Joelseff Posted January 18, 2013 Share Posted January 18, 2013 As a departure from the multiple "do I have a chance?" Or "does being a lifeguard in summer camp count as HCE?" posts, I figure I would post one for the PA-Cs. I was sitting at lunch today after a hellacious morning, filled with Flu ridden diabetic, antibiotic seeking COPDers who apparently all came to my office in a bus or something, enjoying my brief moment of peace when it dawned on me......SOMEONE has to write these #@&%! charts!!! I liken charting to "doing the dishes." At first It's not much but before you know it you got stacks and stacks of them and SOMEONE has to do them....and that someone sadly is me....FML.... What do you consider "the dishes" in your practice? Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 18, 2013 Moderator Share Posted January 18, 2013 Using an EMR wearing/using vocera (electronic dog collar so you can never escape the nurses) call backs work comp forms(because documenting in triplicate is fun!) Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 18, 2013 Share Posted January 18, 2013 Middle of the night clinic visits to see someone who"forgot" to make it in for f/u appointment from the previous middle of the night visit! Oh, did I forget that it's snowing and the wind is blowing like mad making -20 seem even colder! The not being able to sleep b/c you are so po'ed after the visit is icing on the cake! Link to comment Share on other sites More sharing options...
jmj11 Posted January 18, 2013 Share Posted January 18, 2013 Returning phone calls at the end of a long hard day, when I was hoping to actually see the sun for the first time in a couple of weeks (always going to work in the dark, working through lunch and going home in the dark). The worst phone calls are: 1) (after spending a hour persuading someone to start on a preventative medication because they report severe migraines every day) and the message is, "I took that 1/2 20 MG Nadolol you gave me and immediately I had chest tightness, numbness down both arms, my arches in my feet went flat, my stools now floats, my nails have lines in them now and never did before. I called my mom, who is a nurse in Atlanta, and she told me that prescribing nadolol for headaches was very stupid and dangerous. She is really angry at you. . . as is my dad (he is a brain surgeon) . . . and my pastor (he is the Pope) . . . and my neighbor (Oprah) . . . and my aunt . . . did I mention my grandma (Nobel Prize winner) is mad as hell at you too. Grandma said that Dilaudid is what her neurologist gives her and he is brilliant. Please call me back before 7 PM because I'm leaving for the International Space Station in an hour and will be out of reach for nine months." Okay, I digress. 2) Dr. X at the ER wants you to call him asap, he is mad as hell at you because YOUR patient (whom I haven't seen in a year and never did anything I asked them to do, including keeping their follow up) is in HIS ER. (Hmm . . . I think when they walk into the ER, the patient is NOW, the ER Doctor's patient.) The other "dishes" are: PRIOR AUTHS for Drugs which the insurance company has no clue what they are for or why I chose them and me telling them is like talking to a fence post. Link to comment Share on other sites More sharing options...
jdenning Posted January 18, 2013 Share Posted January 18, 2013 Thank you thank you for something different than the "do I have a chance" threads.... My first chuckle was that you apparently have time for lunch (!) I try to eat at my desk and do calls very similar to what Mike describes. The best one this week was from a school nurse who was "shocked" that we would order oral prn lorazepam (you know, that nice stuff that melts right in your cheek?) for breakthrough seizures in a student with medically intractable epilepsy and don't we know that you shouldn't put anything in the mouth of a person having a seizure???? I left her a message back offering orders for oral ativan or rectal diastat - you choose...and I'll gladly send the order. I'd die if we had paper charts. I actually stay mostly caught up on EMR I have a whole host of daily dishes but the one that REALLY gets me is the paperwork from the "scooter store." 28 pages. No kidding. We even have a charge code for this now. ANd home health. Fill out 5 pages of why the patient is homebound and then have to run around to find an MD to sign it I can think of endless examples..... Link to comment Share on other sites More sharing options...
Joelseff Posted January 18, 2013 Author Share Posted January 18, 2013 LOL, no I have 5 minutes to myself at "lunch" but I eat at my desk while I "do the dishes." ;) Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Guest Paula Posted January 18, 2013 Share Posted January 18, 2013 Getting a note from BC/BS that my medicare patients lipitor is not on the formulary and to change to another drug. To find out what drug is on the formulary requires logging onto their site and searching for the formulary, no where to be found until you realize you have to apply for the insurance...huh? Why can't the form letter have the alternates just listed for us? And trying to get a representative on the phone is ridiculous. SO, I just write for simvastatin and hope it is on the list. No one else in the office wants to do this type of research. The next dish is when a my SP is almost in tears because he is so overwhelmed with his practice, that I have to do the paperwork to authorize albuterol inhaler for a child to take to school.....not a hard task, but the SP is not all that overwhelmed. I laughed and said Good Grief when the nurse asked me to do the paperwork. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted January 18, 2013 Moderator Share Posted January 18, 2013 The worst phone calls are: 1) (after spending a hour persuading someone to start on a preventative medication because they report severe migraines every day) and the message is, "I took that 1/2 20 MG Nadolol you gave me and immediately I had chest tightness, numbness down both arms, my arches in my feet went flat, my stools now floats, my nails have lines in them now and never did before. I called my mom, who is a nurse in Atlanta, and she told me that prescribing nadolol for headaches was very stupid and dangerous. She is really angry at you. . . as is my dad (he is a brain surgeon) . . . and my pastor (he is the Pope) . . . and my neighbor (Oprah) . . . and my aunt . . . did I mention my grandma (Nobel Prize winner) is mad as hell at you too. Grandma said that Dilaudid is what her neurologist gives her and he is brilliant. Please call me back before 7 PM because I'm leaving for the International Space Station in an hour and will be out of reach for nine months." Okay, I digress. This is poetry. Oh, and E- we have Vocera too. At our place, I guarantee the nurses hate it more- they have the "collars" but we have the full-on phones that make it so much simpler to call out from. At our main facility, the clerks don't do any of the calling or paging- we do that ourselves, so the phones are invaluable so that we're not constantly tied to the desk. Link to comment Share on other sites More sharing options...
jen0508 Posted January 18, 2013 Share Posted January 18, 2013 Dictating. It takes me about 5 min to dictate each chart. 25 patients a day, thats over 2 hours dictating... blah!! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 19, 2013 Moderator Share Posted January 19, 2013 Dictating. It takes me about 5 min to dictate each chart. 25 patients a day, thats over 2 hours dictating... blah!! if you switch from dictation to emr you will easily DOUBLE your documentation time. I can document a great note via dictation in 2-3 min which is several pages long. to get that depth of documentation via emr takes me 10-20 min/chart once I deal with all the mandatory bs that has nothing to do with pt care. a procedure note to remove a simple splinter via emr in our system is 2 pages long with probably 50+ things to enter, very few of which have anything to do with the procedure. I know I am old fashioned. I like dictation>paper>>>emr. I also like stick shift cars with roll down windows, stereos with knobs instead of buttons, and watches I can wind. Link to comment Share on other sites More sharing options...
just_me Posted January 19, 2013 Share Posted January 19, 2013 I also like stick shift cars with roll down windows, stereos with knobs instead of buttons, and watches I can wind. :O_O::O_O::O_O: I just couldnt... Link to comment Share on other sites More sharing options...
mickey008 Posted January 19, 2013 Share Posted January 19, 2013 Do I have a chance ? ;) kidding .. Appreciate you guys so much for helping us out on top off all the bs you have to deal with ! :) Link to comment Share on other sites More sharing options...
entpac Posted January 19, 2013 Share Posted January 19, 2013 Waiting on hold for a peer to peer review for radiology approval. I have never been "denied" the ordered study. Can't understand why the approving authority can't figure it out by our documentation. Link to comment Share on other sites More sharing options...
jmj11 Posted January 19, 2013 Share Posted January 19, 2013 I also like stick shift cars with roll down windows, stereos with knobs instead of buttons, and watches I can wind. Just picked up my Jeep unlimited soft top in Portland last week end. It is an automatic. The first I've ever owned in my life. Weird. Jeeps shouldn't have automatics. Does make driving in Seattle's hills a bit easier though. Good news, still has roll down windows and no electronic crap. That's why I've always driven jeeps or old Landrovers. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 19, 2013 Moderator Share Posted January 19, 2013 just got a new car a few days ago (2013 honda fit) after my last car( a 98 civic) was stolen from the parking lot at work and found stripped 2 days later. stick shift. no option for roll down windows. Link to comment Share on other sites More sharing options...
Teasip Posted January 19, 2013 Share Posted January 19, 2013 I love the references regarding manual transmission, roll down windows, etc.. How about being able to actually fit under a car and change your own stinkin' oil without ramps or jack stands? I always believed that you weren't good at dictating (good lord, almost twenty years ago now) if you didn't get a call from MR/transcriptionist asking if you could slow down. It was great to also have default, problem-oriented PE's to have them throw in, as long as they truly met the default exam that you set up. GOSH, I miss the good ol' days! Link to comment Share on other sites More sharing options...
jmj11 Posted January 19, 2013 Share Posted January 19, 2013 just got a new car a few days ago (2013 honda fit) after my last car( a 98 civic) was stolen from the parking lot at work and found stripped 2 days later.stick shift. no option for roll down windows. Sorry about the car. Meth heads are people too. They need a way to make some bucks to buy their chemicals. I hope you had good insurance. We only had one car stolen (my daughter actually lost the car . . . forgot where she had parked it . . . someone took it). It was recovered a couple of weeks later, with several small repairs completed, like the radio was fixed and it had a full tank of gas. Not many turn out like that. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted January 20, 2013 Share Posted January 20, 2013 if you switch from dictation to emr you will easily DOUBLE your documentation time.I can document a great note via dictation in 2-3 min which is several pages long. to get that depth of documentation via emr takes me 10-20 min/chart once I deal with all the mandatory bs that has nothing to do with pt care. a procedure note to remove a simple splinter via emr in our system is 2 pages long with probably 50+ things to enter, very few of which have anything to do with the procedure. I know I am old fashioned. I like dictation>paper>>>emr. I also like stick shift cars with roll down windows, stereos with knobs instead of buttons, and watches I can wind. In my student-experience in EM all the documentation we did was the "T-sheet". My first EM job is the same way...the only documentation I have to do is on the T-sheet, and of course writing admit orders. I'm starting a PRN job at a larger hospital urgent care and was surprised to find that I will have to document full h&p via either EMR or dictation. Is this common in EM / Urgent Care?? One of the MANY things I loved about EM was the simplicity of documenting on a T-sheet. Link to comment Share on other sites More sharing options...
Teasip Posted January 20, 2013 Share Posted January 20, 2013 Loved the paper version of T-Systems. Company sold by original ED physicians to a larger entity I've heard. Did some brief consultation work with them when they were developing the electronic version. Never got to see the finished product since I left EM shortly thereafter. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 20, 2013 Moderator Share Posted January 20, 2013 electronic T is by far the best em emr out there...unfortunately most systems are going to epic which I personally detest but have learned to use. takes me at least 3x as long as a t-sheet and probably 4 times as long as dictation. most places are going to an emr. it's hard to escape them in 2013. my job at which I dictate goes to epic this summer.... Link to comment Share on other sites More sharing options...
Just Steve Posted January 20, 2013 Share Posted January 20, 2013 it's my understanding that there are federal dollars tied to EMRs...I am sure some of you folks will set me straight, but if I recall hearing correctly, providers need to be on electronic medical records by a certain date to keep receiving Medicare reimbursement or something like that Link to comment Share on other sites More sharing options...
Teasip Posted January 20, 2013 Share Posted January 20, 2013 Wish they had also developed an electronic record for primary care.... Link to comment Share on other sites More sharing options...
jmj11 Posted January 21, 2013 Share Posted January 21, 2013 it's my understanding that there are federal dollars tied to EMRs...I am sure some of you folks will set me straight, but if I recall hearing correctly, providers need to be on electronic medical records by a certain date to keep receiving Medicare reimbursement or something like that It is a carrot and a stick. A practice can receive as much as $48,000 in incentive money over three years for implementing EHR but will receive a reduction in payments (forgot the amount) if they don't. PAs got screwed in the law. We are required to live up to the letter of the law for the EHR requirements but the incentive money is max out based only on medicare payments made to the SP and the PAs work in seeing patients is totally invisible. So in my situation, where I see 99% of the patients, the attestation is a huge burden, and the maxim incentive money we can get (because PAs are invisible to them) is about $6-8,000 over three years rather than $48,000. Link to comment Share on other sites More sharing options...
Guest Paula Posted January 21, 2013 Share Posted January 21, 2013 It is a carrot and a stick. A practice can receive as much as $48,000 in incentive money over three years for implementing EHR but will receive a reduction in payments (forgot the amount) if they don't. PAs got screwed in the law. We are required to live up to the letter of the law for the EHR requirements but the incentive money is max out based only on medicare payments made to the SP and the PAs work in seeing patients is totally invisible. So in my situation, where I see 99% of the patients, the attestation is a huge burden, and the maxim incentive money we can get (because PAs are invisible to them) is about $6-8,000 over three years rather than $48,000. This is one of the reasons I started doubting the AAPA. I emailed them about this and never got an answer. There was a response in one of the PA journals that AAPA "assumed" that PAs would be part of the incentive program because of their relationship with doctors. Then, they tried to fix it and CMS only partially fixed it for PAs who are in rural clinics AND are the main provider. So, I still do not qualify, but we do not have EHR's yet either, so it doesn't matter for me yet. But, I was enraged that AAPA was negligent, IMHO, and this has hurt the PA profession. Does anyone know if this incentive money is ongoing? We start EHR in about 6 months and I will be really irritated then if I work my butt off for nothing. Link to comment Share on other sites More sharing options...
jen0508 Posted January 21, 2013 Share Posted January 21, 2013 In my student-experience in EM all the documentation we did was the "T-sheet". My first EM job is the same way...the only documentation I have to do is on the T-sheet, and of course writing admit orders. I'm starting a PRN job at a larger hospital urgent care and was surprised to find that I will have to document full h&p via either EMR or dictation. Is this common in EM / Urgent Care?? One of the MANY things I loved about EM was the simplicity of documenting on a T-sheet. I dicate a full H & P. I work for a small town EM group, they are pretty old fashioned. Its annoying sometimes, but i feel that i am able to defend my medical decision making better by dicating rather than checking boxes on a T sheet Link to comment Share on other sites More sharing options...
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