What is wrong with medicine.

This photo helps capture part of what is wrong with medicine today. I got what I am calling a little love note from our coding specialists at the hospital today:
What is a coding specialist you ask? Let me explain. There is an endless game played by insurance companies and hospitals. The insurance companies and government want to pay as little as possible. The hospitals want to make as much money as they can. Insurance companies and the government therefore have all these rules about how they will pay for this diagnosis but not that one. The people who make decisions about these rules are definitely not doctors. Hospitals therefore do everything they can to make sure they get all the possible money for each admission. For instance:

Any doctor would understand that urosepsis means someone who is very seriously ill with systemic symptoms stemming from a bladder or kidney infection. But those who will pay have decided that if you call something "urosepsis" it means just a basic UTI. You have to write "sepsis due to UTI" as well as "UTI" to make sure you get paid to take care of your critically ill patient. Similarly, you can't just write "CHF" for heart failure, but you have to specify "acute systolic heart failure." Of course none of these words mean much to any of you.

All that to say that I never get it right. I am forever leaving off whatever specifier I need to and usually I am left green notes that say things like "Dr. Tell - Is this malignant hypertension that was present on admission? If so, please document."

So now we have numerous people whose actual job it is to go around and read the charts and make sure that I write "acute blood loss anemia" instead of just "anemia." This means more people we have to pay which means higher health care costs. Don't get me wrong - I am very thankful for these ladies and was especially happy to see such a lovely note in my chart. It is just sad that we are forced to spend so much time and money doing things like this, as opposed to using those resources taking care of patients.


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