We often get letters of gratitude and thanks. It is very rewarding to diagnose an obscure headache disorder that is an easy fix that changes someone’s life. However, today we got the first critical letter that we have received since we opened our doors two years ago. In this letter the patient expressed her anger that I had typed on a laptop during her visit, therefore, even though she is much better, she is never coming back.
This really hurts for a couple of reasons. First of all, if my typing communicates that I don’t care or that I’m not listening, then nothing can be further from the truth. I have lost many of nights sleep thinking about my patients and how I can help them better. But the second reason is that no one hates this situation more than I do, being forced to type on a laptop all through the visit. Medicine didn’t use to be that way. I want to briefly explain our side and I would welcome any solution to this problem.
The Documentation Requirements
Medical care is under a growing requirement to document what occurs during the visit. The first level of documentation is what we require to help you get well. These are the really important notes. The second layer is what the lawyers say we must document to prevent lawsuits. The next layer of additional documentation is what the insurance companies now require so that they will pay us. The last layer is the part of Health Care Act (AKA “Obama Care”) known as the HITECH Act. It is requiring medical practices to use electronic medical records (EMRs), use them a lot, or face cuts in their—already dismal—Medicare payments. The problems with EMRs are; 1) The good ones are very expensive, over $40,000 just for the software, 2) They are one size fits all (designed for Family Practice) and for a sub-specialty practice, such as headache, they are very cumbersome to use and actually slow things down despite our many modifications and 3) Due to the HIPAA laws, there has to be so much security with patient records that they are constantly locking us out, make it much slower than normal computer typing.
The simple solution, you would think, is hiring a transcriptionist or taking a few mental notes and then sitting and typing after the appointment. Both of these are not possible due to financial limitations.
The Financial Limitations
I have touched on our financial situation before and sometimes I come back and delete those postings. It is not considered professional to talk about medical finances and the other point, is that it sounds like we are whining. But you have to understand the economics of running a headache practice to understand the predicament we are in. Headache medicine is not a lucrative business and that’s why headache clinics are few and far between. Reimbursement for what we do is extremely low and the work is very time consuming. I’m confident that the reimbursement is low because headache disorders themselves are disrespected.
In our practice we are extremely frugal in how we run our business. I, Michael, pay myself at the 5th percentile of my profession. I now earn less than I did 20 years ago. I do my own day to day business management and even my own janitorial work. We all work very hard, with typical 10 hour days. I’m not sharing this for pity sake as I love helping people get well and I was never in to headache medicine for the money. If I wanted to get rich I would certainly do something different like driving a garbage truck.
The demand for our services is through the roof and we see patients all day long. We have to charge a ridiculous amount for office visits. However, because medical practice expenses are exuberant and the insurance companies pay us pennies on the dollar we are often faced with insolvency. There is no way we could afford to pay someone to sit in the room and do all our typing for us. My biller tells me that If we saw fewer patients so we would have time to type between them that we would be quickly bankrupt.
So we have to live in this uncomfortable world where I have to sit and look at a computer screen and type in information as I’m listening carefully to my patients. If I don’t keep up the typing our practice would quickly cease to exist.
If you have any other ideas how we could avoid this necessary evil, please let me know. But please don’t misunderstand this as rudeness or lack of interest. I just wish there was another way.