From the Headlines: Medical Records Affect More than Your Health

Did you know that you could be denied life insurance or long term care insurance because of an error in your medical record? Financial planner Carolyn McClanahan, who is also a doctor, warns "I don't think consumers know how often errors occur in medical records and how those records can impact them."

McClanahan says even if you aren't denied coverage, you could end up paying higher premiums because of errors or unclear information in your medical record. For example, if a doctor dictates that you suffer from anxiety but fails to state that it is situational anxiety, this lack of detailed information may result in higher premiums.

To read the article in its entirety, visit http://cbs4.com/topstories/local_story_296221310.html.

It's so important to request a copy of your medical records and check them for accuracy and completeness. It can be a matter of additional and unnecessary cost - but it can also be a matter of life and death.

From the Headlines: Importance of Recertifying Physicians

An article printed September 20, 2007, in Modern Healthcare brings up the need for physicians to participate in Maintenance of Certification, citing "As medical science advances almost daily, lifetime certification no longer suffices to assure quality of care."

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20070920/FREE/309210007/0/mostreadmonth

You might wonder what Maintenance of Certification is exactly. "It is a voluntary process, above and beyond licensure, designed to ensure that practicing physicians stay current in their specialties... (it) requires that physicians demonstrate—on an ongoing basis—the knowledge and skills that are needed to deliver excellent care."

The article goes on to explain that many of the country's largest insurance companies are embracing Maintenance of Certification, in part by offering higher plan reimbursements to physicians who opt to participate.

With the complexity of medicine today, this makes nothing but good sense to me. I would want to know that my physician was actively pursuing continuing education and doing everything possible to remain completely up-to-date regarding his/her specialty.

From a documentation standpoint, it is equally as important that other members of the healthcare team make a commitment to lifelong learning. Certified medical transcriptionists (CMT), for example, are required to submit proof of 30 continuing education credits every 3 years in order to maintain their credential. Credits must be spread out over 4 core and 2 complementary areas so that a CMT does not become "lopsided" in their education. With so much emphasis on the privacy and security issues surrounding medical documentation, a minimum of one-fifth of the required credits must be in the medicolegal arena. Another one-fifth must be directed to technology advancements in the industry and other issues directly affecting the workplace. The other core areas are clinical medicine and medical transcription tools.

Without continuing education, transcriptionists and other practitioners cannot exercise sound critical thinking as they perform their jobs. Anyone with the ability to affect patient care should not only be credentialed - but should be commited to ongoing learning.

From the Headlines: Chip Implants Linked to Tumors

In 2005, the US Food and Drug Administration approved implanting microchips into humans to enable physicians to access the medical records of those patients. Sound a little sci-fi? The technology was touted as innovative and potentially life saving, and approximately 2000 humans worldwide have already been implanted with these chips.

Microchips have been implanted in animals for decades, in part as a means for tagging domestic pets for simple identification in the event they run away from home. But studies are starting to surface showing a connection between these implanted microchips and malignant tumors. So far these tumors are reportedly only showing up in animals, but you can't help but think about those 2000 human guinea pigs who are already implanted.

Regardless of the recent publicity around this issue, the FDA is standing by their approval of this technology. VeriChip Corp., the company that owns the current patent, estimates there are approximately 45 million potential chip-bearers in America alone.

Will the benefits of instantly available medical histories over-ride the potential health implications of these implanted microchips? Only time will tell.

From the Headlines: Concerns about IT's Effect on Patient Care

At a recent meeting of the American Nurses Association, nurses stated that increased IT has added to their workload and cut down their time with patients. They expressed frustration over the fact that they often have to enter information into more than one system - for example, an electronic medical record and a prescription ordering system. While they feel a more integrated system might be better, one nurse still said, "Even with technology everywhere, patient care is still the main thing in nursing."

(To read the article in it's entirety, visit http://www.ihealthbeat.org/articles/2007/9/4/Nurses-Raise-Concerns-About-Health-ITs-Effect-on-Patient-Care.aspx)

While I recognize the need to streamline processes in an effort to lower costs, it has never made sense to me to require a nurse (or, heaven forbid, a physician!) to take on the additional responsibility of documenting the patient care encounter. These health professionals have been trained in patient care. This is their area of expertise. Accurate documentation requires a completely different set of skills.

Case in point: I recently visited my family practice doctor for my annual exam. The clinic I go to has installed docking stations in all of the exam rooms and the physicians and nurses now carry around laptop computers so that they can document their patients' encounters directly into their electronic medical record system using a series of drop down menus and text fields. When the nurse asked me to name my list of medications so she could type them into my record she stopped on "ranitidine, " asking me if I knew how to spell it. Of course I do! Not only am I an observant healthcare consumer, but I also happen to be trained in medical terminology and healthcare documentation (specifically, medical transcription). I carefully spelled it out for her, and under her breath she mumbled, "Hmm. I've never heard of that one." Perhaps if I had called it by it's brand name - Zantac - rather than the generic form, she would have recognized it.

The point is, this very capable healthcare professional went to school to learn nursing skills - how to take blood pressure and do wound care and assess patient needs. While the training of a medical transcriptionist may be similar in some respects to nursing (terminology, anatomy and physiology, study of disease processes, etc.), at one point the two professions branch off in entirely different directions. Just as you shouldn't expect a medical transcriptionist to accurately assess a patient's blood pressure, you should not expect a nurse to know the intricacies of accurate healthcare documentation.

I think the nurse quoted in the article above said it well - "...patient care is still the main thing in nursing." Though if the current trend continues, they can add documentation skills to their palette of skills.

If healthcare facilities really want to cut costs by adding extra responsibilities to already overworked staff, why not try having physicians clean the toilets and empty the trash cans at night? Surely they can save money by canceling their janitorial service. At least no one's life depends upon them doing a good job at that.

From the Headlines: Medicare Won't Pay for Mistakes

Starting October 1, 2008, Medicare will no longer reimburse hospitals for preventable errors that could be avoided if hospitals followed proven preventive procedures or common-sense precautions. If a surgeon leaves a sponge inside the patient during a routine surgery, Medicare won't pay for the secondary procedure to retrieve the sponge. Furthermore, the hospitals will be prohibited from billing patients or insurers for these charges. The hospitals must absorb the expenses.

The Centers for Disease Control and Prevention estimates that 270 people a day - or 99,000 patients every year - die from infections they acquired after they entered the hospital. The Agency for Health Care Research and Quality has found that about 32,000 patients are injured annually in hospitals, often from preventable medication errors - when patients are given too much or too little medication or the wrong drug entirely.

Let's face it, accidents happen. Humans are, by nature, error prone. But in an environment of escalating costs for healthcare, something has to give. Someone has to be held accountable.

This bold move by Medicare is sure to raise debates both pro and con. If I were a gambler, I'd bet my next paycheck that within a year of the new Medicare rule taking effect private insurance companies will institute similar rules.