by Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN
by Michael Miller DO, FACOS, FAPWCA, WCC
It has been said that even a blind squirrel finds a nut once in a while. Like Isaac Newton who discovered gravity courtesy of an apple hitting his noggin and Ben Franklin discovering electricity by flying a key laden kite into a Philadelphia storm, even lowly rambling wound care guys trip over the truth. So many questions and so few answers until…there amongst the trees appears a forest. And so, in the spirit of the Indianapolis Colts finding a diamond in Andrew Luck, I am pleased to announce that I have recently identified the presence of a multi-tribal primitive species existing amongst us. Based on their aberrant business behavior, their ability to masquerade as Homo sapiens, their will-o-the-wisp flashes of humanity (interspersed with maniacal idiocy) and their unquenchable thirst for complexity and deception, I have proudly named them after our current governmental medical overlords.
Bureaucratis Medicarum (Subhumanis) was recently identified by a team of physicians and their biller/coders (led humbly by myself) poring through documents, claim denials, and insidious SPAM. Based on countless complex and indecipherable correspondence, we have identified several better known tribes that represent this species. They include: AnthemBlewit, In-cigna-ficant, Inhumana, Saga-less-Sickpoint, Medicareless, and the more primitive, poorer, less educated cousin, Med-impede.
The majority of our evidence came from a review of correspondence from what appears to be the original but now defunct Fiscal Intermediary called NGS (roughly translated from “Nobody gets sympathy”).We identified a sudden change in leadership to the successor WPS based on carbon dating, DNA Rapid Sequencing and looking at the dates on e-mails. It appears that each tribe has an inherent mutational genetic version of the Hayflick 50, which increases incompetence and reduces efficiency as it ages allowing newer tribes to usurp the weaker. Interestingly however, it appears that the most inefficient, incompetent and apathetic members are absorbed into the new tribes and become trainers. One universal feature is that the tribal chieftains all assume the respected title of “Medical Dissuader.”
Heads of the departments embark on frequent “Vision Quests.” They go to sleep to have a psychotic break from reality in which they temporarily believe that they must help people. This behavioral aberrancy has been termed “Hallucinatory Altruism.” These Vision Quests apparently help them learn what to avoid in their day-to-day existence as the residual humanitarian trauma causes them to exhibit the caring, compassionate nature of a three year-old on a diet of Lucky Charms marinated in Jolt Cola.
Tribal members gain status by forcing adversaries to comply with mandates with more status points received when the victim complies in response to written commands and points lost when actual person-to-person communication occurs. Carefully translated tribal documents demonstrated repeated use of derogatory terms to define tribal enemies including “Providers”, “Clients” and “Hospitals” with special emphasis placed on “Patients”, and their equivalent of the F-bomb, “Claimants.”
If one looks closely, there is evidence that your current, modern insurance payers may actually have members of these primitive, one-dimensional thinking species. Things that strongly suggests their presence include receiving documents requesting information with the new heading unrelated to a previous old one; responses to your correspondence requesting the same information while acknowledging receipt of the original, identical submission; cited names and phone extensions of accountable personnel whose names and extensions change between each correspondence; and the more confrontational and hence, less obvious battle plan of asking for patient records, citing random(and all too often ambiguous or non-pertinent) rules and regulations and then seeing if you (the enemy) are astute enough to fight or merely fall for the bluff by allowing your challenge to go unchallenged. American Indian terminology defines this as “Counting Coup.” Since their methodology is based on a “smoke and mirrors” mentality, the disciplinarians (the terms Department Head and Case Manager are more recent titles) assure that tribal members who are potentially in direct contact with outsiders limit their education to that comparable to the average 3rd grader (though with better hygiene). Interestingly, the less education and compassion a Department Head/Case Manager can maintain amongst their inferiors, the more meteoric their rise to positions of authority. One universal key to the survival of their genotype is the ability to create layer upon layer of tribal officials, none of whom ever takes responsibility and thus, eliminates any life-shortening stress on their part.
After extensive review of a myriad of documents, use of University experts on primitive societies and talking to my buddy, Eric in Wisconsin, we feel that the essence of identifying their presence comes down to recognition of several repetitive findings (think quasi forms of bureaucratic, psychological dung) including their genetic inability to agree on best therapy, their unquenchable thirst for inconsequential, numerical data and their incessant failure to commit to a given, logical recommendation.
I know there are many of you reading this blog who are showing your agreement in bobble-head-like fashion. I want to assure you that, despite this diatribe which I have attempted to write in acerbically, humorous fashion, I am nonetheless convinced that these oversight entities can and must survive. However, they need to realize that an employee’s entry into the inner sanctum of the tribe means unquestionable loss of reference as to how their decisions affect providers and patients on a day-to-day basis. You cannot serve two masters and so working for payers means you do not work for patients…PERIOD.
Why not utilize these same people in a way easily recognized as efficient such as by tracking outcomes-based care evaluations wherein comparison of costs, outcomes, etc., in the same fashion as nursing homes are performed and moreover, published for the public to see? I was recently looking at the chart of the patient who saw me after abandoning her Wound Dabblers after two 11044 surgeries and 48 hyperbaric dives for a diabetic heel ulcer. I found it interesting that the X-rays eight weeks later showed no evidence of change in the normal, bony architecture despite two documented surgeries which removed “infected” bone. Moreover, she had never received antibiotics for the osteomyelitis diagnosis that put her in a long-term care facility. Call me paranoid, but I think her care probably needs to be looked at a little more closely. Never mind that my changing her subsequent care to a bi-weekly 11042 wound debridement, a foam dressing changed every other day and full weight bearing produced 75 percent healing in three weeks.
When will there be meaningful reviews such as a “Gestalt-ish” overview of diagnoses, average time to healing, average costs to heal, and patient satisfaction? Bad actors (those Wound Dabblers) always eventually stick out like sore thumbs. There needs to exist an easily reached and identifiable ombudsman function whose job it is to be an entry point for all complaints and concerns from caregivers like myself; who would not just refer it to another internal entity for resolution, but act as the point of contact for that concern until some form of resolution is reached. Let me assure you, writing to your legislator is a great way to vent your spleen, but they are far too busy to do more than act as a gadfly to vex insurers with thinly veiled but idle threats. Why not hire a panel of physicians, billers and lay people who review cases and decide what is and is not appropriate? These would be part-time, compensated positions in which their opinions would be used by the next level to juxtapose accepted community and evidence-based medical standards to find a common thread on which to base a treatment decision in human, compassionate, realistic terms. I cannot imagine that any doc, nurse, or patient who has experienced any aspect of the health care system even once, would not jump at the chance to be a part of the “fix.”
And yet, the trend towards increasing complexity in the name of better care progresses in tsunami fashion. ICD-10 seems to be the Lindsey Lohan of the health care industry. Outside it oozes with glitz and potential but beneath the facade it appears to exemplify the term “train wreck.” The delay in implementation seems to bode only significantly more time spent in uncompensated and less productive outcomes. Why this unquenchable thirst towards complexity? Will knowing that there has been a documented trend towards injuries of the fourth finger on the left hand result in any meaningful data that can impact care… perhaps result in a federal mandate to invent a glove to protect the fourth finger PIP joint?
As far as the migration of these tribal members into other professions and venue, we have reason to believe their influences extend beyond the medical profession into the Banking, Mortgage/Title claim (more on this next blog) and soft-serve ice cream industries. Until we ramble together next time.
About The Author
Michael Miller DO, FACOS, FAPWCA, WCC is the Founder and Medical Director of The Wound Healing Centers of Indiana and IndyLymphedema, as well as a clinical consultant, teacher, inventor, and published author.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.