Why medical coding trumps caring


In the not too distant future, the following ad for primary care physicians, nurse practitioners, physician assistants, and registered nurses could be the norm.


65 percent of time entering data pertaining to patients' health history, present condition, and suggested treatment.

20 percent of time on telephone contacting insurance companies and obtaining permission for suggested procedures and prescriptions.

15 percent of time face-to-face contact with patients.


Working knowledge of EPIC, Cerner, and MEDITECH, patient clinical and billing software systems.

Experience and working knowledge in DRG's coding and billing.

Must be proficient in data entry using equipment such as laptop, iPad, iPhone, and

portable computer stations.

Exceptional telephone speaking and negotiating skills in dealing with third party authorization representatives.

Must be skilled at maintaining stringent time allotments for patient visit.


Graduate of an accredited medical and or nursing school

Completion of residency at an accredited institution

Board certified in family practice medicine

Valid license to practice in the State of Vermont

Valid DEA license to dispense medical prescriptions

This is what the practice of medicine has come down to after one has spent years in training to take care of patients in both a hospital and office setting. We have, in effect, turned our medical providers into data entry clerks and telephone negotiators.

The medical profession itself is in part to blame. They thought that there would be a panacea when the direct billing of patients was removed from their hands and into the domain of government and insurance companies. Also, when it was presented some 10 years ago that hand-written patient records were going to be a thing of the past, all jumped aboard to embrace it.

What was not known, at the time, was how the health care consulting industry, medical software developers, and equipment providers envisioned a gold mine – ready to be mined – and so they did. And by doing so, they have, in effect, "highjacked" the health care profession.

And what a "gold mine" it has been for one software company – Epic Systems Corp. of Verona, Wisc. According to a recent article in the Boston Globe, the Massachusetts General Hospital System (Partners) is spending over $1.2 billion with EPIC, upgrading its multi hospital clinical and billing software systems.

Initially, EMR had three goals – knowledge of each patient's health history, a national database on what care is being dispensed and at what cost, and, of course, a much better system of billing patient services. And with the advent of medical information technology we now have The United States Office of National Coordinator for Health Information Technology.

According to the Globe's piece, an unnamed nurse at Brigham and Women's Hospital was quoted, "EHR detracts from [her] time spent actually working with patients. I know people throughout the hospital, and they find the same thing: It's tedious, labor intensive and you feel like you can't do what you want to do." How many other Providers would like to speak out and let the public know what they think, but for fear of losing their jobs, elect not to do so?

Of course the consultants, third party payers, software and equipment vendors will tell us that their approach to medicine is the future and exceptional patient care will result.

The amount of time a Provider spends in front of a patient needs to be 85% and not 15%. The Providers are the ones who should be "driving the bus," not the software developers and the legions of consultants.

In viewing Norman Rockwell's painting, "The American Doctor," (George Russell, M.D. of Arlington), I did not see a laptop in the doctor's hands. Compassion and Caring were evident. We need to get back to when caring trumps coding.

Don Keelan writes a bi-weekly column and lives in Arlington.


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