Friday, October 22, 2010

Allergies Know No Vacations

Many allergy sufferers are plagued with year-round symptoms. Avoidance of most allergens is nearly impossible. What works?

Topical nasal steroids (like Flonase, Nasacort, Rhinocort, Omnaris) work the best. They are very effective anti-inflammatory agents. However, to achieve the maximal effect they take several days of application. The down side to intranasal steroids is that they can be drying to the nasal mucosa, making nose bleeds more likely. Intranasal steroids also increase susceptibility to viral and bacterial upper respiratory infections, which have the potential to lead to lower respiratory infections.

Topical antihistamines (like Astelin) work within 10-30 minutes of application, and are very effective. They too can be drying, making nose bleeds more likely, and they can also predispose to infections.

Leukotriene inhibitors (another type of anti-inflammatory agent, like Singulair) are tablets that work very effectively. Inflammation is caused by multiple pathways, and leukotriene inhibitors block pathways that are not affected by steroids or antihistamines. They are a great addition to an allergy sufferer's regimen if their allergy symptoms are not under control with other agents. They are not usually used as a first line agent because they are expensive, and because more symptoms can be effectively treated with steroids and antihistamines.

Oral antihistamines work great. They are nearly as effective as topical antihistamines, but take a few hours to feel the effect. The main advantage of oral antihistamines is cost. There is a generic version of loratadine (sold originally as Claritin) available at a cost of only pennies per day, compared to $2-5 per day for intranasal steroids or antihistamines. Easy to take pill form is another advantage.

First line treatment for severe allergy sufferers is intranasal steroids. Topical antihistamines and oral antihistamines can be added as needed.

The most affordable option is generic oral antihistamines followed by the addition of intranasal steroids as needed.

Whatever you and your doctor choose, take the medication as directed. If you are a year-round allergy sufferer, you must take precautions every day of the year.

Tuesday, October 19, 2010

iRVU Is Here

e-MedTools, the people who make MedicalTemplates and E/M Code Check, have created a new smartphone app - iRVU.

iRVU tracks the wRVUs a health care provider generates. Not only will iRVU tally the wRVUs, it will also generate a wRVU/Encounter number.

The total number of wRVUs generated and the number of wRVUs/Encounter are benchmarks used to determine individual productivity, estimate revenue generated, and compare one health care provider's productivity with another.

Virtually every medical practice uses these benchmarks to assess physician productivity and relative value to the practice.

e-MedTools have some awesome products.

Monday, October 18, 2010

Allergy Season and Flu Vaccines

Allergy season is winding down, thank goodness, but flu season is right around the corner!

If you have not already received your influenza vaccine this year, now is a great time to get one. Many drug stores and discount department stores are providing affordable flu vaccines in places where you likely already shop! Convenience, too!

Who can benefit from a flu vaccine? Everyone!

Any person with a chronic medical condition, not just a disease affecting the lungs, needs a flu vaccine. "Comorbid conditions" as it is called, increase a person's susceptibility to worse side effects from an influenza infection.

Others at risk of worse side effects include young children. They have smaller airways and they can succumb very quickly to infections.

Adults caring for children are at higher risk of catching the flu because they are more likely exposed to greater numbers of infected people, AND they can readily spread the flu to other small children.

Residents of a facility that house multiple unrelated people (i.e., nursing homes, apartment buildings, mental health facilities, prisons, etc.) also pose risks due to the increased chance that one or more of the residents will have the flu. In addition, the closer quarters increase the likelihood of being close enough to someone to catch the flu who has already been infected.

Even otherwise healthy people benefit from vaccination. Who does not have family members in school, loved ones with a chronic health condition, or family members in nursing homes? No one wants to be the reason another person gets sick.

Finally, the flu vaccine can not only decrease the likelihood of getting the flu, it can decrease the severity of illness should you get the flu. This can decrease the number of days missed from school or work (or play).

Do yourself and your family and friends a favor. Get the flu vaccine. You'll be glad you did!

Friday, October 15, 2010

Medical Documentation, Billing and Coding

Medical documentation, billing and coding requires knowledge of complex, changing rules. Thank goodness for medical documentation, billing and coding experts who can be so darn helpful!

Thank goodness, too, for point of care tools that make medical documentation and coding much easier to understand and implement, and save time and money!

A couple of these tools deserve mentioning again.

E/M Code Check is such an exciting smartphone application! It has a concise, easy to follow format. Each page is really information packed, and the buttons to transition to the next page are very easy to use, unlike some other smartphone apps.

E/M Code Check incorporates great graphics, providing a great deal of information (pictures are worth a thousand words!) on personal documentation and coding habits. The feedback this tool provides is terrific, and it will help most anyone to learn where they need to improve.

Like some other companies, E/M Code Check provides a free version, making money by inserting ads, but the $34.99 version is worth every cent!

E/M Code Check provides Medicare reimbursement rates (based on national averages), tallies them based on the encounter types entered, and graphs personal coding distribution levels!

E/M Code Check also reinforces the use of MedicalTemplates for documentation of patient encounters. MedicalTemplates are terrific tools for prompting health care providers to document a complete history and physical exam. Sometimes the situation or conversations in patient encounters can derail a train of thought. Who hasn't had to return to a patient room to ask about some missing piece of the social history? With MedicalTemplates a physician can be confident that they are consistently documenting a thorough patient encounter note. Best of all, thorough documentation using MedicalTemplates saves time. Most aspects of the patient encounter can be documented with a simple check mark, but there is ample space to write personal notes.

If you haven't checked out these products, go to

Tuesday, October 12, 2010

10 Reasons To Own E/M Code Check

The folks at e-MedTools have created another terrific medical documentation tool!

E/M Code Check is an application for smart phones (iPhone, Android, etc.) that contains important financial data for physicians. This tool not only provides benchmark data from Medicare, such as coding distribution curves and average reimbursement rates, it provides succinct summaries of documentation requirements for coding levels for many types of clinical encounters. E/M Code Check even includes encounter information not found in other medical documentation tools.

The most exciting feature of E/M Code Check is the Personal Productivity Log that tallies all patient encounter codes, then reports the data in a graph format that includes a personalized coding distribution graph, reimbursement, average number work RVUs per encounter, etc.

In today's economy, and with Medicare dropping the reimbursement rates twice in 2010 for sub-specialist physicians, and more cuts to Medicare reimbursement rates planned for December 2010 and January 2011, this tool is indispensable!

10 Reasons to Own EM Code Check

Monday, March 22, 2010

Business In Medicine

The Lung Doctor has published "Business In Medicine" on Scribd. "Business In Medicine" is a brief discussion of the economic impact of the health care industry, health care reform, how physicians are actually paid for health care services provided, physician employment and contract concerns, and medical documentation. The target audience is health care providers, but the information is beneficial to all health care consumers and legislators.

"Business In Medicine" is a great primer for medical students and physicians in training. The health care industry is a complex web of predatory practices involving every component of the health care system: legislation, government run health care insurance, private health care insurance companies, hospitals, and medical professional groups.

The discussion of medical documentation includes the Medicare E&M Service Coding Audit and Worksheet from e-MedTools.

Business in Medicine

Thursday, March 11, 2010

Merlin Olsen Has Died of Mesothelioma

My deepest sympathies to the family of Merlin Olsen, who died as a complication of mesothelioma, a rare but aggressive cancer of the lungs and pleura. It is never easy to lose a loved one. Peace be with you.

Tuesday, March 2, 2010

Socialism In Medicine

Medicine is a business! Healthcare providers provide an essential service. Why then are so many people uncomfortable associating healthcare with business and profit-making?

According to Wikipedia, business is defined as follows: "A business . . .is a legally recognized organization designed to provide goods and/or services to consumers.. .The owners and operators of a business have as one of their main objectives the receipt or generation of a financial return in exchange for work and acceptance of risk. Notable exceptions include cooperative enterprises and state-owned enterprises.."

The healthcare system is NOT a free market system. Insurance companies and governmental agencies impose significant restrictions on the healthcare industry. If it were a free market system, healthcare would be forced to focus keenly on the relationship between healthcare consumer and healthcare provider. Satisfaction and competitive, quality service would be critical to financial success and would become standard. Costs are naturally constrained by monetary influences. This is the for many who propose socializing healthcare.

For obvious reasons, there will be a wide range of services that healthcare consumers will be able to afford. A question often used in the context of healthcare is whether individuals have an inherent right to healthcare. A rarely discussed extension of that question then becomes, how much healthcare does an individual have a "right" to access, and who makes that determination?

It is ludicrous to mandate any business to routinely provide services for free, or at unrealistic prices that make their business unsustainable. Yet, the government controls how much physicians and hospitals may charge for their services, then determines a "fair" price, and pays only a percentage of that "fair" price! For example, a healthcare provider may be legally allowed to "charge" no more than $100 for a service, but the government insurer deems that only $60 is a "fair" price, and then proceeds to pay only 80% of $60, or $48! This is why the current healthcare system, based on an artificial government imposed limitations is a financial failure! The current healthcare system has not failed because of healthcare providers. It has failed because of governmental interference.

Ironically, veterinary medicine is a free market business. Perhaps more ironic is the acceptance of a free market system in the production of weapons of mass destruction, ammunition, tanks, planes and military vessels! According to the publication, Government Executive (August 15, 2002), in 2001 more than $92 Billion dollars of taxpayer money were spent on the top 100 government contractors.

Healthcare consumers have been removed from the financial process of healthcare delivery for so long, and have become so reliant on a third party payor system with deep pockets that there has been little accountability for healthcare costs. Government handouts have created a dependent society. Healthcare consumers do not ask, or in many cases care, how much healthcare costs. Advances in healthcare mean that much can be done, but at what cost personally and economically? Because everything can be done, should everything be done?

Congress knows that healthcare is a business, and one that costs a hefty sum in tax revenue. The government is essentially the largest health insurer in the nation. The Centers for Medicare and Medicaid Services provided healthcare insurance to nearly 100 Million U.S. residents (2004,2005) at a cost of $577 Billion, according to the Henry J. Kaiser Family Foundation. The problem, as we all know, is that the number of people utilizing government funded healthcare insurance has increased while the number of people paying taxes has decreased. Medicare/Medicaid is an unsustainable business.

Congress has now mandated reduced payments to healthcare providers in order to offset the national budget. This merely shifts a significant burden of healthcare costs to individual healthcare providers, forcing them into an unsustainable business! On January 1, 2010 Medicare stopped paying for specialist consultations in the clinic or hospital, shifting to a reduced payment similar to what primary care providers receive, resulting in a reduction of approximately 11%. Despite the fact that specialist physicians have more advanced training and treat more complex healthcare problems, Congress has deemed that all physicians be paid the same. On March 1, all healthcare providers received an additional 21% reduction in payment, thus effectively cutting specialist payments by 25%.

Now Congress wants to bundle healthcare payments by paying only hospitals for all healthcare provided. Hospitals would then be in control of determining how much to pay physicians! Where will the accountability be? How will a physician's worth be determined? Physicians will be completely at the mercy of hospitals. Hospitals can effectively force out private practice physicians, and hire cheaper labor. Many hospitals already hire doctors from other countries because they can pay these physicians less money!

What can the motivation be to impose such limitations that effectively force physicians out of business? The socialization of medicine! Creating a socialist society where the government, or the most elite of the wealthy will be in control of healthcare. Are we ready for conglomerate medicine that is insensitive to local or individual needs? Do we want the government knowing in-depth medical information about each of us? There is a frightening conflict of interest here! The government will have the capability of determining who costs "too much". The government could then begin limiting individual benefits based on cost. Sound familiar?

What is next? Eliminating everyone who is not a valuable contribution to society? Imagine the impact of losing geniuses like Stephen Hawking because of healthcare costs! Imagine legislating who has the right to reproduce, or what fetus to carry to term to eliminate disease carrying genes, or to create a more perfect race?

Congress does value profitability in some medical businesses. The pharmaceutical industry has had substantial influence in legislative decisions preventing Americans from purchasing medications outside the U.S. at a cheaper cost. These companies have agreed to provide expensive medications at a cheaper price to some consumers. But, it comes at the cost of Medicare agreeing to not pay for alternative medications that are just as effective, but cost less.

What is the solution? Free market! The government needs to get out of the business of micromanaging our lives, and let the free market system influence the healthcare market.

Stop Congress from crippling healthcare and micromanaging every one of us!

Monday, February 8, 2010

MedicalTemplates' Outpatient Pulmonary Clinic Evaluation

The folks at e-medtools who create MedicalTemplates have updated their Outpatient Pulmonary Clinic Evaluation for new patient evaluations. This new template looks much better than the previous version! It also appears to have quite a few more convenient features!

The ROS (Review of Systems) has been updated to reflect the ROS on their other templates. Having a ROS with space to document both "yes" and "no" responses makes a great deal of sense medically and legally! The PMH (Past Medical History) is much cleaner, more straightforward, and limited to the most common diagnoses. They have left room, though, for addition of a tailored set of diagnoses, such as specific pulmonary diseases that are not very common. There is also a very nice list of common surgeries that really save on documentation time and effort! Prompters for significant Social History information like ADLs (Activities of Daily Living) and behavioral and occupational risk factors are extraordinarily important to most patients seen by a pulmonologist, but are often excluded from standard medical templates.

The exam is quite extensive with relevant negative and positive findings that, again, stand to save pulmonologists a great deal of time and effort. Time is money, and quality of life is extremely important!

There is significantly more space in the Impression and Plan section, which is a great improvement over the previous version. Space for adequate discussion of the differential diagnoses and treatment options was previously limited.

MedicalTemplates is doing a great job! Documentation of the patient encounter is complex and confusing! There are so many rules that differ with each payor, and often change from year to year, that it makes sense to take a more consistent approach to documenting every patient encounter!

Pulmonary Clinic History and Physical

Sunday, January 3, 2010

Trailblazer Medicare Audit Tool

The folks at e-medtools who create MedicalTemplates, MedSpel and the E and M Audit Tool have created a Trailblazer Medicare Audit Tool. This tool is useful to health care providers in Delaware, Maryland, Virginia and District of Columbia.

Like all their templates, the Trailblazer Medicare Audit Tool is created using a fillable PDF format so that the form can be completed online or printed and completed by hand.

Reimbursement for health care services is complex and confusing. Taking the time to learn and incorporate appropriate medical documentation into every patient encounter note benefits everyone, but is even more critical these days given the severe economic pressures and increased scrutiny by insurance companies.

These Medicare audit tools make great tools for learning the complexities of medical documentation necessary to justify billing levels. When it comes to documentation, if it isn't documented it didn't happen according to medical insurance companies (and lawyers, of course).

Trailblazer Medicare Audit Tool