I have a bit of a vision problem. In a response to my email inquiry SIGforum's Official Eye Doc indicated the likely cause and treatment options. I made an appointment with a local eye doc took a copy of his analysis with me.

And that's when the fun began.

When I made the appointment, and also subsequently when I arrived for the appointment, I told them, very clearly, that I was there for a consultation on a very specific issue. I have done my share of standing in front of a class. I have done a fair amount of technical writing. Even though I might have difficulty understanding what you say (hearing impaired), I speak clearly and I am more than capable of conveying a concept.

No joy.

I was sequestered in an office for the better part of an hour with a blonde. Now I understand the stereotype. Blonde. 'Nuff said.

She felt that she had to check every box even though 99% of her routine was totally irrelevant, nothing at all to do with the reason I was there. Nothing at all.

A tremendous waste of time, and I am sure that my insurance will pay for items that were totally unnecessary.

I tried to keep it on track and focus on the reason that I was there. Nope, it ain't gonna happen.

She wanted to dilate "because it should be done yearly." Uh, sweetheart, my eyes have been dilated and examined at least a dozen times in the past eight months in conjunction with my cataract surgery. No, we don't need to do it again today, it has nothing to do with the reason I'm here, and we don't need to pay for unnecessary things.

She wanted to do a refraction "to make sure that I have the best correction." Uh, sweetheart, we have had multiple refractions in the past eight months in conjunction with my cataract surgery. No, we don't need to do it again today, it has nothing to do with the reason I'm here, and we don't need to pay for unnecessary things. My insurance does not cover refractions, and I am NOT going to pay out of pocket for something that is not needed.

She wanted to check my glasses in order to get the prescription into the record. "Uh, sweetheart, I just handed you a copy of the prescription. Can we move along to the reason I'm here?"

Then came the reading of the charts. Right eye, left eye, both eyes, with glasses, without glasses, NONE OF WHICH HAD ANYTHING TO DO WITH THE REASON I WAS THERE!

All of this wasted time, using her billable time, occupying exam room space, for well over an hour, before the doc made his appearance and got right down to the complaint. Note that he did not refer to ANY of the endless bullshit that Blondie had recorded.

It took the doc about ten minutes to determine his diagnosis and give me a referral to a specialist.

Ten minutes of useful time, out of an hour and a half.

Is it any wonder that medical costs are out of hand? A huge amount of time for useless crap that has nothing at all to do with the problem.

And, so easily avoided. How about the doc making a very short preliminary interview, it might take all of three or four minutes, to determine what screening is actually necessary, what "standard" tests the assistant should administer, etc. before the doc returns for the "real" exam?

In this case, the preliminary triage would have been all that was necessary. An hour and a half could have been boiled down to five or ten minutes.

Yeah, I'm aggravated, and I fully expect the initial appointment with the specialist to go down exactly the same path. Such a waste of time (both theirs and mine) and resources.

So what you're saying is your vision problem prevents you from seeing things their way?

You said "billable time".

There's a hint right there that even Ray Charles can see, and he's both blind, and dead.


I loathe what "business" has become. Nothing but hewers, everywhere.

2 things: Lawyers and ACA. End of discussion.

Jim

I think I would have been a little more insistent that she stop following the "standard" routine, and go get the doc so that you could get down to brass tacks. But you were probably scheduled with that standard prep in mind, so the doctor may not have been free when you arrived.

You can't really blame the girl, she is just doing what she was told to do. It is the doc's fault.

lemmie get this straight.

yer in a room
alone with a blonde

and you never asked what color panties
she was wearing....


I'ma startin to worry about ya....

Lawyers and the ACA BS.

The ruination of healthcare.

quote:

Originally posted by jhe888:
I think I would have been a little more insistent that she stop following the "standard" routine, and go get the doc so that you could get down to brass tacks.[quote]Believe me, I kept dropping hints at this. My impression was that her IQ was not much above room temperature and she either was not capable of independent thought, or maybe she was afraid of the consequences of not following the standard procedure.[quote]You can't really blame the girl, she is just doing what she was told to do. It is the doc's fault.

Maybe not so much the doc's fault, as the office manager. They seem to be in charge of things, in general, and the docs typically do not challenge them as long as the $$$s keep rolling in. I don't know whether you're a sole practitioner, but if you are in a large law firm, your clients might be seeing a similar thing, where the office manager and admin staff do their own thing and the attorneys might be the last to know about it, unless a client speaks up.

quote:

Originally posted by HRK:
lemmie get this straight.

yer in a room
alone with a blonde

and you never asked what color panties
she was wearing....

I'ma startin to worry about ya....

She was not at all offensive to my eyes (although part of that might be attributed to blurry vision), but I am not at all turned on by a female who does not exhibit the capability of thinking logically.

Fortunately, I hit the jackpot with my wife -- brains and beauty. Both wives, actually. Not at the same time, though. That would have been kinky.

quote:

Originally posted by FN in MT:
Lawyers and the ACA BS.

The ruination of healthcare.

This particular bitch has nothing to do with the ACA. It has everything to do with the creation of CMS. I wish everyone understood that EVERY ASPECT of medical billing, coding, reimbursement, etc., including (if not especially) rates that we deal with today is the direct result of the creation and implementation of CMS (or whatever it might have been called back then).

Thanks, LBJ, you socialist bastard. May you rot in hell.

-Rob

quote:

Originally posted by BurtonRW:
This particular bitch has nothing to do with the ACA. It has everything to do with the creation of CMS. I wish everyone understood that EVERY ASPECT of medical billing, coding, reimbursement, etc., including (if not especially) rates that we deal with today is the direct result of the creation and implementation of CMS (or whatever it might have been called back then).

Thanks, LBJ, you socialist bastard. May you rot in hell.

-Rob

Are you saying that MediCare mandates the stupidity that I encountered yesterday? Looking back at it, I now have the feeling that the whole thing was choreographed by the Stooges.

quote:

Originally posted by V-Tail:

quote:

Originally posted by BurtonRW:
This particular bitch has nothing to do with the ACA. It has everything to do with the creation of CMS. I wish everyone understood that EVERY ASPECT of medical billing, coding, reimbursement, etc., including (if not especially) rates that we deal with today is the direct result of the creation and implementation of CMS (or whatever it might have been called back then).

Thanks, LBJ, you socialist bastard. May you rot in hell.

-Rob

Are you saying that MediCare mandates the stupidity that I encountered yesterday? Looking back at it, I now have the feeling that the whole thing was choreographed by the Stooges.

Well... pretty much, yes.

In a slightly generalized nutshell, CMS is the original reason for the national standardization of medical billing and coding. Likewise, CMS reimbursement rates are a key part of the formula for every chargemaster in use (the coverage and reimbursement agreements entered into by insurers and providers).

So... when the government mandates X,Y,Z must be done to be reimbursed under ICD-9 code 1234.5, everyone pretty much falls in line since that's the standard of care / standard of practice.

Health care is not the problem. Even the delivery systems are good for the most part. The problem is that due to excessive government involvement, starting with CMS in the 60s, the financial and regulatory aspect of it is, for the most part, entirely artificial.

-Rob

Just to clarify what's going on: I have pretty good vision in the morning. As the day progresses, my vision gets a bit blurry, more so with each passing hour. Watery eyes, etc. This is definitely associated with the production of tears. I had thought this, and SIGforum's Official Eye Doc (bcereuss) confirmed that in an email exchange. I told them that when I made the appointment at the ophthalmologist's office, and I told them that again when I checked in.

It is associated with tears.

Dilation is not necessary, it won't help one little bit in diagnosing the problem.

Refractionis not necessary, it won't help one little bit in diagnosing the problem.

Reading the eye chart is not necessary, it won't help one little bit in diagnosing the problem.

Checking my glasses for prescription is not necessary, it won't help one little bit in diagnosing the problem.

At each step of the way, I asked "Blondie" why we were doing this, when it clearly was not involved with the reason I was there. She had no answer, other than that was what she was supposed to do. I did not push her too hard, as it was painfully obvious that I was not going to change anything, other than I refused dilation, I refused refraction, I did not surrender my glasses to be checked for prescription, I responded to each of these requests with a refusal. I went along with reading the chart.

Finally, after an hour or more of screwing around like this (no, not screwing around with Blondie, not even tempted), in comes the doc. He takes a look, announces that it appears that my tear production is normal but the plumbing that provides for drainage seems to be blocked, causing a back-up of tears; thus the watery eyes that cause progressively increasing blurriness, hour by hour, during the day. He applies some dye type eye drops so that he can see where the tears are going, says he'll be back in five minutes to take a look.

Five minutes later, he's back, looks, verifies what he thought, declares that his practice does not deal with this and gives me a referral to a specialist who is both an ophthalmologist and a plastic surgeon.

My time spent at that office yesterday, hour and a half, maybe a bit longer. Total productive time, from the time that the doc walked into the exam room until I was walking out of the exam room, less than ten minutes.

Diagnosis: epiphora. Not uncommon in us geezers, tends to show up after age 60 or so.

I'm not sure what the treatment will be, I'm guessing some sort of Roto-Rooter to un-block the drainage system, hope to know more one week from today when I visit the specialist.

My bitch: why in the #)(*&^$ did we need to waste all the time discussing the non-need for irrelevant crap with Blondie? Why can medical practitioners not be guided, just a tiny bit, by the patient's complaint and take a quick look first, without going through all the BS of checking all the boxes on the form, even though a pet rock would be smart enough to recognize that most of them have absolutely nothing to do with the problem?

Is it because the system is set up to treat patients as if they are brainless idiots? 'Cause that's how I feel that they are treating me.

The system is set up to treat all patients the same, because that is what seems most efficient. Almost all patients are in for routine eye exams and to see if they need a new prescription. So the system pushes everyone through that path.

It is an eye exam and glasses practice, so they treat everyone like that, even if you aren't in for eye exams and glasses.

I'm in total sympathy and agreement with you. However I just want to state that the 2 humorous responses had me rolling with laughter. Well done.

quote:

Is it because the system is set up to treat patients as if they are brainless idiots? 'Cause that's how I feel that they are treating me.

quote:

Health care is not the problem. Even the delivery systems are good for the most part. The problem is that due to excessive government involvement, starting with CMS in the 60s, the financial and regulatory aspect of it is, for the most part, entirely artificial.

-Rob

Yes this is the problem. Forms and checklists necessary for reimbursement. Generally not billable time by the physician. This is what happens when we allow the government and large corporations to run health care.

quote:

Originally posted by jhe888:
The system is set up to treat all patients the same, because that is what seems most efficient. Almost all patients are in for routine eye exams and to see if they need a new prescription. So the system pushes everyone through that path.

It is an eye exam and glasses practice, so they treat everyone like that, even if you aren't in for eye exams and glasses.

You might be correct if this were an optometrist practice (eye exams and glasses).

This is an ophthalmologist. MD, as in Medical Doctor, not OD, as in Doctor of Optometry. They specialize in corrective surgery, diseases of the eye, etc. I'll wager that few, if any, patients are there for routine eye exam / prescriptions. They do not sell glasses.

"The system is set up to treat all patients the same, because that is what seems most efficient." And that is exactly what my bitch is about. I was there with a very specific complaint, clearly stated. It would have been much more efficient -- ten minutes instead of more than an hour and a half -- if they had actually listened to what I said, instead of trying to run me through the routine of "treat all patients the same," check all the boxes in order, never mind what the patient says because he clearly doesn't know what the fuck he is talking about.

This is all too common among the non-physician staff at medical practices. Once you're able to actually speak with a doctor, things seem to get straightened out in a hurry, but that does not happen until you get run through the routine, because the first line of defense is a screener who typically does not have the medical training, nor the knowledge, nor the authority, to employ one stinking iota of common sense.

It's not just doctor's offices. Hospital staff have to deal with the same BS. Nursing staff (where I worked) had different things that we had to document based on the patient's admission diagnosis in order for the hospital to get reimbursed. At times I would have to spend more time documenting care than actually providing care.

quote:

Originally posted by mrbill345:
It's not just doctor's offices. Hospital staff have to deal with the same BS. Nursing staff (where I worked) had different things that we had to document based on the patient's admission diagnosis in order for the hospital to get reimbursed. At times I would have to spend more time documenting care than actually providing care.

I can understand the need to document. My wife is a (mental) health care provider.

What I can NOT understand is the pushing to do tests and diagnoses that have absolutely nothing to do with the complaint. Dilation? Really? Because it "should be done yearly?" After having had this done maybe a dozen times since September? Refraction? What in the world has this got to do with a problem that is clearly associated with tear ducts? Kill a half hour reading charts, left eye, right eye, both eyes, with glasses, without glasses. Why? I am NOT there for an eyeglass-related vision correction, I have a medical situation, related to tear ducts. Why are we wasting time reading charts? Why does Blondie think she needs to take my glasses to "read the prescription?" Especially since I have just handed her a hard copy of the prescription?

Yes, do what you NEED to do, that is associated with my problem. Document this. Maybe ten minutes. Not an hour and a half, trying to do things that have NO bearing, whatsoever, on the complaint, just to check some boxes that are NOT required for reimbursement. The insurance company would be much happier NOT being billed for unnecessary bullshit.

I think you have a ID-10-T error in your eye modules.

PC Load Letter should solve it.

Hope you find your page.