I'm a physician and this is very bothersome. Not that we will be judged on outcomes as much but the fact that we are judged on outcomes that are largely out of our control (i.e., patient compliance and patients taking care of themselves). For instance, I am an ophthalmology sub- specialist (retina) and we perform surgery for retinal detachments. I can do a perfect surgery but the success is highly dependent on the patient going home to rest and being in certain positions (i.e., no lying on their back). If they are not compliant, the surgery will fail and will require a reop. This is a category I may be judged on down the road and it can impact my Medicare payment. I cannot go to each patient's home and watch their 24 hour activity. On top of this, retinal detachment surgery, and the postoperative management, are quite time consuming. I do not enjoy this part of my practice but people need it or they will go blind. If I start getting punished by the government, for outcomes out of my control, I may stop doing this particular type of surgery. It would be unfortunate for the patients because they would have to drive two hours to the next closest retina doc.

We already have to check off a lot of stupid boxes on our charts to prove "quality control". It's getting worse. I don't really know who is actually checking these but it's a huge waste of time. No proof it does anything to improve patient care but it makes the beauracrats content, I guess. Nothing the government does will control healthcare costs until people actually start be concerned about their own health

There probably is something the govt. could do to increase healthy behavior but dinging healthcare providers isn't it.

how do you get people to avoid rolling onto their backs after following asleep?

We spend an awful lot of money trying to save people from themselves.

On the bright side, Medicare should save a lot of money when there are no providers left to generate any charges.

Recently had this exact conversation with my brother who is also an ophthlamic surgeon. He already is annoyed that his partners push off most of their Medicare patients onto his schedule because they prefer the richer reimbursement from private payors, and the ratchet just seems to keep tightening. Like you, he's starting to consider just not doing certain procedures and it will require patients to go hours out of their way for care.

It is sad. Truthfully, I love my Medicare age range patients. They are truly "The Greatest Generation". It's not the payment from Medicare that bothers me, it's the endless rules and regulations. New ones showing up every day. An example is ICD-10, the coding book we use for diagnosis. I can't just put "wet macular degeneration" any more, I have to break it down in to a specific categorization. This requires extra searching on the computer (since we are forced to use ridiculous electronic health records). Who freakin cares!!! It doesn't matter how specific you get, it's treated the exact same way. This does not help patient care. It gives the beauracrats something to do and is a complete waste. This is the biggest reason docs quit taking Medicare or Medicaid is the huge burdens from an administrative and legal standpoint.

Usually, they have to be on their side or face down. Momentary slips, where they end up on their back is not bad, but doing it continuously is detrimental. There is specialized medical equipment that can help but most patients are pretty good, especially when they realize failure to follow instructions could mean blindness.

You are correct. I try my best to not be aggressive with surgeries or other procedures. I know people don't wanna be operated on so I do my best to make it an option of last resort (unless 100% needed like retinal detachment surgery). But people get angry at this. They want a quick fix, not a change in lifestyle. Not everyone but a fair number of patients. Some days, it feels like no one wants to eat right, exercise, quit smoking, monitor their blood sugar on a very regular basis, etc...

Are you participating in the CMS PQRS program? I'm the coordinator for our critical care group, and it's quite possibly the most ridiculous sham of a QA/QI program I've ever come across, and yet failing to meet their standards (who knows what they are for our group in particular, because the won't tell us via audit until after collection/submission has concluded) will cost us roughly $40-50k in future annual reimbursement.

Mind blowing clusterfuck of a time waster.

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The devil made me do it the first time, second time I done it on my own - W

Cheap idea: T shirt with front pocket. put a tennis ball in the pocket, sew it shut and wear it backwards.

100% agree. What a HUGE waste of time. Meaningful Use falls under the same category of waste

Or you can just cease toeing the line and absorb the 1-3 % payment penalties and let them go fuckem selves ( we did)

of course we were only ?? short timers until retirement when all this bullshit started .... we didn't go chasing the EMR "bonus" as it just didn't make sense with the cost, practice disruptions and the enforced kowtowing to the whole process.
From reading feed back by those in healthcare who feel disruption of usual work flow is unacceptable, we feel the decision was right.


the penalty does not hurt as much some think.

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RayGovett
Hughson CA
Be Prepared-- Strike Swiftly -- Who Dares Wins- Without warning-"it will be hard. I can do it"

You're more optimistic than I am.

Can you provide a single example of a government program that performed better and lower cost over time?

The normal government process is to get worse and more expensive over time.

Even if something miraculously improves, it's always at a much higher cost than anticipated.