Baxter Health Care Plan

Every time I turn on the news these days, all of the talk is about health care. Unfortunately, we seem a little short on plans and a lot long on opposition. As a member of the health care industry, I sincerely hope we as a country don't let this opportunity pass. However, in the meantime, I thought I would offer up my own health care plan.

My plan has very little to do with such silly things as insurance companies, payees, payers, preexisting conditions, and the uninsured. My plan focuses only on Physicians. That's right, it is all about me. For two days now, I have spent what felt like an inordinate amount of time sitting in classrooms. So far, I have learned how to dictate. [If you are thinking, doesn't that just involve talking into a phone? You would be correct. Irony of ironies, I still have another "class" on dictation to go.] I have learned how to use two different versions of an electronic medical record (EMR), and my schedule this week is littered with 7 more computer systems - one more version of an EMR, three versions of computerized order entry (COE), and three versions of electronic radiology viewing (PACS). I haven't even included the VA yet.

This brings me to step one of my plan. "We" should all get together and come up with one version of the EMR, COE and PACS. When I started training, we wrote notes and orders on paper and had hard copies of X-rays. I am not one of the diehards that thinks we should go back to those days, but every hospital even within the same system surely doesn't need a different EMR, COE and PACS. The VA actually led the charge in the "paperless" charting world. The same system is used in every VA in the country. The truly great thing - all the different VA systems "talk" to each other. I can access here in South Florida the operative report for a surgery my patient had at the VA in Alaska. Isn't it a little embarrassing that the VA is ahead of the "civilian" sector?

Also on my schedule this week is not one, but two coding meetings. I have already completed three hours of computerized modules, but now I guess they want to test me in person to make sure I learned something. As a medical student and resident, you learn that chart documentation should be a clear and concise story of what is wrong with your patient, and how you plan to remedy the situation. As an attending, you learn that chart documentation is a legal tightrope of three choices from column A and two choices from column B with careful attention to include certain "key" words so that you don't get charged with insurance fraud.

Step two of my plan, take physicians out of the billing altogether. We the physicians should go back to clear and concise stories followed by well-developed plans. We should not be thinking about including documentation about length of time spent with patient or pertinent ROS. The only key words should be those pertaining to the health and care of my patient. We should do the job we were trained to do, and leave the business aspect to business people.

I concede that it is a relatively simple plan. It includes no "pork" and I have consulted with no lobbyist. I haven't vetted it through the Congressional Budget Office, and am fairly certain that it will not save a single penny. However, the peace of mind to physicians - priceless.