Aidan Charles Closes The Door Of The Examining Room

There’s no denying it, blogging takes time, truth be told, a considerable amount of time if you want to do it reasonably well.  A medical blogger whose writing talent goes far beyond “reasonably well” is the physician who blogs under the pseudonym Aidan Charles – The Examining Room of Dr. Charles

When I clicked on the link on my sidebar for The Examining Room of Dr. Charles yesterday, what’s this?  No Dr. Charles!

Then I found this post on Grunt Doc


The Examining Room of Dr. Charles
I’m going to take a break from blogging.The Examining Room has been going for almost 3 years. It has been a wonderful experience for me. I’ve met great people, been challenged intellectually, and have had an audience for that bit of creativity still left in me that survived running the gauntlet of medical training.

…The main reason I am taking a break, perhaps a long break, is that my life, like yours, only allows me a finite amount of time for pursuing an avocation. I’d like to try to work on a book. It’s a story you might read one day, or it might simply rest on my bookshelf, unpublished. But it is the writing of the thing that I feel passionate about. Wish me luck.

Thank you, Dr. Charles, for all the excellent free entertainment all these years. Blogging is, after all, a hobby for us in the MedBlog world and hobbies take time, come, and go. You have a writing talent well beyond mortal bloggers, and I hope you do write that book, even if it is about tomatoes.

And come back if you want.  We’d love it.


I understand Aidan, time is a precious commodity and we all need to carefully consider how we spend it.  The medical blogosphere is a richer place thanks to your insightful contributions over the past three years.

Happy book writing.

More Alphabet Soup Please

Today class, we’re going to learn a new acronym…NPPES; and yes, there will be a quiz later!

It all began with HIPAA… You know that one – Health Insurance Portability and Accountability Act of 1996

HIPAA said there needed to be a standard unique identifier for health care providers, and voilà the NPI was created. That’s National Provider Identifier should you need a refresher.

If you want to view or update your NPI data or create a Web login for an existing NPI, well then you need… NPPES!  Now pay attention class, you’ll need to know this for the quiz later – it stands for National Plan & Provider Ennumeration System.

NPPES collects identifying information on health care providers and assigns each a unique National Provider Identifier – NPI.

There’s also an NPIPlanID, but that’s for covered health plans and we won’t be covering that in this lesson.

That’s it for today, but your homework assignment is to read more about NPPES:

Dealing with delinquent medical records – carrot or stick?

There was a good discussion today about medical records completion on a medical/legal listserv to which I subscribe. 

Delinquent medical records are a significant issue for many organizations.  Patient care, as well as timely reimbursement can be seriously impacted by incomplete, inadequate, or unsigned medical records.  Chasing, begging, threatening, and/or cajoling physicians to complete this onerous task can also eat up considerable staff time.

The original listserv question posed was:  “I would like to know how hospitals have dealt with the issue of encouraging/forcing attending physicians to complete medical records in a timely manner.”

Several excellent responses followed, including this one (partially quoted below) from Michael Callahan, Esq.  Mr. Callahan also happens to be one of our scheduled speakers at this year’s annual NAMSS Conference in New York City.


Most hospitals and medical staffs impose non-reportable (to the National Practitioner Data Bank), administrative suspensions for failure to complete medical records in a timely fashion as defined in the bylaws, rules or regs. Typically, physicians receive fair warning about the delinquency before the suspension is imposed.

Keep in mind is that both admitting and clinical privileges should be suspended. All too often, we see physicians admitting under a partner and then the suspended physician treats the patient. The suspension therefore has little effect on trying to remedy the problem.

Other variations on a theme that I have seen include the following:

1. Fines – If uncollected by the time of (re)appointment, the physician must pay the fine and any penalties or the application will not be processed.

2. If the suspension is in effect at time of reappointment, the application is not processed, privileges lapse without a hearing and the physician must reapply. Bylaws or policy should reflect this procedure if adopted.

3. Some policies track the number of days that a physician has been on suspension during the course of the two year appointment. If beyond the designated date, privileges lapse and/or physician is not reappointed. Warnings and notices are given in advance. Again, procedure should be vetted and adopted by the (medical) staff.

At some point in time it is hard to ignore the adverse impact which can arise when a patient is readmitted before the record is completed. I have seen instances where treatment was provided based on the record at hand and if the missing information had been available, a very different procedure would have been performed or drug administered. This mistakes have led to poor outcomes. Under these circumstances, we usually advise the physician that if there is one more instance of an incomplete medical record, the hospital will pursue formal corrective action under the bylaws which, if upheld in the form of a reportable event, will be reported to the Data Bank.

Michael R. Callahan, Esq.
Health Care Department

Katten Muchin Rosenman LLP
Chicago, IL


Getting Ready for Company

If you’re an “average” American, in 2005 you spent 5.7 % of your income on healthcare.  (12.8% on food, 32.7% on shelter, 18.0% on transportation)  As a consumer, you can do research and learn quite a bit about how to get the best automobile or home for your money; you can read restaurant reviews and browse the produce at the local grocery store before you decide what and where to eat.  Obtaining reliable data about the kind of care you can expect to receive at your local hospital, or at big, famous medical center, is quite a different matter.

Patient privacy, HIPAA, HCQIA, peer review, legal privilege, etc., etc.  What happens in Hospital, stays in Hospital. 

All of those issues are legitimate, but where does that leave John Q Patient?  If not in the dark, at least in hazy gloom when it comes to having the ability to make good healthcare choices.

While not a complete answer, the US Government is providing a glimpse into what happens (statistically at least) to patients who entrust their most precious possession, their health, to the care of a hospital.  In April 2005 the Centers for Medicare and Medicaid Services launched “Hospital Compare,” the first government-sponsored hospital quality score card.  There has been quite a bit of buzz in the past few weeks about the recent addition of data on the 30 day mortality rate for heart attack and heart failure patients.

The public release of hospital quality scores for specific treatments is having an impact.  Already I’ve read statements from hospital CEOs and spokespersons, either lauding their great scores, or defending those that are below average.   

We in healthcare know that consumers, and that of course includes all of us, are going to continue to push for more transparency. We’re used to being inspected and regulated by government and accrediting agencies, but now it looks like we’d better get out the good china, because the neighbors will be stopping by for a visit too.   

Health & Human Services – Hospital Compare

American Hospital Association Quality Advisory – May, 2007

Gardens & Glass – An Inspiration of Creative Design

Colorful glass blooms in vibrant hues are nestled among the rich exotic greens of the  Phipps Conservatory and Botanical Gardens during the Chihuly at Phipps: Gardens & Glass Exhibit in Pittsburgh, PA through November 11, 2007.  It’s an artful blend of natural and ethereal beauty, featuring glass by Dale Chihuly.

If you’re in the Pittsburgh area it’s worth the price of admission, if not, here is a sneak peek through the lens of my digital camera.

Click on the photos to see larger images.

Avoiding Allegations of Sexual Misconduct in the Healthcare Setting

The statistics regarding allegations of sexual boundary violations by healthcare providers are sobering. It is estimated that between 20,000 and 80,000 doctors in the US have faced such allegations. And this is not just a physician issue.  Nurses and other healthcare professionals also face potential restriction or revocation of licensure for boundary violations.  The issues are complex and providers are at times surprised by what a patient interprets as inappropriate behavior.

Allegations of sexual impropriety can range from inappropriate use of language to rape.  For the health care provider, sexual assaults are actionable as civil batteries and/or criminal assaults. Hospitals, under the theory of negligent credentialing or supervision can be held liable with respect to hiring, training, supervising, and retaining staff and employed physicians. It is important to note that allegations of sexual impropriety are sometimes made by patients of the same gender as the provider.

Read the full text of the article Avoiding Allegations of Sexual Misconduct in the Healthcare Setting, by Rita Schwab, CPCS, CPMSM and Lisa Venn, J.D., M.A. for guidelines regarding avoiding these types of allegations, as well as dealing with them should they arise.  The article focuses on Ohio law, but provides general guidelines for providers and organizations in all states.


Google as Healthcare Advocate?

Roni Zeiger, M.D., Product Manager, Google asks “Is There A Doctor in the Family?”

‘When I help my loved ones navigate an illness or get up to date with screening tests, I wonder how those who don’t have a doctor in the family manage their health.”

With great difficulty I imagine.

A few years ago I was diagnosed with a potentially serious illness which required surgery.  I was confident that I’d be able to navigate the healthcare system without too many problems since I’d worked as a part of it for years.

Well, let me tell you, this little grasshopper had much to learn.

1.  If you ever hope to see the doctor, be nice to the front-desk schedulers and billers.  This is, of course, easy if they treat you with kindness and professionalism. Along my journey I met a few of these folks who were positively wonderful. Unfortunately I also encountered a few who were bitter, miserable, and out to make as many converts to the dark side as possible.  Here’s what I learned; don’t let them drain away your energy, you have better uses for it.

2. Expect to be overwhelmed.  Overwhelmed with information, emotion, appointments, schedules, tests, conflicting opinions, decisions that have to be made today, and decisions that loom just over the horizon.

3.  Expect to see lots of different healthcare providers.  Physicians, nurses, technicians, therapists, and more. 

4.  Expect to get lots of bills. Within a few months I had received treatment (and bills) from a dozen different doctors.  For those of you familiar with billing, that’s professional, not technical. Technical billing piles on a whole additional stack of mail with catchy phrases like:
This is not a bill (it just looks like a bill);
- This is a bill – you owe this amount; 
– Contact your insurance company to find out why they haven’t paid this bill; and my favorite,
– Your insurance company hasn’t paid and this bill is now past due.  If you don’t pay $847,836.57 within the next 28 seconds we will be forced to turn you over to collection!

Healthcare is a very scary place to visit, and eventually, like it or not, most of us get invited for a sleep-over.

All of this is fertile soil for healthcare advocacy.  Companies and individuals with varying degrees of skill and professional ethics are advertising themselves as advocates. Enter… Google?  Not perhaps a role we might expect for a giant web search company, but Roni Zeiger, M.D., Product Manager for Google writes:

Patients need to see their doctors to get the right medical care. But better-informed patients recover faster, manage chronic illnesses better and may even avoid some illnesses altogether. And patients should feel in control of their situation.

We have been talking to many medical experts to understand what the best guidelines are, and how we can determine which ones apply in different circumstances. If such guidelines were more available to patients, they might be able to, by inputting information such as age, gender or medications, learn about recommended screening tests and other preventive measures, or about harmful drug interactions. (The problem of drug interactions is reason enough to work on this: in the U.S. alone, it is estimated that over 770,000 people are injured or die each year in hospitals from adverse drug events. Many of these medical errors could be prevented if patients or doctors checked for drug interactions.)

As we work on this project, we are of course paying very close attention to privacy. If such a tool were available, you should be able to enter as much or as little information as you want — and it’s important that you be allowed to access this kind of information without entering your name, insurance number or other personal information. We also think that if you want to save this information, you should have that choice so you can access it later or share it with your doctor.

Read the full text of Dr. Zeiger’s article: