note.
ReplyDeleteAre the surgical sites stable that these docs tweet about in the chart? Are they lying? If the sites aren't stable, are they documenting differently? If there's something else going on orthpaedically with the patient are they addressing that?
Are you not there to manage the rest of the patient's care?? Do you not get paid for every visit you make to that patient, or they make to you?? If orthopods are not going to get paid for managing the non-orthopaedic care, why should they address anything more if you're already doing it?
I'm confused.
I have transcribed everything from OR reports, ER reports, Hospitalist reports and on and on....I can tell you that the length of those reports vary GREATLY depending on the doc. I have one that makes ME some great bucks cause he is a repeater. Every patient gets the same freaking report, with a new name and some new vitals shot in the template. I love this man.
ReplyDeleteI have another that can to an entire discharge summary including an H&P in less than 2 minutes of dictating. Of course, the entire thing is one long sentence with no breath taken. I hate this man.
Which man are you Happy?
OK Lou, I hear you but if your patient is POD#1 w/Hgb down to 5 from 14, please comment on that...oh and if your patient develops a DVT in the RLE on POD#3Intra op blood loss as minimal isn't cutting it. Oh and b/c you refuse to let me order lovenox and the 2mg of warfarin daily you wrote didn't cut it, then please comment on that too. I understand everything you wrote...and I'm with you when you're right. As a hospitalist, I am here to to manage the medical issues...but like Happy said, please comment on relevant things. You may, but may of your colleagues don't.
ReplyDeleteWhy did the orthopod get paid so much to do the surgery? Because the time of the surgery is not all that's factored into the cost!
ReplyDeleteSurgery mantra - "If we're not cutting, we're not interested." (i.e. "call the hospitalists to admit this guy with a 'hot' appendix to 'cool it off for a few days'. We'll be on consult for the surgery.")
Surgery ploy - "Consult hospitalist for 'medical management'" - eng - common phrase - often used in place of, "we're done cutting now and would like to sign off."