March 11, 2012: The last few months
Well, I knew it had been a while, but didn't realize that here hadn't been one post all year. It is, honestly, something I always mean to do, but then it's 'well, tomorrow.....'
Let me tell you now that I don't really feel like communicating now, either, but this is the easiest way to explain my literary and phone call absence to the largest number of people, so I'm forcing myself. My apologies for any grammatical faults and lack of polishing, just trying to get stuff down.
There is no great horrible thing going on (what a NICE change!), although things can be boiled down to one issue: I'm exhausted. Here's the long explanation:
In mid-January the decision in the practice was to immediately ramp up the EMRs: electronic medical records. You have probably all been subjected to this in your own office visits, because everyone is being forced into jumping on board now. The insurance companies love EMRs for many reasons, not the least of which is no longer having to decipher doctor's handwriting and lots of papers. It has also made it easier to set standards (lead by Medicare, as usual) which determine the level, and therefore reimbursement, of all levels of office visits. Their goal (or at least one of the main ones) is to be sure that doctors are providing enough of an exam and decision-making to justify their charges. (Practically speaking, of course, this the same as the infamous 'no child left behind': doctors don't have to change anything they do with the patients, they just have to know how to fill out the computer forms the right way.)
When you are dealing with any huge change in doing something, there are bound to be growing pains. There are dozens, probably hundreds, of different EMR programs across the country. So my doctors decided, wisely, to sit back and see which ones emerged as the best and most user friendly. What we've discovered is that they all seem to suck. You can argue that any major change is going to be difficult, but every practice any of us has spoken to says not only is the change-over painful, but the use doesn't seem to get much better over time. The need to change over to EMRs, however, is inevitable. And it's not just the charting, it's everything: scheduling, prescribing medications & billing.
As an incentive for doctors and their practices to go through the horror of a dramatic change in their charting practices, there is a 'bonus' for switching over to EMR. The bonus started a few years ago, falls every year and in a few years will no longer exist as every practice should have switched over, and then in another few years any practice not having switched over will be fined. This year is the last that there is a decent incentive to change over. Before you think it's all profit, you need to know that there is no reimbursement for the hundreds of thousands (seriously) to implement this huge time-consuming change-over, so these 'bonuses' are needed to defray costs.
We started about September of last year, all of us getting our feet wet, learning how to use the system. The doctors assumed that the medical assistants (MAs) would be able to enter the patient's medical history, hospital reports, labs and tests--after all, they surmised, it was just data-entry. It took a few a few months for it to be evident that this system was not working. The patients are just too complicated, and with many having been there for 10-15-20 years there is a lot to sift through. Additionally, a lot of diagnoses need to be added but require being coded precisely for billing. So guess who's really, really, really good at getting all that stuff in? (One of the times that being detail oriented, slightly OCD and a little anal retentive comes in handy!) Getting this stuff in affects patient care, legal coverage and billing. While JG, the big boss, initially balked at paying my hourly wage instead of an MAs, the decision was sealed when the head biller went to him and said she was able to be more efficient, and therefore make more money, on the charts I had entered. (Most of you probably don't know that several lifetimes ago I used to do the billing for an ambulance and portable X-ray company. Who knew that would come in handy again?)
So, I've gone from working either three or four days a week, 24-32 hours a week alternating, to working 36-40 hours a week. At first I even went in for a few Saturdays, working six days a week, but that rapidly became clear that it wasn't a good idea. The plus side here is clear: more money. As someone who lives in fear of becoming more disabled my finances are of utmost importance, along with my ability to pay for insurance if I can't work. (Briefly: Yes, there is social security disability, but that is time-consuming to get, often taking 6-12 months before checks start coming in. And here's a fun fact I didn't know until the last few years: even when you are on disability it takes two years before you can get Medicare disability. That means paying for private insurance for almost three years. If I can get insurance with my medical issues it will run about $1,000 a month. It seems that most people end up on Medicaid, but you can't have any assets for that. So, if I want to keep what I've worked so hard for, a house and some money in retirement accounts, I have to pay for insurance to avoid Medicaid.)
If I can plough extra money into my home equity loan (paid for windows) and my mortgage principal while the mortgage rates are still low, then a refinance could knock off years, as well as significant interest, off my current mortgage. This would give me more options if I get worse. I'm not saying I will, just being practical and trying to plan for all possibilities. So, a few months of 'extra' money could give me a ton more of security, which makes me happy and more relaxed.
Of course, everything has a down side. More hours mean less rest and having to cram more things into the off hours. It also has translated into a substantial increase in my chest pain.
So, dramatically curtailing my already-limited social life and so tired that I get home and just shut down. People seem to have a difficult time believing that I can go long periods of time without talking, but really, I can and do. Conversation is exhausting, requires a thought process and being at least marginally interested in what the other person has to say. When I reach a certain level of fatigue and pain even these three things become impossible for me. My phrase is that I 'cocoon in', and everything that is not essential for immediate life takes a back seat. When I feel like I do right now, my chest hurting so much that even not breathing causes pain, I just stop functioning. The only reason I can type coherently is several hours on the couch recuperating after being at a long Fellowship meeting and a busy Saturday. I lie on the couch, watch TV, get up to eat and use the bathroom. That's it. When I feel a little better I can sit up and type.
The good news is that it takes much less time for me to recuperate than it did two years ago. But this isn't just one or two weeks, it's going to be for several months. I actually did fairly well for the first four weeks, and then started getting worse. I'm hoping that part of it is my body just not being used to working five days a week and that it will start adjusting. I haven't worked this much since before my second surgery in 2006, so it's been a long time since my body has had to do this. It may get better, and the hectic pace of getting the first several waves of charts entered will probably start to decrease in another few months, allowing me to leave on time (I'm now staying at least until 6pm on regular work days, then 5-6 hours on the usual days off) and maybe do just four days a week.
There is no way to know how long I'll be able to function at my current level, and there is no known damage to my heart by 'just' not resting enough. I tell myself that any potential damage is countered by the psychological benefit of being financially more secure. It's short-term sacrifice and hardship for long-term benefit, and that's something I've always been good at doing. The end justifying the means and all.
One of the ways I've coped with the spectre of becoming more disabled is that if it happens I can look back and know that I did all I could to give myself the most options and security, and then what will be will be. That's what getting sick does: it decreases your options, takes away your choices. I've had to give up dreams of what my future might have been because of the reality of a chronic, debilitating illness. It sucks. It isn't fair. I didn't do anything to deserve this. But it is what it is.
People often tell me how fortunate I am to have a job, how lucky I am they kept me on. The interesting thing is that the people I work with are never the ones who feel that way; on the contrary, they say how lucky my bosses are to have me there. Know that I am very cognizant that I'm fortunate to have the choices I do, but all were in some way gained because of my work ethic and sacrifices made in the past. Nothing in life is truly free, and this job wasn't gained and maintained because of 'luck'. But that means that when I don't feel well, when my chest is screaming in pain and every breath hurts, I still drag myself in, am pleasant and professional--and conversant. But when I'm done at work and walk out, I shut down, because it's the only way my body can continue to do this for the time necessary.
So that's why I'm not returning phone calls, making social plans or even sending out e-mails. I'll try to post every couple weeks, to again make this the central information place on me until I can go back to being more personal.
Thanks for continuing to check in, Laurie
Let me tell you now that I don't really feel like communicating now, either, but this is the easiest way to explain my literary and phone call absence to the largest number of people, so I'm forcing myself. My apologies for any grammatical faults and lack of polishing, just trying to get stuff down.
There is no great horrible thing going on (what a NICE change!), although things can be boiled down to one issue: I'm exhausted. Here's the long explanation:
In mid-January the decision in the practice was to immediately ramp up the EMRs: electronic medical records. You have probably all been subjected to this in your own office visits, because everyone is being forced into jumping on board now. The insurance companies love EMRs for many reasons, not the least of which is no longer having to decipher doctor's handwriting and lots of papers. It has also made it easier to set standards (lead by Medicare, as usual) which determine the level, and therefore reimbursement, of all levels of office visits. Their goal (or at least one of the main ones) is to be sure that doctors are providing enough of an exam and decision-making to justify their charges. (Practically speaking, of course, this the same as the infamous 'no child left behind': doctors don't have to change anything they do with the patients, they just have to know how to fill out the computer forms the right way.)
When you are dealing with any huge change in doing something, there are bound to be growing pains. There are dozens, probably hundreds, of different EMR programs across the country. So my doctors decided, wisely, to sit back and see which ones emerged as the best and most user friendly. What we've discovered is that they all seem to suck. You can argue that any major change is going to be difficult, but every practice any of us has spoken to says not only is the change-over painful, but the use doesn't seem to get much better over time. The need to change over to EMRs, however, is inevitable. And it's not just the charting, it's everything: scheduling, prescribing medications & billing.
As an incentive for doctors and their practices to go through the horror of a dramatic change in their charting practices, there is a 'bonus' for switching over to EMR. The bonus started a few years ago, falls every year and in a few years will no longer exist as every practice should have switched over, and then in another few years any practice not having switched over will be fined. This year is the last that there is a decent incentive to change over. Before you think it's all profit, you need to know that there is no reimbursement for the hundreds of thousands (seriously) to implement this huge time-consuming change-over, so these 'bonuses' are needed to defray costs.
We started about September of last year, all of us getting our feet wet, learning how to use the system. The doctors assumed that the medical assistants (MAs) would be able to enter the patient's medical history, hospital reports, labs and tests--after all, they surmised, it was just data-entry. It took a few a few months for it to be evident that this system was not working. The patients are just too complicated, and with many having been there for 10-15-20 years there is a lot to sift through. Additionally, a lot of diagnoses need to be added but require being coded precisely for billing. So guess who's really, really, really good at getting all that stuff in? (One of the times that being detail oriented, slightly OCD and a little anal retentive comes in handy!) Getting this stuff in affects patient care, legal coverage and billing. While JG, the big boss, initially balked at paying my hourly wage instead of an MAs, the decision was sealed when the head biller went to him and said she was able to be more efficient, and therefore make more money, on the charts I had entered. (Most of you probably don't know that several lifetimes ago I used to do the billing for an ambulance and portable X-ray company. Who knew that would come in handy again?)
So, I've gone from working either three or four days a week, 24-32 hours a week alternating, to working 36-40 hours a week. At first I even went in for a few Saturdays, working six days a week, but that rapidly became clear that it wasn't a good idea. The plus side here is clear: more money. As someone who lives in fear of becoming more disabled my finances are of utmost importance, along with my ability to pay for insurance if I can't work. (Briefly: Yes, there is social security disability, but that is time-consuming to get, often taking 6-12 months before checks start coming in. And here's a fun fact I didn't know until the last few years: even when you are on disability it takes two years before you can get Medicare disability. That means paying for private insurance for almost three years. If I can get insurance with my medical issues it will run about $1,000 a month. It seems that most people end up on Medicaid, but you can't have any assets for that. So, if I want to keep what I've worked so hard for, a house and some money in retirement accounts, I have to pay for insurance to avoid Medicaid.)
If I can plough extra money into my home equity loan (paid for windows) and my mortgage principal while the mortgage rates are still low, then a refinance could knock off years, as well as significant interest, off my current mortgage. This would give me more options if I get worse. I'm not saying I will, just being practical and trying to plan for all possibilities. So, a few months of 'extra' money could give me a ton more of security, which makes me happy and more relaxed.
Of course, everything has a down side. More hours mean less rest and having to cram more things into the off hours. It also has translated into a substantial increase in my chest pain.
So, dramatically curtailing my already-limited social life and so tired that I get home and just shut down. People seem to have a difficult time believing that I can go long periods of time without talking, but really, I can and do. Conversation is exhausting, requires a thought process and being at least marginally interested in what the other person has to say. When I reach a certain level of fatigue and pain even these three things become impossible for me. My phrase is that I 'cocoon in', and everything that is not essential for immediate life takes a back seat. When I feel like I do right now, my chest hurting so much that even not breathing causes pain, I just stop functioning. The only reason I can type coherently is several hours on the couch recuperating after being at a long Fellowship meeting and a busy Saturday. I lie on the couch, watch TV, get up to eat and use the bathroom. That's it. When I feel a little better I can sit up and type.
The good news is that it takes much less time for me to recuperate than it did two years ago. But this isn't just one or two weeks, it's going to be for several months. I actually did fairly well for the first four weeks, and then started getting worse. I'm hoping that part of it is my body just not being used to working five days a week and that it will start adjusting. I haven't worked this much since before my second surgery in 2006, so it's been a long time since my body has had to do this. It may get better, and the hectic pace of getting the first several waves of charts entered will probably start to decrease in another few months, allowing me to leave on time (I'm now staying at least until 6pm on regular work days, then 5-6 hours on the usual days off) and maybe do just four days a week.
There is no way to know how long I'll be able to function at my current level, and there is no known damage to my heart by 'just' not resting enough. I tell myself that any potential damage is countered by the psychological benefit of being financially more secure. It's short-term sacrifice and hardship for long-term benefit, and that's something I've always been good at doing. The end justifying the means and all.
One of the ways I've coped with the spectre of becoming more disabled is that if it happens I can look back and know that I did all I could to give myself the most options and security, and then what will be will be. That's what getting sick does: it decreases your options, takes away your choices. I've had to give up dreams of what my future might have been because of the reality of a chronic, debilitating illness. It sucks. It isn't fair. I didn't do anything to deserve this. But it is what it is.
People often tell me how fortunate I am to have a job, how lucky I am they kept me on. The interesting thing is that the people I work with are never the ones who feel that way; on the contrary, they say how lucky my bosses are to have me there. Know that I am very cognizant that I'm fortunate to have the choices I do, but all were in some way gained because of my work ethic and sacrifices made in the past. Nothing in life is truly free, and this job wasn't gained and maintained because of 'luck'. But that means that when I don't feel well, when my chest is screaming in pain and every breath hurts, I still drag myself in, am pleasant and professional--and conversant. But when I'm done at work and walk out, I shut down, because it's the only way my body can continue to do this for the time necessary.
So that's why I'm not returning phone calls, making social plans or even sending out e-mails. I'll try to post every couple weeks, to again make this the central information place on me until I can go back to being more personal.
Thanks for continuing to check in, Laurie
posted by Laurie @ 7:54 PM
1 Comments:
At 11:43 PM,
Anonymous said…
Laurie,
Start looking up asset protection,,, I am not sure of the costs, but you can do a land trust, or a business just for your home ( 123 main st, llc) - then rent to yourself,,,,,, thus you don't directly own it, and will not effect and disability/ medicaid values. You also may be abke to mive your money to a living family trust, or something similar.
Deneen
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