I saw this article in the NY Times that was written by a nurse and points out the garbage they have to do that has nothing to do with healthcare. Here are some examples:
- A friend was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10. She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.
- A nurse could spend 10 minutes documenting a patient’s fall risk, or 10 minutes trying to keep patients from falling.
- Hospice care is a covered benefit under Medicare, and the Centers for Medicare and Medicaid Services maintain rigid standards for documentation. They regularly withhold reimbursement if documentation is deemed incomplete or flawed.
- Charting a hospice admission usually takes between two and four hours, and requires filling out a seemingly endless number of data fields — some of them defying logic. I once had an oxygen-dependent centenarian patient in heart failure seeking admission to hospice. The hospice physician asked for further proof that the patient met the strict standards for hospice admission. It was a weekend, and during the time it took for me to collect that information, the patient died.
- The worst, though, are the health risk assessments done for patients in Medicare Advantage, a program that pays for their coverage under certain private insurance plans. These assessments include an exam, an accurate health history, and diagnosis and documentation of the most serious possible version of the patient’s illnesses. This is known as diagnosis “capture,” and the entire process is colloquially referred to as “upcoding.” Because upcoding classifies these patients as higher risk medically, Medicare increases the reimbursement given to their insurance companies without requiring that patients’ new, more severe diagnoses be treated in any way. Independent companies exist to do these evaluations, and according to an exposé published by the Center for Public Integrity in 2014, they cost our government billions of dollars every year.
- Sadly, all the attention given to our paperwork is taking us further and further away from the difficult truth that meeting very ill patients’ needs occurs in real time with real people, not in the paperwork about them.
This is where our medical system is headed. It is called Industrialized Medicine or Healthcare and the sad part is that in the future the new nurses and doctors will accept this crap as the norm and not think for a second otherwise. That is where we lose all humanism and the job of doctors and nurses can be all automated. On the bright side, though, is that the increasing number of administrators will continue to get their medal, awards, accolades and healthy bonuses.