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Author Archives: WhiteCoat

Bad Medic

ERP here from ERstories with a quick news update. I just read that the paramedic who was called to the scene of John Travolta’s son’s impending death allegedly tried to extort millions of dollars from the star.  The claim is that the medic would sell stories to the tabloids saying that Travolta caused the death of his son.  You can argue that Travolta’s Scientology (and possible lack of standard epilepsy treatments) contributed to his son’s death but I think it is unlikley the star “caused” his son’s death.  Now, if this is true, all I can say is that this medic has accrued some seriously bad karma.

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WhiteCoat Challenge #5

Haven’t done a challenge in a while. Cynical’s comment from my post yesterday gave me an idea. Finish this sentence: You know you’re a frequent flyer when … Three best responses as chosen by EP Monthly editors will get their choice of any one of the products at EP Monthly’s Online Store. Cynical’s comments start us off … you comment on your doctor’s new haircut or shoes … your doctor knows your med list and PFSH (past family and social history) by heart … your doctor can recognize you by your feet hanging out of the sheets

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The Germiest Profession Is …

According to a post in the Wall Street Journal’s Health Blog, a study from the University of Arizona’s Department of Soil, Water and Environmental Sciences shows that the job exposing people to the most germs is … a school teacher. Surfaces regularly used by teachers had 10 times more bacteria per square inch when compared with other professions. So kudos to all you school teachers for not only raising our next generation of good citizens, but also for being able to put up with 30+ out of control kids at the same time and for having some damn fine immune systems to boot. Want to cut the number of germs at work? Use disinfectants. People who said they used disinfectants dropped the bacteria counts in their work areas by more than 75%. By the way, know what the “least germiest” profession is? Lawyers. Really. Check the link above. I’m not kidding. Probably a professional courtesy from the other germs. Bwwwaaaaaahahahaha

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How You Know You're a Frequent Flyer

The doctor walks in the room after being on vacation for a few weeks and the first words out of your mouth are … “Gee. Haven’t seen you in a while. What, have you been on vacation or something?”

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How Payments Affect Care

When an unconscious intoxicated multiple trauma patient was brought to the ED, we did a bunch of CT scans to look for injuries. Fortunately there wasn’t anything life-threatening. He was admitted and was later discharged in good condition. I then got a memo from the hospital several days later stating that Medicare would not pay for the CT scan of the patient’s cervical spine. There is a list of diagnosis codes for which Medicare will reimburse hospitals for performing a CT scan of the cervical spine. That list is contained below. If one of the selected codes is not on the patient’s final diagnosis list, then Medicare tells the hospital “tough luck” and pays the hospital nothing for the scan. As part of Medicare’s Conditions of Participation, the patient may not be charged for the exam unless the patient specifically agrees to the charges. When Medicare doesn’t pay, almost always the hospital gets stuck holding the bag. If a patient is a victim of multiple trauma and is unconscious, CT scans of the cervical spine are more likely to show significant injury. This study showed that in multiple trauma patients, CT scans picked up on 98.5% of fractures while cervical x-rays only picked up 43% of fractures. It is uncommon to pick up ligamentous injuries on x-rays or CT scans – generally need an MRI for those. If physicians choose to do a CT scan on an unconscious or poorly responsive patient, according to the “permissible” diagnosis codes, in most cases hospitals have to hope that either an injury or some type of cancer shows up on the CT scan. Otherwise, the CT scan won’t be reimbursed and the hospital eats the cost. What are the other options in multitrauma patients? We could just do only x-rays of the cervical spine, and, if negative, tell patients that everything is OK because the government won’t pay for CT scans unless you meet certain criteria. The 57% of patients with cervical spine fractures missed on x-rays will have all their medical needs met under the new health care reform measures anyway. Or, while bleeding to death and strapped to a backboard wondering if they’re going to live or die, we could give patients an ABN form to sign. “Medicare might not pay for this test, if Medicare doesn’t pay for this test, do you agree to pay the cost of the test yourself — assuming that you live, of course?” We could always perform x-rays on everyone’s necks first and make up notice some “abnormality on radiological or other exam of the musculoskeletal system” to justify the CT scan. That will be a 793.7 to all you CPT coders. We could just say that notice that the patient winced in pain when the neck was palpated – causing “cervicalgia.” That’s CPT code 723.1. Or we can just practice good medicine and let the hospitals get shafted by the system. Of course, if hospitals get shafted enough by the system, they end up closing or reducing services. Then access to care suffers. You get what you pay for. Do a search for “hospital bankruptcy closures” and see how often it happens. Here are a few examples. CT scan payments are just one example of the cat and mouse game that constantly goes on between those providing the services and those “paying” for the services. It is also an example of the “Golden Rule” – he who has the gold makes the rules. Things aren’t going to get better.

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I Think you are in the Doghouse

OK Ladies, how would you feel in this scenario? Suppose you were standing in an examining room with your husband, fully clothed, waiting for the ER doctor to come in and examine you for a slightly embarrassing problem. Suddenly, your husband, who is getting frustrated with waiting, opens the door and grabs the nearest doctor who is walking by. Leading him into the room, without any chance for an introduction or for you to change into a gown, your husband takes hold of your pants, and apparently not caring that you are not wearing any underwear, yanks them down to your ankles while asking the startled doctor “What do you think this rash is?!?!?!” I bet he is sleeping on the sofa for at least a few days.

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