Little White-Coat Lies

From Newsweek:

Not telling your doctor about all the health products you’re taking, even if they seem innocuous, can be particularly risky. A study that appeared in the Journal of the American Medical Association in December shows that about one in 25 adults between the ages of 57-85 are putting themselves at risk for major drug interactions when mixing prescription drugs, such as a commonly prescribed blood thinner, with over-the-counters like aspirin, vitamins and supplements, such as the popular ginkgo biloba. “Patients have to come clean about the various things they put in their bodies,” says Dr. David C. Thomas, associate professor of medicine, at New York’s Mount Sinai School of Medicine. “We ask questions for a reason.”

Inspector general says rural multiple-ownership deal OK

From Modern Healthcare:

In a recent advisory opinion, the HHS’ inspector general’s office has blessed a proposed arrangement involving 23 physicians and podiatrists who own and operate a group practice while maintaining practices outside the group as well. In addition to passing the office’s antikickback inspection, the practice passed a CMS test in June last year on compliance with rules against self-referral.

Although the providers maintain their own separate practices, they also operate as a group in a central location where they provide medical care, consultation, and walk-in urgent care, as well as laboratory and diagnostic radiology services, according to the opinion. The practice, whose name and location were not given, is organized as a limited liability company with a central governing board and a single accounting system that pools revenues and expenses.

Obama’s big idea: Digital health records

From CNN:

President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.

Here’s the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.

Only about 8% of the nation’s 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

Coding Complexity

From Kevin MD:

What’s the difference between ICD codes 401 and 401.0 for hypertension?

Plenty, as Dr. Rob points out. It can mean the difference of whether the physician is paid for the visit or not. He points out more inane examples, such as a positive rapid strep test that gets paid when diagnosed as “pharyngitis,” but not when it’s coded as “strep throat.”

Coding is an important aspect of medicine that isn’t taught well during residency training. It took me about 2 years to learn the ropes, and I admit, I’m still not clear about some coding rules. There is an entire profession dedicated to coding that physicians are expected to just pick up while on the job.

And imagine, the coding morass is about to become exponentially worse with ICD-10, the next iteration that expands the number of the codes five-fold.

If you’re looking for a job, the medical coding business is going to be a hot field going forward.