It was kind of a culmination of all I've written about on my blog the past year was when our hospital Quality Analyzer came into the office and said, "I need to speak with Rick."
I spun around my chair and said, "Hi, Gerri, what can I do for you?"
"I was just wondering if you gave any breathing treatments to the kid in 310 today?"
"Um," so what was the right answer? The truth perhaps? The kid in 310 was admitted with croup yesterday and was ordered to get racemic epinepherine breathing treatments prn. After an awkward moment of silence I settled on the truth. "I didn't give one."
"Oh, I was hoping you did one and forgot to chart." She smiled. "The patient was discharged and now his insurance is refusing to pay for today because we didn't do anything today. If you did a treatment..."
"Do you want to to go in and chart a treatment I didn't do so we can get paid." A provided her with an eerie smile.
She gave me the thumbs up.
Of course she was joking and so was I. Yet this is a perfect example of what is wrong with the healthcare industry. A patient needs to be admitted for observation, and yet because we didn't do anything the patient's insurance won't pay.
"Well," I said, "I guess for now on we'll be giving Q4 breathing treatments on all of Dr. Kipper's patients."
"Sure thing," she said, giving me the thumbs up signs again.
Dr. Kipper was new. The other pediatricians had already learned to order Q4 ventolin and racepic epi prn. That order makes no sense medically, and is a complete waste of time and money and results in RT apathy.
Yet that person sitting in a chair in Washington who makes all the laws was smiling somewhere in a leather chair in Washington as she unwrapped her paycheck.