We Still Have Miles To Go…

I was at my doctor’s office recently and noticed something hanging on the wall. So I took a picture of it.  See below. 

If you can’t read the heading under “Patient Learning System” it says “Your Customized Patient Education Resource”.

If this is customization, I’m a little afraid to see what the non-customized material looks like.

Safe to say – we still have a long way to go in engaging, empowering, and educating patients and healthcare consumers…

Random Musings on Healthcare, Volume I

Sometimes life inspires you.  Sometimes it makes you think. Sometimes it makes you say NO MAS. And sometimes…just sometimes…it makes you blog about random stuff.

Over the past few months I’ve lived life just like the rest of you.  And since I’m such a fan of healthcare, I have begun compiling a mental checklist of random healthcare musings over these past few months.

They’re not in any particular order.  They aren’t really related to one another either.  And since this occurs somewhat often, I’m planning to blog about them.  Behold…you are now reading volume 1.

Consider this a warning: Trying to piece any of this together into some sort of comprehensible fashion may cause your head to explode.

Here it is – Random Musings on Healthcare, Volume 1:

Random Musing #1Children’s Healthcare & Global Billing Codes:  With two daughters, ages 2 and 1, I’ve been to the pediatricians office more than I ever thought I’d be. I’m on a first name basis with some of the staff.  For the record I don’t mind this – it beats waiting in the ER.

Recently I had to attend twice within two weeks for the same condition – an ear infection that decided to stick around even after the first round of antibiotics.

This got me thinking about the billing. Because I’m in a high deductible health plan, I’m going to be seeing these charges in some form or fashion.   Multiple times.  Likely an explanation of benefits (EOB) for each visit. So I can expect about 4 of them. Followed by four bills.  Very efficient…NOT.

This got me thinking even more.  Do you know how a pregnancy is billed in a hospital?  There is a global charge code that hits the insurance once the baby is delivered.  So all of the visits from the beginning of the mother’s pregnancy to the end of the pregnancy is covered under one global charge. Granted there are exceptions for this, like when the expecting mother changes insurance during pregnancy, but let’s go with the original example.

I also believe that global billing codes are used with physician office visits that result in a follow-up imaging test typically when the imaging center is owned by said physician. (Conflict of interests when on a fee-for-service arrangement?  Perhaps a topic for another blog).

So…random musing #1 (keeping in mind that I am not a billing/coding expert and have no idea what sort of affect this may have on the physician’s cash flow):  for conditions and illnesses that may require or typically require multiple visits, create global billing codes.  This could be for PT, OT…or sick kids!  In other words, don’t bill until the acute condition is cured/fixed.

Random Musing #2ER vs Urgent Care:  I have a sister who lives in Texas with her husband and two daughters.  We chatted recently – I was home playing Mr. Mom with my 2 girls while my wife headed out-of-town – and I was in desperate need of some support (for the mom’s out there – you’re all amazing).

Anyway, my sister had shared that she was in the ER recently because of her oldest daughter’s complaints of pain in her ear.  Yup, the ugly ear infection hits again.  Now, this kid is as tough as they come – not your average five-year old.  If she’s complaining of pain…there’s some real pain.

Of course it was Saturday night when this occurred.  Their pediatrician doesn’t have 24 hour coverage.  There are no 24 hour urgent care clinics in her area.  Guess what that meant?  A trip to the ER.  And we all know that trips to the ER are expensive in addition to being incredibly inconvenient – no one likes waiting around for 4 hours.

So here’s random musing #2:  24 hour care in the form of either urgent care clinics, 24 hour nurse lines/nurse practitioner lines (with the ability to prescribe basic meds), or round the clock on call doctors for pediatrician practices – I’m talking standard practice for all pediatrician offices.  Oh, and you might as well add 24 hour pharmacies to the list though I think I’ve seen more of them than anything else I mentioned above.

Random Musing #3ER in Mexico vs. United States: I was in Mexico in December due to a death in my wife’s family.  All of the family was gathering on short notice due to the suddenness of the event.  My brother-in-law’s girlfriend from Georgia, who is undergoing treatment for cancer, made the trip down despite the fact that she had just completed a round of chemo.

The toll on her body was so much that when she landed in Mexico City, she ended up in the ER.  In the ER they kept her for a bit, monitored her and then released her.

Guess what the cost was to this young foreigner?  $10.  Just $10.  I didn’t forget any numbers.

So, random musing #3 – heck I’m not really sure.  Either we need to re-evaluate our $300 ER visit co-pays here in the U.S. or Americans need to learn what a true emergency is before going to the ER and utilize 24 hour urgent care for all other urgent situations.

Say…that kind of ties nicely into random musing #2, doesn’t it? I didn’t even plan that…AND…my head didn’t explode!

It’s going to be a good day…I just know it.