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| Having a “WTH Moment”…: Thoughts from a Nurse Practitioner |
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by Kimberly Spering, MSN, FNP-BC - February 28, 2011
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 Provided by Clinician 1
Anyone who actually READS my blog has noticed that I am hard at work on Patient-Centered Medical Home work. Now that the initial processing of formulas is behind me, I’m taking a moment to breathe and regroup. Life is good. We will have a site visit in a week, so I will be busy this weekend working on data collection and figuring out my Excel spreadsheets...but, hey, that’s later this week/weekend. I had an extra day off on Monday. Even if it was spent in my dentist’s office getting drilled for an hour...while thinking he will be making $2450 to make me a new bridge for 2 – 3 hrs. of work...but I digress.
Today, my boss floored me with a casual comment about one of our patients with diabetes and CAD. He had just seen his cardiologist for his semi-annual check-up and had a “new” test...one to measure his radial artery “elasticity.” Hmmm...we scratched our heads for a moment. We’ve read some things about measuring peripheral vascular pulse wave velocity in the attempt to evaluate the high-risk patients with HTN. There is also a lot of controversy about measurement devices and their value in management of care. That is...one has to control the HTN, lipids, DM...and NOWHERE in the guidelines does it mention the effect of vessel elasticity. Yes, it says that you may be able to identify higher-risk patients in those who have “less” elasticity...but the research is still vague with many questions attached...where is it measured, what type of device is best, does it really mean ANYTHING, etc.
So...this patient had the test done...at a cost of $80. My boss called the cardiologist to ask about it, as we haven’t seen any other consults noting this type of test. The cardiologist LAUGHED. Turns out, insurances (including Medicare) will pay them $80 PER TEST, and pay them to do it TWICE a year. It costs the cardiology group $20 per test. That’s a $60 profit PER test. The cardiologist told my boss that their group estimates to make $80,000 PER YEAR by doing this for ALL of their CAD patients. Yes, he admitted to my boss...it doesn’t really change management...they still have to aggressively treat everyone the same, based on risk factors. They are doing “research” to see if it makes a difference in their patient population...but he couldn’t really explain this research to my collaborating physician. (My not-so-humble guess? He didn’t know about it.)
My boss told me this conversation, and my BP spiked to new levels.
WHY, I demanded, do WE in primary care have to bust our minions to prove that we are managing our patients effectively to get adequate reimbursement?
WHY do we have to do SIX-MONTH data collection spreadsheets for our Blue Shield payers to “prove” that we are tracking DM, HTN, Vitamin D levels, etc., in order to get a measly $3 dollars more PER PATIENT? (Which, upon generous estimate, may lead to $1000 per year...MAX.)
WHY do I have to call every single ophthalmology and optometry practice for my DM patients to get a WRITTEN consultation on the chart...because the patient’s “say-so” that he/she had an eye exam isn’t good enough for medical-home?
And yet, a *(#@_$ cardiology group can buy a nice machine and expect to rake in an extra $80K per year...sanctioned by insurances? When a provider STILL has to manage the risk factors...measured by HTN, DM, lipid management. I don’t see any guidelines that state, “managing by radial artery elasticity measurements.”
There is something radically wrong here, my friends. So anyone who wants to preach to ME that insurance reform isn’t needed...come live in my primary care world for awhile. Help me educate my patients...and make mountains of phone calls to get them to come in and do their blood work...and educate them on the dangers of their diseases...and counsel them time-and-time again.
Because that’s where the REAL work is...day in, day out..and that’s where the money SHOULD be.
In my NOT so humble opinion. I guess I need to see my own PCP to get my BP under control now. (smile)
Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| ibnanc3 |
on 03 Mar 2011 at 9:12 pm |
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| Hey kim I hear you and I toltally understand!!! |
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| Dave Mittman, PA |
on 03 Mar 2011 at 2:26 pm |
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Come join Clinician 1 where Kim who is a great clinical NP blogs on her views and passion about being an NP. Id o the same about NP and PA issues.
Dave
www.clinician1.com |
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| Lory Wylot-Thomas RN (St. Petersburg Fl) |
on 03 Mar 2011 at 11:33 am |
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Thank you for speaking out. You should publish your comments in every newspaper in the US!!! I am all for health care reform and the consumers don't hear enough of these stories.
Amen sister! |
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| Greg Woodard (East Tennessee) |
on 02 Mar 2011 at 3:49 pm |
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| That tears it I\'m going to work for a cardiologist :) I enjoyed your post, expecially the passion. Seems I have a \"what the \"flip\"\" moment daily in practice. Like the prior auth for tamiflu that came 5 days later. |
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| Barbara Bryden (Rockville Maryland) |
on 01 Mar 2011 at 4:00 pm |
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You are absolutely correct. It is really a perverse system when primary care providers are all feeling like they've been ironed flat at the end of the day and the people in charge of the finances are telling you that you're not seeing enough patients.
This is a very broken system, and all the little patchwork fixes can only make things more difficult.
I believe that Primary Care Providers have the toughest road to hoe. |
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| Kristi King, FNP (Santa Barbara County) |
on 01 Mar 2011 at 1:19 pm |
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| I couldn't agree more!! Very well written. My saying is "the system is driving the providers to seek their own personal therapy" in coping with this ridiculous "sick care" system we work in. |
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