100 Hours of BS


I actually thought this was a parody from the site Gomerblog.  I was sent this article with title 100 Hours of Meaningful Use Stage 2 Attestation: A Success Story and just started giggling.  Then when I started to read it I realized it was actually real!

Here are some highlights, none were intended to be a joke. Try not to laugh out loud:

  • It wouldn’t happen quite that quickly, but the internal medicine doctor — who runs Symphony Medical Group, a busy, small practice in the Chicago suburbs — nonetheless finished attesting to 17 meaningful use core criteria and three measures from a “menu” of six more difficult criteria, including eight new categories new to stage 2, in six months. Maybe not record time, but pretty close.
  • The work did, indeed, take a lot of her time, which Kahn squeezed in around tending to the 800 or so patients she cares for along with a part-time doctor, a medical assistant, an office administrator and some part-time help. There was no CIO or IT director to assist; she was it.  But it was well worth it, Kahn said. “For me, the decision I made starting with stage 1 is that technology can make me a better doctor,” she said. “The decision to do this was a long-term investment on my part.”
  • While Kahn said attesting to most of the criteria was “easy,” two meaningful use stage 2 requirements in particular — both involving patient engagement and both of which seem to be the thorniest to attest to for docs in smaller practices — were anything but simple. Some of the easy tasks were moving an all-electronic prescription system (except for controlled substances, for which the DEA still requires paper in most cases), and such things as electronically recording and charting demographic and vital sign data for at least 80% of patients.
  • In the end, finishing the attestation process was just a matter of wanting to do it. Kahn just laughed when asked whether it was worth the potential total of $43,720 in federal incentive payments over five years, assuming enough of her business was Medicare-driven. “We were highly motivated to do it,” Kahn said. “In the end did I make money or lose money? It was just part of an overall strategy of excellence in healthcare. That’s the path I wanted to be on.”

Now raise your hand if you either didn’t laugh or didn’t want to puke?



Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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4 Responses

  1. Michael Callaghan says:

    It worries me to no end the number of doctors who seem to have Dr. Kahn’s attitude. I have a partner who wastes time in hospital meetings constantly and regularly comes to me to tell me about some new giant waste of time the medical axis of evil is foisting on us. He with great sincerity tells me how it will improve care, flow etc… As if there haven’t been a hundred such plans that have added to our work and been detrimental to patient care. I am a subspecialist and am so jealous of the opportunity you docs in primary care have to go around the system with direct primary care.

  2. R Watkins says:

    “a busy, small practice in the Chicago suburbs”

    She and a part-time doc have 800 patients? No, not busy at all. She’s got way too much free time on her hands.

  3. SteveofCaley says:

    A few point of coloring outside the line:
    #1) The ‘publication’ was on a company blog which produces the EHR being praised by the doctor. The doctor notes that the EHR company spent a tremendous amount of their own time getting her to pass the MU stage II. Was this how they plan to treat all providers, or was there some back-scratching going on?
    $2) In spite of this, the following is noted:
    “Now come the hard parts to attest to…
    The hardest challenge for Kahn was, she said, attesting to creating an electronic transition of care, or referral. This measure has three parts, not all of them difficult.
    The first entails electronically creating and then sending a summary of care record for more than 50% of referrals. That communication could be by fax, so that was eminently doable, Kahn said.
    The second part was markedly tougher. It requires sending more than 10% of referrals using a federally certified EHR or is part of a national health exchange. “That was a big deal, because you’re not faxing anymore,” Kahn said.For this measure, she was allowed to send to other eClinicalWorks users using the company’s proprietary peer-to-peer external portal. But because not a lot of those are near her, she used the public Direct protocol that Advocate, a local accountable care organization with which she is affiliated, uses to exchange the information with other providers.
    Finally, Kahn attested to the hardest requirement — establishing an electronic connection and exchanging test information with a randomly chosen third-party provider that was not on eClinicalWorks’ system or Direct.After many hours coordinating the exchange (Kahn estimates she spent more than 100 hours total attesting to stage 2), she succeeded. “That was really tricky,” she said.”
    Okay. There are three methods that were required to be documented.
    -The first uses the FAX machine, which came shortly after the mimeograph, and around the Disco Revolution. I note that Canon and Xerox have nerds-on-the-ground in Botswana, handling their digital printer/copier/fax needs, so we can assume that the technology is no longer “emerging.”
    -The second requires interoperability with the same manufacturer of EHR. This seems a bit redundant, as the test of the referral process is to be EHR brand-transparent. Nevertheless, it could be done, using an electronic clearinghouse through which to put referrals – albeit driven by the EHR system used, not the doctor’s choice.
    -The third involved actual transactions to other providers in a brand-transparent way. That took ‘many hours.’ The amount of 100 hours was cited in the paragraph.
    Useful technology is that which is driven by utility to the end-user. That sounds jargony, but it’s true. The internal combustion engine was not driven by the Model T – that was a recreational luxury. It was first driven by the TRUCK, which allowed the transport of things within cities at a fraction of the cost of the horse. The paving of the roads, the gasoline station, the repair shop were all brought into existence to service the truck; then, the automobile followed.
    The same goes on here for trains. Passenger trains in the US are not much to speak of; but trains cannot be beat for moving massive amounts of freight. Kilotons of taconite ore, you ship on the water or load in a train – not in a truck.
    Using this measure, then, the EHR is truly an atrocity. Referrals in a city could be much more easily handled by handwritten notes delivered by bicycle messenger; or to get modern, the telephone. Even the lowly FAX machine is really state-of-the-art when it comes to delivering readable facts.
    I garden. I use a gasoline string trimmer (which needs repair) and a small Japanese sickle. They do comparable jobs. The gasoline string trimmer is much faster AND SAFER. The use of the sickle is a quaint hobby. If the EHR mentality were to be used in agriculture, the romance of the scythe and ox-drawn plow would be seen across the land – with the appropriate iApps to assist in what to plant and reap.
    We’re on the way.

  4. paula says:

    excited to see the Onion now has a medical offshoot

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