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More changes

April 28, 2012 by New FNP


Well, it is happening. The clinic I work in will be closing its doors soon, partly due to money issues and partly because the physician is retiring, and I am back on the employment search train again. The sad part about this, though the PA I work with is going to try to take as many patients along to the next job (and mine will go with me), is how many physicians won’t take Medicaid anymore. It just doesn’t pay, and the loss of income on each patient, coupled with the impossibility of finding specialists to refer Medicaid patients to, and the restrictions on what we can and can’t order for them, it is not a viable option for a lot of physicians to take Medicaid. On the patients’ side, if they have share of cost, it is often so high, they can’t afford to get healthcare anyway. The whole thing just stinks.

The good news is that there are several options for me and I will not be jobless for long, if at all. The bad news is that things are so up in the air that I haven’t found a lot of emotional space to write in my blog recently, though I did get a new bike, well actually a recumbent trike. An arthritic girl’s best friend! And my dog’s favorite thing, too!

 

Posted in Dogs, Health care, NP practice, recumbent trike, Uncategorized | Tagged , , , , , , , | 2 Comments »

ICD-10 and why healthcare is expensive

February 11, 2012 by New FNP


I was in the bathroom at work yesterday, and this poster is hanging on the door.

Really???? What are these idiot politicians thinking of when they dream up this stuff?
And they constantly cut the pay to the providers and then expect them to try to keep up with all of these ridiculous new regulations and rules.

Do they actually believe that all of this stuff is going to improve healthcare, decrease fraud and decrease the cost of healthcare?  Evidently they do:

Check this link: ICD-10 benefits for healthcare providers

Note that the guy writing it, if you even get half of what he is saying, is an IT guy, NOT a healthcare professional. The talk is about “data-driven” patient care. Huh? My patient care is driven by the patient’s needs, not some IT guy’s addiction to data in his little cyber-world. I don’t think that a coding set is going to alter the fact that a laceration that is bleeding all over the place needs to be sutured. Who gives a crap if the cut is caused by a paring knife versus a steak knife. Time is wasted in asking the difference and looking up the code in a set of 140,000 codes.

“The increased auto adjudication of claims due to increased granularity of ICD-10 code will help in reduced number of claims being investigated or rejected due to insufficient information. ” Right. The fact the patient is cut and bleeding is not enough information to pay for a suture job?

The codes are bordering on the ridiculous. I heard stuff I couldn’t believe. Yet, when looking them up, it turns out to be true. Example: Here in Florida, there is the occasional person who gets injured at the beach. Here are the codes for one type of incident:

2012 ICD-10-CM Diagnosis Codes > External causes of morbidity V00-Y99 > Exposure to animate mechanical forces W50-W64>

Contact with nonvenomous marine animal W56- >

Type 1 Excludes

  • contact with venomous marine animal (T63.-)
W56Contact with nonvenomous marine animal
W56.0Contact with dolphin
W56.01Bitten by dolphin
<span class="identifier">W56.01XA</span> is a billable ICD-10-CM diagnosis codeW56.01XA…… initial encounter
<span class="identifier">W56.01XD</span> is a billable ICD-10-CM diagnosis codeW56.01XD…… subsequent encounter
<span class="identifier">W56.01XS</span> is a billable ICD-10-CM diagnosis codeW56.01XS…… sequela
W56.02Struck by dolphin
<span class="identifier">W56.02XA</span> is a billable ICD-10-CM diagnosis codeW56.02XA…… initial encounter
<span class="identifier">W56.02XD</span> is a billable ICD-10-CM diagnosis codeW56.02XD…… subsequent encounter
<span class="identifier">W56.02XS</span> is a billable ICD-10-CM diagnosis codeW56.02XS…… sequela
W56.09Other contact with dolphin
<span class="identifier">W56.09XA</span> is a billable ICD-10-CM diagnosis codeW56.09XA…… initial encounter
<span class="identifier">W56.09XD</span> is a billable ICD-10-CM diagnosis codeW56.09XD…… subsequent encounter
<span class="identifier">W56.09XS</span> is a billable ICD-10-CM diagnosis codeW56.09XS…… sequela
W56.1Contact with sea lion
W56.11Bitten by sea lion
<span class="identifier">W56.11XA</span> is a billable ICD-10-CM diagnosis codeW56.11XA…… initial encounter
<span class="identifier">W56.11XD</span> is a billable ICD-10-CM diagnosis codeW56.11XD…… subsequent encounter
<span class="identifier">W56.11XS</span> is a billable ICD-10-CM diagnosis codeW56.11XS…… sequela
W56.12Struck by sea lion
<span class="identifier">W56.12XA</span> is a billable ICD-10-CM diagnosis codeW56.12XA…… initial encounter
<span class="identifier">W56.12XD</span> is a billable ICD-10-CM diagnosis codeW56.12XD…… subsequent encounter
<span class="identifier">W56.12XS</span> is a billable ICD-10-CM diagnosis codeW56.12XS…… sequela
W56.19Other contact with sea lion
<span class="identifier">W56.19XA</span> is a billable ICD-10-CM diagnosis codeW56.19XA…… initial encounter
<span class="identifier">W56.19XD</span> is a billable ICD-10-CM diagnosis codeW56.19XD…… subsequent encounter
<span class="identifier">W56.19XS</span> is a billable ICD-10-CM diagnosis codeW56.19XS…… sequela
W56.2Contact with orca
W56.21Bitten by orca
<span class="identifier">W56.21XA</span> is a billable ICD-10-CM diagnosis codeW56.21XA…… initial encounter
<span class="identifier">W56.21XD</span> is a billable ICD-10-CM diagnosis codeW56.21XD…… subsequent encounter
<span class="identifier">W56.21XS</span> is a billable ICD-10-CM diagnosis codeW56.21XS…… sequela
W56.22Struck by orca
<span class="identifier">W56.22XA</span> is a billable ICD-10-CM diagnosis codeW56.22XA…… initial encounter
<span class="identifier">W56.22XD</span> is a billable ICD-10-CM diagnosis codeW56.22XD…… subsequent encounter
<span class="identifier">W56.22XS</span> is a billable ICD-10-CM diagnosis codeW56.22XS…… sequela
W56.29Other contact with orca
<span class="identifier">W56.29XA</span> is a billable ICD-10-CM diagnosis codeW56.29XA…… initial encounter
<span class="identifier">W56.29XD</span> is a billable ICD-10-CM diagnosis codeW56.29XD…… subsequent encounter
<span class="identifier">W56.29XS</span> is a billable ICD-10-CM diagnosis codeW56.29XS…… sequela
W56.3Contact with other marine mammals
W56.31Bitten by other marine mammals
<span class="identifier">W56.31XA</span> is a billable ICD-10-CM diagnosis codeW56.31XA…… initial encounter
<span class="identifier">W56.31XD</span> is a billable ICD-10-CM diagnosis codeW56.31XD…… subsequent encounter
<span class="identifier">W56.31XS</span> is a billable ICD-10-CM diagnosis codeW56.31XS…… sequela
W56.32Struck by other marine mammals
<span class="identifier">W56.32XA</span> is a billable ICD-10-CM diagnosis codeW56.32XA…… initial encounter
<span class="identifier">W56.32XD</span> is a billable ICD-10-CM diagnosis codeW56.32XD…… subsequent encounter
<span class="identifier">W56.32XS</span> is a billable ICD-10-CM diagnosis codeW56.32XS…… sequela
W56.39Other contact with other marine mammals
<span class="identifier">W56.39XA</span> is a billable ICD-10-CM diagnosis codeW56.39XA…… initial encounter
<span class="identifier">W56.39XD</span> is a billable ICD-10-CM diagnosis codeW56.39XD…… subsequent encounter
<span class="identifier">W56.39XS</span> is a billable ICD-10-CM diagnosis codeW56.39XS…… sequela
W56.4Contact with shark
W56.41Bitten by shark
<span class="identifier">W56.41XA</span> is a billable ICD-10-CM diagnosis codeW56.41XA…… initial encounter
<span class="identifier">W56.41XD</span> is a billable ICD-10-CM diagnosis codeW56.41XD…… subsequent encounter
<span class="identifier">W56.41XS</span> is a billable ICD-10-CM diagnosis codeW56.41XS…… sequela
W56.42Struck by shark
<span class="identifier">W56.42XA</span> is a billable ICD-10-CM diagnosis codeW56.42XA…… initial encounter
<span class="identifier">W56.42XD</span> is a billable ICD-10-CM diagnosis codeW56.42XD…… subsequent encounter
<span class="identifier">W56.42XS</span> is a billable ICD-10-CM diagnosis codeW56.42XS…… sequela
W56.49Other contact with shark
<span class="identifier">W56.49XA</span> is a billable ICD-10-CM diagnosis codeW56.49XA…… initial encounter
<span class="identifier">W56.49XD</span> is a billable ICD-10-CM diagnosis codeW56.49XD…… subsequent encounter
<span class="identifier">W56.49XS</span> is a billable ICD-10-CM diagnosis codeW56.49XS…… sequela
W56.5Contact with other fish
W56.51Bitten by other fish
<span class="identifier">W56.51XA</span> is a billable ICD-10-CM diagnosis codeW56.51XA…… initial encounter
<span class="identifier">W56.51XD</span> is a billable ICD-10-CM diagnosis codeW56.51XD…… subsequent encounter
<span class="identifier">W56.51XS</span> is a billable ICD-10-CM diagnosis codeW56.51XS…… sequela
W56.52Struck by other fish
<span class="identifier">W56.52XA</span> is a billable ICD-10-CM diagnosis codeW56.52XA…… initial encounter
<span class="identifier">W56.52XD</span> is a billable ICD-10-CM diagnosis codeW56.52XD…… subsequent encounter
<span class="identifier">W56.52XS</span> is a billable ICD-10-CM diagnosis codeW56.52XS…… sequela
W56.59Other contact with other fish
<span class="identifier">W56.59XA</span> is a billable ICD-10-CM diagnosis codeW56.59XA…… initial encounter
<span class="identifier">W56.59XD</span> is a billable ICD-10-CM diagnosis codeW56.59XD…… subsequent encounter
<span class="identifier">W56.59XS</span> is a billable ICD-10-CM diagnosis codeW56.59XS…… sequela
W56.8Contact with other nonvenomous marine animals
W56.81Bitten by other nonvenomous marine animals
<span class="identifier">W56.81XA</span> is a billable ICD-10-CM diagnosis codeW56.81XA…… initial encounter
<span class="identifier">W56.81XD</span> is a billable ICD-10-CM diagnosis codeW56.81XD…… subsequent encounter
<span class="identifier">W56.81XS</span> is a billable ICD-10-CM diagnosis codeW56.81XS…… sequela
W56.82Struck by other nonvenomous marine animals
<span class="identifier">W56.82XA</span> is a billable ICD-10-CM diagnosis codeW56.82XA…… initial encounter
<span class="identifier">W56.82XD</span> is a billable ICD-10-CM diagnosis codeW56.82XD…… subsequent encounter
<span class="identifier">W56.82XS</span> is a billable ICD-10-CM diagnosis codeW56.82XS…… sequela
W56.89Other contact with other nonvenomous marine animals
<span class="identifier">W56.89XA</span> is a billable ICD-10-CM diagnosis codeW56.89XA…… initial encounter
<span class="identifier">W56.89XD</span> is a billable ICD-10-CM diagnosis codeW56.89XD…… subsequent encounter
<span class="identifier">W56.89XS</span> is a billable ICD-10-CM diagnosis codeW56.89XS…… sequela
Do you get paid more to stitch up an killer whale (orca) bite than a sea lion bite? How does this information improve patient care in the future as stated by the panting IT guy? Will there be required signage on a beach that says “Caution: orcas are 19.75% more likely to bite you than dolphins. Stay clear of orcas.”?
ICD-9 codes numbering at 17000 was bad enough, but 144000 is clearly over-the-top.
This one is also so very necessary here in Florida:  2012 ICD-10-CM Diagnosis Code V91.07XA: Burn due to water-skis on fire, initial encounter.

According to the poster, every form, every procedure, every contract has to be changed to conform to the new rules. Everyone has to be retrained. I love the part where the coding clerks are required to have “a more detailed knowledge of anatomy and medical terminology”. And the nurses have to “revise or recreate every order”. Sure, they have time for that.

Here is a good one, in light of the fact that the government can’t get its shit together with current new guidelines and hasn’t paid our little clinic yet this year for any Medicare or Medicaid bills we turned in,(also note ICD-10 has been delayed due to its cumbersomeness, but when the government says GO! there can be no delay on your part!). The poster states “changes to software, training, new contracts and paperwork have to be paid for.” By whom? The individual provider, of course.  A report by a Nachimson Advisors Study shows that on average, the costs of transitioning to ICD-10 were as follows: Small practice (3-9 physicians) = $83,000, Medium practice (10-99 physicians) = $285,000, Large practice (100+ physicians) = $2.7 million.

There comes a time in each person’s mind when they are just overwhelmed and stop giving a crap.

This will do it.

And all I want to do is take care of patients. I wish the politicians and IT guys would walk a mile in our shoes.

Posted in Health care, NP practice, Uncategorized | Tagged , , , , , , , , , , | 3 Comments »

An eventful month

February 1, 2012 by New FNP


Sorry I haven’t blogged for a while. I had to make a trip to Europe as my mother as very ill, and did pass away. In a way it is a relief as she had been ill and in pain for quite a while. She is at rest now. My family and I have to deal with international laws about wills and estates, which has taken up a lot of time and energy. Mom wasn’t quite as organized as we would have liked.

Back at home, I am still loving my new job. I get to see all the basic day-to-day health issues. Last week was allergy and sinuses week, seasoned with occasional bronchitis. This week was thrush and cerumen impaction week. There also has been an increasing stream of PAPs, the ladies are catching on to the fact that there is a female provider in the house now. I did request, rather strongly, that I wanted to have the clear plastic speculums (specula?)and not the ancient metal ones I found in the drawer. They complied, thankfully. It is hard enough to peer down a vagina and locate a cervix with the lamp over your shoulder, without also having to deal with old-fashioned metal speculums. This IS a rural health clinic, but I have to draw the line somewhere. 🙂

It is great getting positive feedback. The assistants and the PA and physician all keep telling what wonderful things the patients are saying about me. Someone get a pin, my head is getting bigger. This afternoon, a patient was dropping off his Hemoccult cards (he refused a colonoscopy even though he has a history of polyps), and the nursing assistant said he didn’t look too good. The patient agreed to come back and let me have a look at him. When I walked into the room, he told me “My wife thinks you walk on water.” Well, that is tough to live up to, and I remarked that I hoped I wouldn’t fall off that pedestal, to which he replied, “well you wouldn’t drown if you did.” The hemoccults came back positive x3, his labs which I had ordered the last visit showed anemia. A glance at the last two notes showed a weight loss of 8 pounds in a month, and he was complaining of some vague abdominal “twinges”. I wasn’t able to locate the site of the pain when I palpted his abdomen, but I thought I felt something, well, thick. I told him about the hemoccult tests and the anemia. He agreed to go to GI to be checked out. I told the girl p front to make sure that he got an appointment as soon as possible. I am frankly worried about him.

This afternoon, when I was getting ready to leave, the physician sat down next to me and said “Did you hear about the 85 year old woman you sent to get an ultrasound of the abdomen and pelvis because she had some tenderness and a little vaginal bleeding?” I hadn’t, she had come back while I was away. “I just wanted to let you know that she has ovarian cancer and is getting surgery soon. I am glad you caught that.” Wow.

Posted in About NPs, Health care, NP practice | Tagged , , , , , | 5 Comments »

Change of venue

December 30, 2011 by New FNP


After a few months with the GI group, I made the decision (not easy) that it was not the place for me for various reasons, including that a specialty is not as interesting as family practice. The multiple MDs and lack of support in my role of new grad and new employee made for a large amount of stress. I was offered a position in a small rural health clinic nearby which had only one doctor and a PA, and a very friendly staff . Moving jobs was a no-brainer, especially as there is a good possibility that my student loans will get paid off by HRSA.

It seems that sometimes things are not as advertised. The place which seems really great at first, may not be a good fit after all. I suppose in retrospect, that my biggest concerns (the large amount of MDs and the fact that a specialty would require a lot more studying to catch up) were legitimate. The support promised did not materialize, and on top of that I ended up feeling quite alone, as I was in this middle area, not allowed to “socialize” with the staff, and not considered part of the MD inner circle either. Turns out, I was never actually in the loop af

So, now I find myself in a totally different environment, where we all feel like a big family with joking around a bit accepted, and a group of people willing to help each other out and work as a true team. The physician and PA are completely supportive. What a difference! It is nice to hear someone tell you did a good job at the end of the day.

And, being back in a family practice environment is great. Well, I had almost forgotten the “Oh and by the way, I also wanted to talk about…..” after the visit was over and the chart done. I am getting better again at the “well, we can make another appointment for you to go over that.”

I feel so much less anxious and stressed, I might be able to get back into more regular blog posts!

I wish you all a happy new year, and hope that  all of you had a fantastic holiday.

Posted in Uncategorized | 5 Comments »

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