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It Just Takes a Minute to Erode Family Medicine with Unfunded Mandates

August 7, 2011
By

Thanks to everyone who wrote me back on some of the “simple” screening tests that “just take a few minutes” that well-meaning special interest groups want family physicians to give away their time to administer. And remember, the family physicians’ nurses are busy also, so if a special interest expects only nurses to deal with the screenings, their time must be paid (and more globally, the family physician will probably need enough overall increased payment to hire a new nurse, which still won’t increase family physician income, but it will create more work for the physician.)

I’m sure this isn’t exhaustive, but here is what we came up with:

Screen for:

Depression

Anxiety disorders

Bipolar Disorder

Post Traumatic Stress Disorder

Suicide risk

Autism

Eating disorders

Exercise type and amount

COPD (in smokers mostly, but maybe secondhand smoke exposure)

Glaucoma

Peripheral neuropathy (mostly in diabetics)

Autonomic neuropathy (in diabetics)

Peripheral artery disease

Carotid artery disease

Smoking status

Asking about other smokers in the house

Readiness to quit if the patient does smoke

Guns in the house

Intimate partner violence

Dementia/Alzheimer’s disease/cognitive impairment

Fall risk

Gait and balance

Incontinence

Independent functional activities such as balancing a check book

Seat belt use

Water heater temperature setting

CO monitor in the house

Alcohol abuse

Other substance abuse

“Cardiac” screening for young athletes

Sexual activity

Notice I left off the list components of well child exams mandated under state and federal law that are kind of paid for by being bundled in the overall fee. Examples include lead levels and developmental assessments.

This next section includes the comments of  a reader that isn’t as much about screenings as it is  other work family physicians are asked to do so others can be paid. This is what he wrote:

We tend to call the small trivial tasks that other want us to perform “Death by minnow bites”

I won’t give you all of them due to time sake but just some of my favorites:

1) Primary care docs in Ohio have to complete the form for diabetic shoes when the podiatrist orders them for a patient.

2) Our medical record system “Epic” requires you to state whether the medication is a cap or tab.

3) To get OTC meds paid for by your flexible spending account you need a script. I had to write a script for alcohol swabs and band-aids the other day.

I’ll add to this list filling out forms so radiologists can be paid.

 

So in the end, we came up with over 30 different diseases or conditions some group or another expects family physicians to screen for without being paid for the time and effort it takes to not only ask the questions, but then deal with the patients with abnormal results (which doesn’t mean they necessarily have the disease. Screening tests are often constructed to over diagnose disease to minimize the number of missed cases.) Some of these screening steps are targeted to specific populations — diabetics for example — but most aren’t.

For the non-family physicians out there: If you were a family physician, would you ask all these questions without payment 25 times a day?

 

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One Response to It Just Takes a Minute to Erode Family Medicine with Unfunded Mandates

  1. Yunusemre on October 30, 2012 at 7:31 am

    I’m in total agreement. CMS drppoed the ball back in late 2008, prior to the Final Rule mandating ICD-10-CM/PCS in 2013, by failing to publish empirical data from other early adopters of ICD-10 that indeed the transition would improve quality of care, patient safety and lead to improved outcomes. While we know that gaining early by-in from physicians is critical, we are now less than 650 days out from the go-live date with only anecdotal support for ICD-10. It didn’t take a crystal ball to know that there would be tremendous physician push-back as the go-live date loomed ever closer. Regardless of the AMA’s position and clout, I would not hold my breath in anticipation of a delay, or reprieve, in the transition to ICD-10. In the end, hospital providers must work that much harder to engage physicians and gain their support for the transition, all along hoping that ICD-10’s touted benefits will sway physicians to support the mandate. Angela CarmichaelAngela Carmichael, MBA, RHIA, CCS, CCS-P AHIMA Approved ICD-10-CM/PCS Trainer

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