where the writers are
Day 2

Second day and I didn't leave the office until past 8pm, I had still been in the trenches after 6. Several notes still haven't been written, I just had to make myself leave. I did have several pretty complex patients but I failed to take control of myself. While I think it is therapeutic to create the illusion I have all the time in the world, I don't, and I'm going to have to dig in and figure this one out, it's costing me time at home while I'm still awake.

The catch is the burden of writing a note which meets the standards of CMS, in other words Medicare and Medicaid. It feels as though the regulations were written for no other reason than to give them a reason to refuse the pitifully small payment that they dole out grudgingly for some of the most intractable and unwell patients. The individual who really needs me to spend time with him, rather than devoting 20 minutes to writing a note which both meets criteria for payment, and adequately describes the visit, the interaction and the plan. These goals seem to have nothing to do with each other. It ain't easy...

So the dilemma: does one short change the patient to meet the need to bill, or does one risk an audit and spend the time really present with the patient, chancing that payment will be denied. And let's remember this is what I do for a living so reimbursement is paramount.

It isn't a happy thing. Mix in my need to leave a plan that can be understood and executed by others should I become too unwell to work. That's already happened once so I know it's a reality. And the days in clinic start to become unbelievably complicated internally. The constant tension between competing interests is the additional stressor that makes work so laborious and draining. And as we all say, I went into this to help people.

Thursday is another day, I'll try to do better.