How to do risk-adjusted diagnosis coding the right way

Policy
April 3, 2018

Medical practices with risk-adjusted contracts must sharpen their diagnosis coding. Practices that are part of accountable care organizations (ACOs) or that have risk-adjusted contracts with commercial payers have an economic incentive to accurately report the disease burden of their patients. In fee-for-service medicine, physicians are paid based on the fee schedule associated with a CPT code, and any modifier attached to that code. The diagnosis code establishes the medical necessity …

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So you missed the bull market. What can you do now?

Finance
April 2, 2018

We are now nine years into the current bull market, and the S&P 500 has risen over 300% from its March 2009 low.

Unfortunately, there are some investors that have been left behind. They sold their stock in 2007-2008 and never got fully back into the stock market. For example, a reader on the Bogleheads forum recently posted this question:

“I have had about $450k sitting in cash for too …

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5 things pathologists want other doctors to know

Physician
April 1, 2018

1. Clinical history is important. What did you see when you took the biopsy?  Was there a mass there?  Does the patient have a history of malignancy?  These are all important questions, and they help pathologists arrive at the most accurate diagnosis possible.  Rarely, the best we can give you is a differential, but the more clinical information given to us, the more likely we can narrow things down and pinpoint …

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The first time this doctor hated a patient. And what he did next.

Physician
March 31, 2018

“Dr. WHAT?!” she spat.

“Gold … man. Gold, like the precious metal, and, y’know — a man.” This carefully crafted response was curated and vetted by countless returned pages, and it rarely failed to produce a chuckle. The patient was not amused, and she referred to me, instead, with a disdainful, “Rosenberg.” Every day I re-introduced myself, and every day — “Rosenberg.”

This 36-year-old female admitted for road rash and multiple rib …

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What should physicians look like? Should it matter?

Physician
March 28, 2018

I don’t remember her name, but I do remember her light brown hair, the simple nose ring that looped out of her left nostril, and the calm and centered presence she had with patients. She came across as unassuming, professional, and caring. We were both in medical school, though she was two years behind me. I admired how she treated people.

I don’t remember his name, but I do remember that …

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An emergency physician delivers a baby, and realizes that it isn’t for him

Physician
March 27, 2018

I’m an emergency physician. In common parlance, an ER doc. Which means, like a little kid who will eat dirt on a dare, there’s not much I won’t try in the practice of my profession. Many of my colleagues have had far more challenging careers than me, I assure you. But I have some stories to tell. Cyanide overdose while moonlighting as a resident. Patient nearly dying from bite by …

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Clinical plagiarism: the problem of copy and pasting in EMRs

Tech
March 26, 2018

It is all too common for a section in a progress note to look something like this:

# Aspiration pneumonia:

  1. Continue vancomycin 1 g bid
  2. Continue Zosyn 3.325 g q6h
  3. Follow-up blood cultures
  4. Follow-up sputum cultures
  5. MRSA nares screen negative
  6. Blood cultures negative
  7. Discontinue vancomycin

Yesterday, a version of this note (lines 1 to 5 to be precise) had my name on it. Today, it is signed by someone else. Read it …

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Learn typical community acquired pneumonia with a Medcomic

Conditions
March 26, 2018

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP.

The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, …

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The medical student who cries

Education
March 25, 2018

I’m a default crier. I happy-cry, stress-cry, romantic-comedy-cry, regular-comedy-cry and, apparently, I even doctor-in-training-cry.

Crying is a tough response, especially for someone who wants to take care of sick patients. My default reaction poses challenges for my future career. I had my first taste of this when a patient actor brought me to tears. An actor? That’s ridiculous, you might think. It was all pretend and yet, I broke down. I’m …

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A physician is often the only person that sets the tone of hope, or despair

Physician
March 24, 2018

It was mid-afternoon in the ever-bustling surgical intensive care unit (ICU). The nurse, one of those experienced, battle-hardened savants of human symptoms, called me into one of the patient rooms. He was tachypneic on the ventilator with labored breathing and declining oxygen saturations; with each inspiration, his diaphragm would paradoxically elevate, his stomach bulge and the ventilator alarm with the dyssynchrony. Intubated, sedated and unaware, he was fighting for his …

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Using marijuana 2 times a month cost this doctor his license

Physician
March 23, 2018

If a physician has a substance use or mental health problem, it is in everyone’s interest — the physicians themselves, their patients and their families — for them to get treatment. And if they go for treatment, they deserve to be treated fairly, but given my six years of experience as an associate director in one state physician health program (PHP) and in working with physicians from all across the …

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5 ways to build a relationship with hospital administrators

Physician
March 23, 2018

My desire to write this piece stems from my recent realization that I wasted a good part of my early career in medicine. While I was happily working in my pathology “bubble,” I was completely oblivious to the great untapped potential I had to affect change not just within, but also outside of, my department. In an effort to encourage other physicians to find ways to make an impact, I …

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What you should know about colon polyps

Conditions
March 22, 2018

When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …

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The difficult conversations physicians have with patients

Physician
March 21, 2018

A 60-year-old lady came for follow-up after a recent stay in the hospital. She was diabetic — horribly uncontrolled — the result of which was that she had already been on dialysis for four years. She ended up in the emergency room with chest pain. Diabetic patients are at higher risk than the general population of having heart attacks.

She underwent studies to evaluate for blockages in her heart. The cardiologist …

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This medical student scored a 281 on the USMLE Step 2 CK. You can, too

Education
March 21, 2018

Once a minor hurdle on the road to Match Day, the USMLE Step 2 CK is now required by many residency programs before ranking applicants. For those with low Step 1 scores, Step 2 CK is even more critical, as it represents a student’s only opportunity to compensate for Step 1 performance. I was happy with my Step 1 score but planned to take Step 2 CK well before applying …

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What do you do when your loved one becomes suddenly ill?

Physician
March 21, 2018

When someone you love who has always been healthy and a go-getter suddenly takes ill, it can be very scary and confusing for both of you. It can be particularly scary and confusing for your loved one. Your loved one, while healing, is also experiencing grief/loss, and not just over the loss of health. Even as adults, we can sometimes feel like bad things won’t ever happen to us. Feeling …

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10 tips to help patients through benzodiazepine withdrawal

Meds
March 20, 2018

As physicians, we are experts at prescribing medications. However, we often fail miserably when it comes to recognizing adverse reactions and tapering medications. It’s something that is simply lacking in our medical training. I have become a victim of this with benzodiazepines, as I detailed in a prior blog post. Benzodiazepines, in particular, are very difficult drugs to taper. I would like to share with you …

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