Doctoring Health Care Reform Reflection

Guest Post — Tips for survival in the new healthcare environment

It is with great pleasure that I offer the following guest post from Edward J. Schloss, MD, (Twitter ID @EJSMD) the medical director of cardiac electrophysiology at Christ Hospital in Cincinnati, OH.

One of the many rewards of writing a blog is making friends. Jay Schloss started as a ‘social media’ friend but now that we have met, had dinner and communicate regularly, I consider Jay a regular bud.  We share many of the same interests: electrophysiology, endurance sports (Jay is runner), writing (see his many guest posts on Cardiobrief) and of course, we both strive to master the obvious.

I was honored that Jay sent me these eight tips for survival in the new healthcare climate. They were in response to my post yesterday on Healthcare reform’s disruptive effects on doctors. Although Jay’s words speak directly to doctors, I believe they are congruent with the goals of this blog–to educate, to give a look behind the curtain, to archive useful information and ultimately, yes, to better mankind. Thanks again, Jay.

Tips for survival in the new healthcare environment

By Dr Jay Schloss,

1. Good Tech: It’s time to admit much of your job is now data entry. If that’s the case, you should arm yourself with the best technology to make this job palatable. For me that means using my own computer. I have a very fast Apple MacBook Air that I run on the hospital WiFi network. This comes with me from room to room. There are no log-in/log-outs as I move. Keystroke macros automate many tasks. Reboots and crashes are rare. I’m facing the patient when I’m working and I never have to worry about finding a free workstation. In my office, I’m working at a stand-up desk ( This keeps my legs fresh and back straight. In the hospital, I’m working standing, seated, in patient room, in the elevator, in the cafeteria, wherever I want.

2. Minimize the BS: Don’t confuse box checking with delivery of health care. Sail through the BS as quickly as you can. Save your creative juices for the parts of your documentation that people actually read. Don’t waste your time making things look perfect. Just focus on meeting regulatory compliance and not setting yourself up for a lawsuit.

3. Delegate: No way you can do all of this yourself. Cultivate relationships with high quality individuals and delegate tasks. Your job is to be the quarterback, not the whole team.

4. Don’t Bill for Everything: Sometimes it’s appropriate to give away billing, as long as you provide high quality care. If you’re pressed for time, skip all the painful documentation. Assess the problem, communicate what you know to the patient and the referring doctor, write a quick note and don’t bill anything. You are serving your mission to provide high quality care and saving the health care system a few bucks at the same time.

5. Mobilize Support for Change: Do your job, but don’t take all this lying down. Doctors got into this mess by not speaking up. If we continue to roll over, it’s only going to get worse. Make yourself a positive agent of change. Speak up in emails, meetings, and hall conversations with administrators. Get a voice in social media. Start a blog. Write a few tweets. Because most of your colleagues are as passive as deer in the path a truck, your voice can be heard.

6. Find a Professional Outlet: As our work becomes more and more devalued, it’s easy to start feeling unimportant. All of us thrive on achievement and approval. If direct patient care is losing some of it’s meaning, add something else. Step up involvement in research, do some consulting (give away the money if you are concerned about conflicts of interest), give a talk, do charity work, write some blog comments.

7. Hold Fast to Your Values as a Doctor: No matter how bad it gets, do not . . . I mean DO NOT let go of your values as a caregiver. The people evaluating you may not value the same things you do. You know that quality metrics do not ensure quality. Keep doing the extra stuff that regulators don’t notice or measure. If that means seeing fewer patients, then so be it. Each patient you treat needs to have you at your best.

8.  Take Refuge with your Patients:  Even on the crappiest of crap days, a good face to face patient interaction can change everything.  In the exam room, with the door closed, the rest of the world can melt away.  Nothing feels better than making this connection, and knowing you have changed someone’s life.  This is the part of healthcare delivery no one can touch.  I doubt our regulators have any clue what I’m talking about here, and that’s OK.  It will be our little secret that we guard until the end.

9 replies on “Guest Post — Tips for survival in the new healthcare environment”

Nice column on the inaptly named “Affordable Care and Patient Protection Act” and its implications for “providers”, f/k/a doctors. Here is my favorite line: “Doctors got into this mess by not speaking up.” And in some cases, surprisingly, by actually speaking in favor of it and then voting for the politician who promised to make it happen…..Go figure!

It is my understanding that not billing for services rendered constitutes billing fraud as physicians are not allowed to charge any patient (or insurance company) less than the Medicare contract rates. So-called “prompt pay discounts” do permit exceptions, but simply providing the care, documenting appropriately, and omitting the bill could be flagged in a Medicare chart audit.

Please let me know if I am mistaken. There are so many ways to unknowingly commit billing fraud these days, and I’m sure they will only multiply after the ICD-10 implementation deadline.

I imagine there are a lot of facets to the answer to your question (many of which I’m sure I don’t know) – but I interpreted Dr. Schloss’ comment on “Don’t bill for everything” as what might occur if, for example – you in real life had an “extended visit” with complex decision making but for one of many possible reasons decided to only bill for a simple visit (much less complex documentation needed; much less time required if this occurred at a moment when you were swamped … ). Who’s to know? – and the patient got “quality care” without being “fully billed” …

Love the point about box-checking. In anesthesia, our electronic medical records are all about the check boxes. We bill based on them, we get sued based on them, our work is judged as quality or not quality based on them. It’s easy to get caught up with the boxes, especially for residents. Forget the boxes until the case is over. Focus on the patient.

Nice post. Would make a pretty solid mission statement / compass for any clinician. I happen to know Dr. Schloss as a premier clinician by any measure, with an uncompromising stance on giving patients his all. However, with the ever-present laptop, he walks the fine line between the unapologetic nerd and the hip tekkie. If only the Air came in lime green. One point about devaluing the importance of billing: for physicians who rely MUCH more on office billings than procedure based EP, it could be more of a problem…

Thanks for everyone’s feedback.

VBM: I’ll always consider myself a doctor. The word provider makes me bristle.
Shirie: I hear you. We see examples all the time in which documentation requirements stand squarely in the way of providing quality care. We need to get our noses off the computer screen and look at our patients.
Ken and PGYx: Not sure what to add about the billing issue. I have to say that all this feels like some kind of “Bizarro World” situation. Rich Fogoros MD (@DrRich1 of the Covert Rationing Blog) calls this a regulatory speed trap. I’m all about following the rules, but sometimes it’s hard to keep track of what the rules actually are. When in doubt, do what is right for the patient. For those of us lucky enough to have personnel support, it should be possible to get all of the documentation done in most cases. See tip #3 above.
Gene: You should write your own set of survival tips. Rarely have a seen a doctor maintain composure and excellence with as much grace as yourself. I look to you as a role model for how to do it right. As far as the procedure issue goes, you know the door is open. Stop down and we’ll put some pacers in together.

Since I wrote this I came up with a tip #8. I’m sure there could be more, but this one is important and needs to go up now:

8. Take Refuge with your Patients: Even on the crappiest of crap days, a good face to face patient interaction can change everything. In the exam room, with the door closed, the rest of the world can melt away. Nothing feels better than making this connection, and knowing you have changed someone’s life. This is the part of healthcare delivery no one can touch. I doubt our regulators have any clue what I’m talking about here, and that’s OK. It will be our little secret that we guard until the end.


The last 5 or 6 posts here have been great – interesting, informative, insightful.

This blog has ‘good legs’ in 2013. Thanks for sharing with us.

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