Re: Core Measures Question

[Guest guest]

,Sorry you are going through this. Sounds like a nightmare! It sounds like someone got "Mycoplasma pneumoniae" (the name of the bacteria) mixed up with mycoplasma pneumonia (the diagnosis). I would argue that you shouldn't be judged on a protocol that didn't apply to your patient. The M & M report sounds more like a public health reporting requirement. Maybe someone at the Tulare County Medical Society or California Academy of Family Physicians can help? Maybe you need to hire a lawyer? Good luck! SetoSouth Pasadena, CALast week I had a 31 y/o F. with dry cough which progressedto retching and some vomiting, feeling weak, has 3 kids at home, a job, and was gettingworn out. I had done a CBC which was normal, but a mycoplasmaserology came out positive IgM. A cocci serology (we are in theSan Joaquin Valley) was pending. I had started her on zithromaxp.o. as outpatient, but decided to admit her for some IV fluids. Unfortunately itwas coded as "mycoplasma pneumonia". I think I mentioned possible pneumonia in my H & P, but the CXR was negative. Now I'm getting docked by the "Core Measures" nurse who states I should haveput her on broader spectrum coverage for community aquired pneumonia, done blood cultures etc. She improved and went home after 48 hours tofinish off the zithromax p.o.. Interestingly, the cocci serologycame back after she got home and it was also positive IgM! So I don'treally know for sure what she has, but the nurse's letter threatens to put something in my file that could affect reappointment etc. Then I got another threatening letter from anther nurse at the county health dept. that I needed to submit an M & M report on the cocci or face possible fines and imprisonment and discipline by the State Medical Board. Any thoughts?

[Guest guest]

Well, I don't think it's that serious, but it shows what can happen

sometimes when you turn zealous people loose with an algorithm and

start losing track of what we used to all " common sense " . The hospital

is very sensitive to the reports that come out in the paper based on

the Core Measures. I think the zealotry of the Core Measures

personel reflects that, but some common sense might help out their

statistics as well.

>

> > Last week I had a 31 y/o F. with dry cough which progressed

> > to retching and some vomiting, feeling weak, has 3 kids at home, a

> > job,

> > and was getting

> > worn out. I had done a CBC which was normal, but a mycoplasma

> > serology came out positive IgM. A cocci serology (we are in the

> > San Joaquin Valley) was pending. I had started her on zithromax

> > p.o. as outpatient, but decided to admit her for some IV fluids.

> > Unfortunately it

> > was coded as " mycoplasma pneumonia " . I think I mentioned possible

> > pneumonia in my H & P, but the CXR was negative. Now I'm

> > getting docked by the " Core Measures " nurse who states I should have

> > put her on broader spectrum coverage for community aquired pneumonia,

> > done blood cultures etc. She improved and went home after 48 hours to

> > finish off the zithromax p.o.. Interestingly, the cocci serology

> > came back after she got home and it was also positive IgM! So I don't

> > really know for sure what she has, but the nurse's letter threatens to

> > put something in my file that could affect reappointment etc. Then I

> > got another threatening letter from anther nurse at the county health

> > dept. that I needed to submit an M & M report on the cocci or face

> > possible fines and imprisonment and discipline by the State Medical

> > Board.

> > Any thoughts?

> >

> >

> >

>

[Guest guest]

alex, you made a mistake. It was chlamydia pneumoniae!

> Well, I don't think it's that serious, but it shows what can happen

> sometimes when you turn zealous people loose with an algorithm and

> start losing track of what we used to all " common sense " . The hospital

> is very sensitive to the reports that come out in the paper based on

> the Core Measures. I think the zealotry of the Core Measures

> personel reflects that, but some common sense might help out their

> statistics as well.

>

>

>>

>> > Last week I had a 31 y/o F. with dry cough which progressed

>> > to retching and some vomiting, feeling weak, has 3 kids at home, a

>> > job,

>> > and was getting

>> > worn out. I had done a CBC which was normal, but a mycoplasma

>> > serology came out positive IgM. A cocci serology (we are in the

>> > San Joaquin Valley) was pending. I had started her on zithromax

>> > p.o. as outpatient, but decided to admit her for some IV fluids.

>> > Unfortunately it

>> > was coded as " mycoplasma pneumonia " . I think I mentioned possible

>> > pneumonia in my H & P, but the CXR was negative. Now I'm

>> > getting docked by the " Core Measures " nurse who states I should have

>> > put her on broader spectrum coverage for community aquired pneumonia,

>> > done blood cultures etc. She improved and went home after 48 hours to

>> > finish off the zithromax p.o.. Interestingly, the cocci serology

>> > came back after she got home and it was also positive IgM! So I don't

>> > really know for sure what she has, but the nurse's letter threatens to

>> > put something in my file that could affect reappointment etc. Then I

>> > got another threatening letter from anther nurse at the county health

>> > dept. that I needed to submit an M & M report on the cocci or face

>> > possible fines and imprisonment and discipline by the State Medical

>> > Board.

>> > Any thoughts?

>> >

>> >

>> >

>>

>

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

From Drain,

I got one of those querying letters about a patient of mine that had a myxomatous mitral valve replacement who was billed in the hospital as having CHF, and then they wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the initiative, and forwarded the letter to the cardiologist, requesting a letter from her to answer this question (nurses don't send these things to specialists, and specialists are very nasty about having their expertise questioned) and then I called the nurse asking about the mis-diagnose management system. I got her supervisors number and called him about the problem with the variance between the diagnostic code and the actual disease and its treatment and from him I got the identity of actual person who had used the wrong code, and then I called that person's supervisor. Many calls later, lots of supervisors later, several apologetic letters later from all these people: not only am I off the hook but I have never (NEVER) heard again from that group's oversight committees.

Two weeks ago I got a letter from another insurance company saying that one of my old (three years ago) patients has not been following up on her labs and so forth. I called the patient and gave her three copies of that letter, one to keep, one to use in her complaint, and one to fore ward to her current specialist to let him complain again. Today I got the formal apology letter from the insurance company.

We should not just swallow this stuff. Make them eat their words. You are the professional here, and if they threaten you they should be made to look like total officious nuisances.

Joanne Holland DVM/MD

Subject: Core Measures QuestionTo: Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with dry cough which progressedto retching and some vomiting, feeling weak, has 3 kids at home, a job, and was gettingworn out. I had done a CBC which was normal, but a mycoplasmaserology came out positive IgM. A cocci serology (we are in theSan Joaquin Valley) was pending. I had started her on zithromaxp.o. as outpatient, but decided to admit her for some IV fluids. Unfortunately itwas coded as "mycoplasma pneumonia". I think I mentioned possible pneumonia in my H & P, but the CXR was negative. Now I'm getting docked by the "Core Measures" nurse who states I should haveput her on broader spectrum coverage for community aquired pneumonia, done blood cultures etc. She improved and went home after 48 hours tofinish off the zithromax p.o.. Interestingly, the cocci serologycame back after she got home and it was also positive IgM! So I don'treally know for sure

what she has, but the nurse's letter threatens to put something in my file that could affect reappointment etc. Then I got another threatening letter from anther nurse at the county health dept. that I needed to submit an M & M report on the cocci or face possible fines and imprisonment and discipline by the State Medical Board. Any thoughts?

[Guest guest]

I would also bill these people for wasting your professional time to

sort out their errors.

> From Drain,

>

> I got one of those querying letters about a patient of mine that had

> a myxomatous mitral valve replacement who was billed in the hospital as

> having CHF, and then they wondered why I wasn't putting the 23 year old

> patient on a beta blocker.

> I took the initiative, and forwarded the letter to the cardiologist,

> requesting a letter from her to answer this question (nurses don't send

> these things to specialists, and specialists are very nasty about having

> their expertise questioned) and then I called the nurse asking about the

> mis-diagnose management system. I got her supervisors number and called him

> about the problem with the variance between the diagnostic code and the

> actual disease and its treatment and from him I got the identity of actual

> person who had used the wrong code, and then I called that person's

> supervisor. Many calls later, lots of supervisors later, several

> apologetic letters later from all these people: not only am I off the hook

> but I have never (NEVER) heard again from that group's oversight committees.

> Two weeks ago I got a letter from another insurance company saying

> that one of my old (three years ago) patients has not been following up on

> her labs and so forth. I called the patient and gave her three copies of

> that letter, one to keep, one to use in her complaint, and one to fore ward

> to her current specialist to let him complain again. Today I got the formal

> apology letter from the insurance company.

> We should not just swallow this stuff. Make them eat their words.

> You are the professional here, and if they threaten you they should be made

> to look like total officious nuisances.

>

> Joanne Holland DVM/MD

>

>

>

>

> Subject: Core Measures Question

> To:

> Date: Friday, September 12, 2008, 9:33 AM

>

> Last week I had a 31 y/o F. with dry cough which progressed

> to retching and some vomiting, feeling weak, has 3 kids at home, a job,

> and was getting

> worn out. I had done a CBC which was normal, but a mycoplasma

> serology came out positive IgM. A cocci serology (we are in the

> San Joaquin Valley) was pending. I had started her on zithromax

> p.o. as outpatient, but decided to admit her for some IV fluids.

> Unfortunately it

> was coded as " mycoplasma pneumonia " . I think I mentioned possible

> pneumonia in my H & P, but the CXR was negative. Now I'm

> getting docked by the " Core Measures " nurse who states I should have

> put her on broader spectrum coverage for community aquired pneumonia,

> done blood cultures etc. She improved and went home after 48 hours to

> finish off the zithromax p.o.. Interestingly, the cocci serology

> came back after she got home and it was also positive IgM! So I don't

> really know for sure what she has, but the nurse's letter threatens to

> put something in my file that could affect reappointment etc. Then I

> got another threatening letter from anther nurse at the county health

> dept. that I needed to submit an M & M report on the cocci or face

> possible fines and imprisonment and discipline by the State Medical

> Board.

> Any thoughts?

>

>

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

so Joanne I see you have had your Wheaties today. I do the Lynn HO thing yesterday I had a patietn who needed six million things and though I had tried to schedule enough time every time we worked on an issue it was another pandoras' box of bureaucarcy and decision making Sees an out of state specialist who ignores my multiple requests for records and is doing nothing acc. to patietn even , but patien goes becasue q 6mo he hopes-- he hopes you know that the guy will offer him something, why are we doing this?many issues to sort out etcetc And he now needs a PA for some med becasue the specialist was allowed to put him on it but not me !!. I barely looked up. Take out your card,see that number on the back, here;s the phone, ask to have a prior auth form sent to me ,here ;s my fax number ,and I went working on re doing every one of his precscription allover agian plus sorting out his billing question plus thinikng about what else to be done clincially assessing his pain etcetc

he was growling more than I was by the time he was done with that insuracne company I was out of breath but I got him everything he needed pretended to be happy and had a sense of humor and stayed on time for the next patietn.Access is my name work arounds are my game.

From Drain,

I got one of those querying letters about a patient of mine that had a myxomatous mitral valve replacement who was billed in the hospital as having CHF, and then they wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the initiative, and forwarded the letter to the cardiologist, requesting a letter from her to answer this question (nurses don't send these things to specialists, and specialists are very nasty about having their expertise questioned) and then I called the nurse asking about the mis-diagnose management system. I got her supervisors number and called him about the problem with the variance between the diagnostic code and the actual disease and its treatment and from him I got the identity of actual person who had used the wrong code, and then I called that person's supervisor. Many calls later, lots of supervisors later, several apologetic letters later from all these people: not only am I off the hook but I have never (NEVER) heard again from that group's oversight committees.

Two weeks ago I got a letter from another insurance company saying that one of my old (three years ago) patients has not been following up on her labs and so forth. I called the patient and gave her three copies of that letter, one to keep, one to use in her complaint, and one to fore ward to her current specialist to let him complain again. Today I got the formal apology letter from the insurance company.

We should not just swallow this stuff. Make them eat their words. You are the professional here, and if they threaten you they should be made to look like total officious nuisances.

Joanne Holland DVM/MD

Subject: Core Measures Question

To: Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with dry cough which progressedto retching and some vomiting, feeling weak, has 3 kids at home, a job, and was gettingworn out. I had done a CBC which was normal, but a mycoplasma

serology came out positive IgM. A cocci serology (we are in theSan Joaquin Valley) was pending. I had started her on zithromaxp.o. as outpatient, but decided to admit her for some IV fluids. Unfortunately it

was coded as " mycoplasma pneumonia " . I think I mentioned possible pneumonia in my H & P, but the CXR was negative. Now I'm getting docked by the " Core Measures " nurse who states I should have

put her on broader spectrum coverage for community aquired pneumonia, done blood cultures etc. She improved and went home after 48 hours tofinish off the zithromax p.o.. Interestingly, the cocci serologycame back after she got home and it was also positive IgM! So I don't

really know for sure

what she has, but the nurse's letter threatens to put something in my file that could affect reappointment etc. Then I got another threatening letter from anther nurse at the county health dept. that I needed to submit an M & M report on the cocci or face

possible fines and imprisonment and discipline by the State Medical Board. Any thoughts?

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

I would just talk to them. Consult an ID specialist if you must, but these letters are sure to come more often. Hospitals are in pressure cooker for higher quality.

Subject: Core Measures QuestionTo: Date: Friday, September 12, 2008, 11:33 AM

Last week I had a 31 y/o F. with dry cough which progressedto retching and some vomiting, feeling weak, has 3 kids at home, a job, and was gettingworn out. I had done a CBC which was normal, but a mycoplasmaserology came out positive IgM. A cocci serology (we are in theSan Joaquin Valley) was pending. I had started her on zithromaxp.o. as outpatient, but decided to admit her for some IV fluids. Unfortunately itwas coded as "mycoplasma pneumonia". I think I mentioned possible pneumonia in my H & P, but the CXR was negative. Now I'm getting docked by the "Core Measures" nurse who states I should haveput her on broader spectrum coverage for community aquired pneumonia, done blood cultures etc. She improved and went home after 48 hours tofinish off the zithromax p.o.. Interestingly, the cocci serologycame back after she got home and it was also positive IgM! So I don'treally know for sure

what she has, but the nurse's letter threatens to put something in my file that could affect reappointment etc. Then I got another threatening letter from anther nurse at the county health dept. that I needed to submit an M & M report on the cocci or face possible fines and imprisonment and discipline by the State Medical Board. Any thoughts?

[Guest guest]

Thanks for the replies. It really helps. All I need now to

close the loop is letters from UR and the insurance company

questioning the whole admission

in the first place, along with the appropriate threatening sanctions.

Isn't practicing in the modern health care environment fun?

>

>

> Subject: Core Measures Question

> To:

> Date: Friday, September 12, 2008, 11:33 AM

>

>

>

>

>

>

> Last week I had a 31 y/o F. with dry cough which progressed

> to retching and some vomiting, feeling weak, has 3 kids at home, a

job,

> and was getting

> worn out. I had done a CBC which was normal, but a mycoplasma

> serology came out positive IgM. A cocci serology (we are in the

> San Joaquin Valley) was pending. I had started her on zithromax

> p.o. as outpatient, but decided to admit her for some IV fluids.

> Unfortunately it

> was coded as " mycoplasma pneumonia " . I think I mentioned possible

> pneumonia in my H & P, but the CXR was negative. Now I'm

> getting docked by the " Core Measures " nurse who states I should have

> put her on broader spectrum coverage for community aquired

pneumonia,

> done blood cultures etc. She improved and went home after 48 hours

to

> finish off the zithromax p.o.. Interestingly, the cocci serology

> came back after she got home and it was also positive IgM! So I

don't

> really know for sure what she has, but the nurse's letter threatens

to

> put something in my file that could affect reappointment etc. Then

I

> got another threatening letter from anther nurse at the county

health

> dept. that I needed to submit an M & M report on the cocci or face

> possible fines and imprisonment and discipline by the State Medical

> Board.

> Any thoughts?

>

[Guest guest]

Go girls!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of

Sent: Friday, September 12, 2008

2:44 PM

To:

Subject: Re:

Core Measures Question

so Joanne I see you

have had your Wheaties today.

I do the Lynn HO thing yesterday I had a patietn who needed

six million things and though I had tried to schedule enough time every

time we worked on an issue it was another pandoras' box of

bureaucarcy and decision making Sees an out of state

specialist who ignores my multiple requests for records and is doing

nothing acc. to patietn even , but patien goes becasue

q 6mo he hopes-- he hopes you know that the guy will offer him

something, why are we doing this?many issues to sort out etcetc And he

now needs a PA for some med becasue the specialist was allowed to

put him on it but not me !!. I barely looked up. Take out

your card,see that number on the back, here;s the phone, ask to have a prior

auth form sent to me ,here ;s my fax number ,and I went

working on re doing every one of his precscription allover agian plus

sorting out his billing question plus thinikng about what else to be done

clincially assessing his pain etcetc

he was growling more than I was by the time he was done with

that insuracne company

I was out of breath but I got him everything he needed pretended to be happy

and had a sense of humor and stayed on time for the next

patietn.Access is my name work arounds are my game.

On Fri, Sep 12, 2008 at 4:19 PM, joanne holland <joandvmmd> wrote:

From Drain,

I got one of those

querying letters about a patient of mine that had a myxomatous mitral valve

replacement who was billed in the hospital as having CHF, and then they

wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the

initiative, and forwarded the letter to the cardiologist, requesting a letter

from her to answer this question (nurses don't send these things to

specialists, and specialists are very nasty about having their expertise

questioned) and then I called the nurse asking about the mis-diagnose

management system. I got her supervisors number and called him about

the problem with the variance between the diagnostic code and the actual

disease and its treatment and from him I got the identity of

actual person who had used the wrong code, and then I called that person's

supervisor. Many calls later, lots of supervisors later,

several apologetic letters later from all these people: not only am I

off the hook but I have never (NEVER) heard again from that group's oversight

committees.

Two weeks ago I got a

letter from another insurance company saying that one of my old (three years

ago) patients has not been following up on her labs and so forth. I

called the patient and gave her three copies of that letter, one to keep, one

to use in her complaint, and one to fore ward to her current specialist to

let him complain again. Today I got the formal apology letter from the

insurance company.

We should not just

swallow this stuff. Make them eat their words. You

are the professional here, and if they threaten you they should be made to

look like total officious nuisances.

Joanne Holland DVM/MD

From: alcald3000 <alcald3000>

Subject: Core Measures Question

To:

Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with

dry cough which progressed

to retching and some vomiting, feeling weak, has 3 kids at home, a job,

and was getting

worn out. I had done a CBC which was normal, but a mycoplasma

serology came out positive IgM. A cocci serology (we are in the

San Joaquin Valley) was pending. I had started her

on zithromax

p.o. as outpatient, but decided to admit her for some IV fluids.

Unfortunately it

was coded as " mycoplasma pneumonia " . I think I mentioned possible

pneumonia in my H & P, but the CXR was negative. Now I'm

getting docked by the " Core Measures " nurse who states I should

have

put her on broader spectrum coverage for community aquired pneumonia,

done blood cultures etc. She improved and went home after 48 hours to

finish off the zithromax p.o.. Interestingly, the cocci serology

came back after she got home and it was also positive IgM! So I don't

really know for sure what she has, but the nurse's letter threatens to

put something in my file that could affect reappointment etc. Then I

got another threatening letter from anther nurse at the county health

dept. that I needed to submit an M & M report on the cocci or face

possible fines and imprisonment and discipline by the State Medical

Board.

Any thoughts?

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

[Guest guest]

Go girls!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of

Sent: Friday, September 12, 2008

2:44 PM

To:

Subject: Re:

Core Measures Question

so Joanne I see you

have had your Wheaties today.

I do the Lynn HO thing yesterday I had a patietn who needed

six million things and though I had tried to schedule enough time every

time we worked on an issue it was another pandoras' box of

bureaucarcy and decision making Sees an out of state

specialist who ignores my multiple requests for records and is doing

nothing acc. to patietn even , but patien goes becasue

q 6mo he hopes-- he hopes you know that the guy will offer him

something, why are we doing this?many issues to sort out etcetc And he

now needs a PA for some med becasue the specialist was allowed to

put him on it but not me !!. I barely looked up. Take out

your card,see that number on the back, here;s the phone, ask to have a prior

auth form sent to me ,here ;s my fax number ,and I went

working on re doing every one of his precscription allover agian plus

sorting out his billing question plus thinikng about what else to be done

clincially assessing his pain etcetc

he was growling more than I was by the time he was done with

that insuracne company

I was out of breath but I got him everything he needed pretended to be happy

and had a sense of humor and stayed on time for the next

patietn.Access is my name work arounds are my game.

On Fri, Sep 12, 2008 at 4:19 PM, joanne holland <joandvmmd> wrote:

From Drain,

I got one of those

querying letters about a patient of mine that had a myxomatous mitral valve

replacement who was billed in the hospital as having CHF, and then they

wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the

initiative, and forwarded the letter to the cardiologist, requesting a letter

from her to answer this question (nurses don't send these things to

specialists, and specialists are very nasty about having their expertise

questioned) and then I called the nurse asking about the mis-diagnose

management system. I got her supervisors number and called him about

the problem with the variance between the diagnostic code and the actual

disease and its treatment and from him I got the identity of

actual person who had used the wrong code, and then I called that person's

supervisor. Many calls later, lots of supervisors later,

several apologetic letters later from all these people: not only am I

off the hook but I have never (NEVER) heard again from that group's oversight

committees.

Two weeks ago I got a

letter from another insurance company saying that one of my old (three years

ago) patients has not been following up on her labs and so forth. I

called the patient and gave her three copies of that letter, one to keep, one

to use in her complaint, and one to fore ward to her current specialist to

let him complain again. Today I got the formal apology letter from the

insurance company.

We should not just

swallow this stuff. Make them eat their words. You

are the professional here, and if they threaten you they should be made to

look like total officious nuisances.

Joanne Holland DVM/MD

From: alcald3000 <alcald3000>

Subject: Core Measures Question

To:

Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with

dry cough which progressed

to retching and some vomiting, feeling weak, has 3 kids at home, a job,

and was getting

worn out. I had done a CBC which was normal, but a mycoplasma

serology came out positive IgM. A cocci serology (we are in the

San Joaquin Valley) was pending. I had started her

on zithromax

p.o. as outpatient, but decided to admit her for some IV fluids.

Unfortunately it

was coded as " mycoplasma pneumonia " . I think I mentioned possible

pneumonia in my H & P, but the CXR was negative. Now I'm

getting docked by the " Core Measures " nurse who states I should

have

put her on broader spectrum coverage for community aquired pneumonia,

done blood cultures etc. She improved and went home after 48 hours to

finish off the zithromax p.o.. Interestingly, the cocci serology

came back after she got home and it was also positive IgM! So I don't

really know for sure what she has, but the nurse's letter threatens to

put something in my file that could affect reappointment etc. Then I

got another threatening letter from anther nurse at the county health

dept. that I needed to submit an M & M report on the cocci or face

possible fines and imprisonment and discipline by the State Medical

Board.

Any thoughts?

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

[Guest guest]

Go girls!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of

Sent: Friday, September 12, 2008

2:44 PM

To:

Subject: Re:

Core Measures Question

so Joanne I see you

have had your Wheaties today.

I do the Lynn HO thing yesterday I had a patietn who needed

six million things and though I had tried to schedule enough time every

time we worked on an issue it was another pandoras' box of

bureaucarcy and decision making Sees an out of state

specialist who ignores my multiple requests for records and is doing

nothing acc. to patietn even , but patien goes becasue

q 6mo he hopes-- he hopes you know that the guy will offer him

something, why are we doing this?many issues to sort out etcetc And he

now needs a PA for some med becasue the specialist was allowed to

put him on it but not me !!. I barely looked up. Take out

your card,see that number on the back, here;s the phone, ask to have a prior

auth form sent to me ,here ;s my fax number ,and I went

working on re doing every one of his precscription allover agian plus

sorting out his billing question plus thinikng about what else to be done

clincially assessing his pain etcetc

he was growling more than I was by the time he was done with

that insuracne company

I was out of breath but I got him everything he needed pretended to be happy

and had a sense of humor and stayed on time for the next

patietn.Access is my name work arounds are my game.

On Fri, Sep 12, 2008 at 4:19 PM, joanne holland <joandvmmd> wrote:

From Drain,

I got one of those

querying letters about a patient of mine that had a myxomatous mitral valve

replacement who was billed in the hospital as having CHF, and then they

wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the

initiative, and forwarded the letter to the cardiologist, requesting a letter

from her to answer this question (nurses don't send these things to

specialists, and specialists are very nasty about having their expertise

questioned) and then I called the nurse asking about the mis-diagnose

management system. I got her supervisors number and called him about

the problem with the variance between the diagnostic code and the actual

disease and its treatment and from him I got the identity of

actual person who had used the wrong code, and then I called that person's

supervisor. Many calls later, lots of supervisors later,

several apologetic letters later from all these people: not only am I

off the hook but I have never (NEVER) heard again from that group's oversight

committees.

Two weeks ago I got a

letter from another insurance company saying that one of my old (three years

ago) patients has not been following up on her labs and so forth. I

called the patient and gave her three copies of that letter, one to keep, one

to use in her complaint, and one to fore ward to her current specialist to

let him complain again. Today I got the formal apology letter from the

insurance company.

We should not just

swallow this stuff. Make them eat their words. You

are the professional here, and if they threaten you they should be made to

look like total officious nuisances.

Joanne Holland DVM/MD

From: alcald3000 <alcald3000>

Subject: Core Measures Question

To:

Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with

dry cough which progressed

to retching and some vomiting, feeling weak, has 3 kids at home, a job,

and was getting

worn out. I had done a CBC which was normal, but a mycoplasma

serology came out positive IgM. A cocci serology (we are in the

San Joaquin Valley) was pending. I had started her

on zithromax

p.o. as outpatient, but decided to admit her for some IV fluids.

Unfortunately it

was coded as " mycoplasma pneumonia " . I think I mentioned possible

pneumonia in my H & P, but the CXR was negative. Now I'm

getting docked by the " Core Measures " nurse who states I should

have

put her on broader spectrum coverage for community aquired pneumonia,

done blood cultures etc. She improved and went home after 48 hours to

finish off the zithromax p.o.. Interestingly, the cocci serology

came back after she got home and it was also positive IgM! So I don't

really know for sure what she has, but the nurse's letter threatens to

put something in my file that could affect reappointment etc. Then I

got another threatening letter from anther nurse at the county health

dept. that I needed to submit an M & M report on the cocci or face

possible fines and imprisonment and discipline by the State Medical

Board.

Any thoughts?

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

[Guest guest]

way to go, but, how sad we spend our intellignce on work arounds and fighting back. " I ain't sayin' you treated me unkindYou could have done better but I don't mind

You just kinda wasted my precious timeBut don't think twice, it's all right "

Go girls!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of

Sent: Friday, September 12, 2008

2:44 PM

To:

Subject: Re:

Core Measures Question

so Joanne I see you

have had your Wheaties today.

I do the Lynn HO thing yesterday I had a patietn who needed

six million things and though I had tried to schedule enough time every

time we worked on an issue it was another pandoras' box of

bureaucarcy and decision making Sees an out of state

specialist who ignores my multiple requests for records and is doing

nothing acc. to patietn even , but patien goes becasue

q 6mo he hopes-- he hopes you know that the guy will offer him

something, why are we doing this?many issues to sort out etcetc And he

now needs a PA for some med becasue the specialist was allowed to

put him on it but not me !!. I barely looked up. Take out

your card,see that number on the back, here;s the phone, ask to have a prior

auth form sent to me ,here ;s my fax number ,and I went

working on re doing every one of his precscription allover agian plus

sorting out his billing question plus thinikng about what else to be done

clincially assessing his pain etcetc

he was growling more than I was by the time he was done with

that insuracne company

I was out of breath but I got him everything he needed pretended to be happy

and had a sense of humor and stayed on time for the next

patietn.Access is my name work arounds are my game.

From Drain,

I got one of those

querying letters about a patient of mine that had a myxomatous mitral valve

replacement who was billed in the hospital as having CHF, and then they

wondered why I wasn't putting the 23 year old patient on a beta blocker.

I took the

initiative, and forwarded the letter to the cardiologist, requesting a letter

from her to answer this question (nurses don't send these things to

specialists, and specialists are very nasty about having their expertise

questioned) and then I called the nurse asking about the mis-diagnose

management system. I got her supervisors number and called him about

the problem with the variance between the diagnostic code and the actual

disease and its treatment and from him I got the identity of

actual person who had used the wrong code, and then I called that person's

supervisor. Many calls later, lots of supervisors later,

several apologetic letters later from all these people: not only am I

off the hook but I have never (NEVER) heard again from that group's oversight

committees.

Two weeks ago I got a

letter from another insurance company saying that one of my old (three years

ago) patients has not been following up on her labs and so forth. I

called the patient and gave her three copies of that letter, one to keep, one

to use in her complaint, and one to fore ward to her current specialist to

let him complain again. Today I got the formal apology letter from the

insurance company.

We should not just

swallow this stuff. Make them eat their words. You

are the professional here, and if they threaten you they should be made to

look like total officious nuisances.

Joanne Holland DVM/MD

Subject: Core Measures Question

To:

Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with

dry cough which progressed

to retching and some vomiting, feeling weak, has 3 kids at home, a job,

and was getting

worn out. I had done a CBC which was normal, but a mycoplasma

serology came out positive IgM. A cocci serology (we are in the

San Joaquin Valley) was pending. I had started her

on zithromax

p.o. as outpatient, but decided to admit her for some IV fluids.

Unfortunately it

was coded as " mycoplasma pneumonia " . I think I mentioned possible

pneumonia in my H & P, but the CXR was negative. Now I'm

getting docked by the " Core Measures " nurse who states I should

have

put her on broader spectrum coverage for community aquired pneumonia,

done blood cultures etc. She improved and went home after 48 hours to

finish off the zithromax p.o.. Interestingly, the cocci serology

came back after she got home and it was also positive IgM! So I don't

really know for sure what she has, but the nurse's letter threatens to

put something in my file that could affect reappointment etc. Then I

got another threatening letter from anther nurse at the county health

dept. that I needed to submit an M & M report on the cocci or face

possible fines and imprisonment and discipline by the State Medical

Board.

Any thoughts?

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Yes! Finally, some Bob Dylan being quoted on the list!ThanksTimOn Fri, September 12, 2008 9:34 pm EDT,

wrote:

way to go, but, how sad we spend our intellignce on work arounds

and fighting back.

" I ain't sayin' you treated me unkindYou could have done better but I don't mindYou just kinda wasted my precious

timeBut don't think twice, it's all right "

Go girls!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ]

OnBehalf Of Jean

AntonucciSent:

Friday, September 12, 20082:44 PMTo: Subject: Re: Core Measures Question

so Joanne I

see youhave had your Wheaties today. I do the Lynn HO thing yesterday I had a patietn who neededsix million things and though I had

tried to schedule enough time everytime we worked on an issue it was

another pandoras' box ofbureaucarcy and decision making Sees an out of

statespecialist who ignores my multiple requests for records and is doingnothing acc. to patietn even , but patien goes becasue q 6mo he hopes--

he hopes you know that the guy will offer himsomething, why are we doing

this?many issues to sort out etcetc And henow needs a PA for some med becasue

the specialist was allowed toput him on it but not me !!. I barely looked

up. Take out your card,see that number on the back, here;s the phone, ask to

have a priorauth form sent to me ,here ;s my fax number ,and I went working on re doing every one of his precscription allover agian plussorting

out his billing question plus thinikng about what else to be done clincially

assessing his pain etcetc he was growling more than I was by the time

he was done withthat insuracne company I was out of breath but I

got him everything he needed pretended to be happyand had a sense of humor and stayed on time for the nextpatietn.Access is my name work arounds are my

game.

On Fri, Sep

12, 2008 at 4:19 PM, joanne holland joandvmmd@...> wrote:

From Drain,

I got one of those querying letters

about a patient of mine that had a myxomatous mitral valve replacement who was billed in the hospital as having CHF, and then

they wondered why I wasn't putting the 23 year old patient on a

beta blocker.

I took the initiative, and

forwarded the letter to the cardiologist, requesting a letter from her to answer this question (nurses don't send these things to specialists, and specialists are very nasty about having their

expertise questioned) and then I called the nurse asking about

the mis-diagnose management system. I got her supervisors number

and called him about the problem with the variance between the

diagnostic code and the actual disease and its treatment and from him I got the identity of actual person who had used the

wrong code, and then I called that person's supervisor. Many

calls later, lots of supervisors later, several apologetic

letters later from all these people: not only am I off the hook

but I have never (NEVER) heard again from that group's oversight committees.

Two weeks ago I got a letter from

another insurance company saying that one of my old (three years ago) patients has not been following up on her labs and so forth. I called the patient and gave her three copies of that letter, one to

keep, one to use in her complaint, and one to fore ward to her

current specialist to let him complain again. Today I got the

formal apology letter from the insurance

company.

We should not just swallow this

stuff. Make them eat their words. You are the professional

here, and if they threaten you they should be made to look like

total officious nuisances.

Joanne Holland DVM/MD

Subject: Core Measures Question To: Date: Friday, September 12, 2008, 9:33 AM

Last week I had a 31 y/o F. with dry cough

which progressed to retching and some vomiting, feeling weak, has

3 kids at home, a job, and was getting worn out. I had

done a CBC which was normal, but a mycoplasma serology came out

positive IgM. A cocci serology (we are in theSan Joaquin Valley)

was pending. I had started her on zithromax p.o. as

outpatient, but decided to admit her for some IV fluids. Unfortunately it was coded as " mycoplasma pneumonia " . I

think I mentioned possible pneumonia in my H & P, but the CXR

was negative. Now I'm getting docked by the " Core

Measures " nurse who states I should have put her on

broader spectrum coverage for community aquired pneumonia, done

blood cultures etc. She improved and went home after 48 hours to finish off the zithromax p.o.. Interestingly, the cocci serology came back after she got home and it was also positive IgM! So I don't really know for sure what she has, but the nurse's letter threatens

to put something in my file that could affect reappointment etc.

Then I got another threatening letter from anther nurse at the

county health dept. that I needed to submit an M & M report on

the cocci or face possible fines and imprisonment and discipline

by the State Medical Board. Any

thoughts?

-- If you are a patient please

allow up to 12 hours for a reply by email/please note the new email

address.Remember that e-mail may not be entirely secure/

MDph fax

-- If you are a patient please allow up to 12

hours for a reply by email/please note the new email address.Remember

that e-mail may not be entirely secure/ MD 115 Mt

Blue Circle ph fax

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

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