I made rounds today on 9 patients. I would categorize the issues:
- Stabilize acid-base status
- End-of-life discussion
- Nuclear medicine stress test in woman with recent NSTEMI
- Cellulitis which followed a traumatic amputation
- Hyponatremia secondary to psychogenic polydipsia and (perhaps) thiazides, presented as altered mental status
- Achalasia – needs myotomy
- Lung cancer with bony metatases – needs biopsy documentation
- Patient s/p below knee amputation for gangrene – awaiting rehab placement
- Severe tonsillitis – probably bacteremic – responding to clindamycin
Did I do a good job? Would any of the current performance measures apply?
I can provide a similar list almost every day I make rounds. What is the point of performance measures if they do not relate to the main issues that I see on daily rounds? How would you judge my quality?
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Ok, but what I really want to know is: Did you code these encounters as 1, 2 or 3s and if so are you SURE you got the right number of ROS catagories in your hospital note. Oh , and exactly how long did the end of life discussion last? Did you document that? And about that ALOS problem – why is the NSTEMI patient still in the hospital ? That stress test is an outpatient procedure!
I bet each of your patients got excellent care with careful judgement on your part just like the vast majority of us deliver daily. Too bad you will probably get “RAC-ed” this year and have to pay most of it back.
Isn’t it interesting that in the health care debate that the internists (the few left anyway) and FPs are left out of the equation? THE big secret is that we COULD cut costs and improve care – there is documentation of that . Wonder why nobody asks us what is needed? Wait! I know! Performance Measures are the answer!