Triple Crown

Years ago, after a short hospital stay, my father opined, "If you stay in the hospital long enough, they will kill you." Never thought much more about it until I entered medical coding and boy, was he right.

It's like the Run for the Roses.

And.....they're off!

And it's Afib early out of the gates with a strong start, followed closely by Anti Coag.

Afib and Anti Coag holding strong in the lead going into day 1.

As we round day 1, it's Afib and Anti Coag holding the lead spots, CDiff is bringing up the rear of the top three and eyeing the track ahead closely. Trochanteric FX, who had a rough start, a distant fourth, followed by History of Falls who is trying to assert its place in the lineup.

Coming into day 2, it's Afib and Anti Coag holding strong, CDiff a few strides behind in third, Trochanteric FX lagging terribly in fourth. History of Falls is history.

And we round day 2 with Afib still in the lead, Anti Coag in second, and CDiff in third. And Trochanteric FX goes down! What a stumble! And Trochanteric FX is out of the race! Devastating!

And into day 3 we go......And CDiff makes a break! Closing the gap on Afib and Anti Coag!! What a remarkable turn of events! Who would have known CDiff had the strength! CDiff overtakes Anti Coag from the inside and sets its sight on Afib as we round out day 3.

And coming into day 4 - , CDiff overtakes Afib for the lead!! Remarkable endurance! Did you see how CDiff squeezed through like that! And we have CDiff in the lead, folks, widening the gap for first over Afib and Anti Coag.

And we round out day 4 with CDiff in the lead, Afib a memory, Anti Coag an after-thought in third. Trochanteric is being led off the track. Godspeed. A fine showing.

And into day 5 it's.....LOOK AT THAT! It's MRSA! MRSA, who barely made it out of the gate, MRSA, who was discounted by all as a remote chance is now galloping full speed - MRSA, who had been rounding the days quietly as if on a summer stroll, now overtaking Anti Coag, sights set on Afib, while CDiff struggles to maintain the lead!

And now, rounding day 5 it's still CDiff in the lead. MRSA looks mighty strong.....overtaking Afib and leaving Anti Coag in the dust! Hard to believe those two started so strong. Now all eyes are on CDiff and MRSA.....what a race! Can CDiff prevail? Or will the silent sleeper MRSA finally be recognized as a contender in this race?

All eyes on CDiff and MRSA.....CDiff struggling to hold the lead, MRSA ....and MRSA from the outside! It's MRSA! Overtaking CDiff for the lead! Approaching the finish line it's MRSA! It's MRSA - winning out over very strong contenders Afib, Anti Coag, and CDiff.....

And it's MRSA, for the win.

Yep.

Big Brother on Z79.52

As a medical coder, I've been ready for the new ICD-10 code set for three years. Bring it on, I say. Because I'm sick of the training, re-training, and refreshers. I got it already. Jeebus.

During that hang time, each year, the American Medical Association begged, pleaded, sobbed, cajoled, and lobbied on behalf of providers in the country to put off this huge undertaking of getting on a coding system that the rest of the world has been using for decades.

The AMA cited cost as the overarching obstacle for providers; training, updating EMRs, extra staff to field denials, or the new code system doesn't go with my tie. 

But, that is the AMA. They want to protect providers and I am on board with that no matter how many ICD-10 refreshers I am subjected to.

I'm more dubious about the much larger picture this new code set provides to insurance carriers and just what those carriers will do with this shiny new influx of medical information. 

For example, right now, V58.69 is indicated for long-term use of medications. The medications that fall into this category can be methadone, opiates, and other painkillers. It's ambiguous. The medication could be anything 'not elsewhere classifiable'. 

Not anymore. With ICD-10, a code can be assigned that specifically states long-term use of opiates. No more hiding that monkey. 

Obesity, too. Right now, the code is either 278.00 for obesity and 278.01 for morbid obesity. It's not specified as to why a person is obese. 

Not anymore. With ICD-10, there are codes that indicate if the obesity is due to medication being taken by the patient or due to excess calories. 

For nicotine dependence, there used to be one code routinely used: 305.1. Now, there are different codes to indicate if it's cigarettes, chewing tobacco, or other. (Other being patches, gum, lozenges, or e-cigs). It's all out there now. 

Right now, carriers are assigning risk pools with the ambiguous system we have in place because that's all they have.

Not anymore.

This new coding system is going to seriously change the landscape of assigning patient risk that, in turn, drives premiums.

It's going to be interesting to see what happens because this new system has been lauded as the best thing since the birth of the HIPAA fairy.

Cake

Ahhh....the living wage. 

I can remember a year ago when this topic started to rear its head in the news. I can also remember taking to social media to throw in my support. Many of the people in my circle thought I'd finally had a fucking nervous breakdown considering how rabidly narrow my views can be on certain topics. (I am very serious about personal responsibility and accountability and have little to no sympathy at times.)

But yes, I was for the living wage. Seattle was the first to jump on board and I applauded the $15 threshold to anyone who would listen. 

But it's not because I gave a rat's ass about those working people or believed that $15 an hour should be the minimum wage because I'm nice and compassionate. I'm not.

It's because I knew, after crunching the numbers, that anything above $13.25 an hour would get a family three off Medicaid and food stamps. 

So I was pretty disinterested in anyone who was champing to raise the wage to $10 an hour. Completely ineffective, in my opinion. Double dipping the system at that point.

Ahh yes. My motives are sneaky at best. But hey, workers win by getting their precious living wage, and, as a taxpayer, I win because those workers can quit squatting on my paycheck in the form of Medicaid and food stamp budgets. 

So, in Seattle, at least, the workers got what they wanted. 

And the Seattle business owners were so incredibly pleased and righteous at proclaiming that they, YES, believe workers deserve a living wage and dagnabit, we are going to show the country it's the right thing to do!!

So imagine my surprise (not really), when perusing the news this afternoon, that I found a headline that specifically addressed Seattle's business owner's dumbfoundedness that workers are now demanding LESS hours!!

Why? Oh. So they don't lose their Medicaid and food stamps. 

Does it get any richer than that?? It's absolutely delicious.

Workers demanded a fair living wage. Cities gave it to them. And only now are these workers starting to realize...hey wait a minute! 

"You mean I have to pay taxes now? And buy my own food? Oh hell no....and pay for healthcare?"

Now Seattle business owners are scrambling to find help because people are just not showing up for work. Talk about bite the hand that feeds you.....literally.

I cannot WAIT to see what Los Angeles does - which is the next large city to phase in living wage over the next five years. 

I bet they put the brakes on that post-haste.....or lose votes. 

Or find some loophole and raise the poverty level to include......hell even me!

File 13

Reading doctor's notes and billing for his or her services for a living provides me with a unique perspective on a wide array of hot health care topics. I have a pretty accurate view of patient type, payer type, hospital outcomes, unpaid balances, and my favorite.....waste. 

And that is what galls me to no end. The wasted health care resources that could be better utilized elsewhere. 

I am not referring to hospital waste, unnecessary tests, inappropriate drug administration and things of that nature. Sure, these things exist, but with the JC all over facilities to bend over backwards to meet the standards patient care, waste will happen. "Better safe than sorry" is how most facilities and providers approach patient care nowadays.

I am referring to patient waste. 

Case in point:

Patient presents to the ED at 2 am. H&P illustrates that earlier that day, while getting in the car, patient is pretty sure a stink bug was sat upon. Patient didn't think much about it, but later started getting itchy 'down there' and was worried about having been bitten and/or stung. 

I would love to hear anyone's explanation on how this qualifies as an ED visit. A non-venomous stink bug.

Oy.

Case in point 2:

Patient presents to primary care because earlier in the day, patient stepped on a bee, removed the stinger, iced it up, but needed to be seen urgently (!) because the area on the foot was still red and sore at 4 pm.

People. Just ..... no.

So when I hear public complaints about how ridiculous ED wait times are or how difficult it is to get an appointment in primary care I have to either laugh or open a vein.  

This country has just gotten to a crazy point where no one can deal with or tolerate any amount of discomfort so off to the ED they go or to the phone to harass the front desk staff in primary care to demand a same day appointment. 

Wasted health care resources. 

There really are enough doctors to go around. There are just too many wasteful patients clogging up the resources.