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DOCtalk by Dr. Gregg 7/14/14

July 14, 2014 News 5 Comments

Just Another Pug

By sheer force of will, he pulled himself up from his corner stool. He gripped the ropes for an extra second to make sure his buckling knees would hold. What round was this? He wasn’t sure. The twelfth? Thirteenth? It felt like the four hundredth. He was a game pug, always ready for the fight, but this one seemed like it might be one fight too many. He remembered Ferdie “The Fight Doctor” Pacheco’s famous line: “They only made one mistake; they signed this fight.”

The bell rang. He drew a deep breath, brought his gloves to his face, and again entered the fray.

His eyes were so swollen he could no longer clearly see his opponent’s face. It could have been anybody peppering him with those barrages of body blows and hammering head shots. As he neared center ring – and his nemesis – he thought back to his glory days, when he easily vanquished every foe. He had stood so long and faced so many; his record was impressive with many wins and only a draw or two.

As the right jab snapped his head back – and snapped his mind back to the present – he realized his heydays were probably past. The following left hook confirmed this as his brain repeatedly bounced back and forth within his skull.

WHAM! The Meaningful Use left staggered him. Endless check boxes and extra steps required to document what he’d always done so that somebody somewhere could tell him that he’d done it whirled through his brain.

POW! The insurance company uppercut caught him right under the chin. Declining reimbursements, endless denials, appeal after appeal, and red tape for red tape’s sake left him woozy.

His counterpunches were useless and no matter what he did, he couldn’t seem to cover up enough.


UGH! The thunderous EHR blow to his midsection almost made him upchuck. He was no slouch, but figuring out which EHR would work for him at a cost that wouldn’t cripple his already slim operating margins was a gut-wrenching challenge. Even worse was the task of finding one with a workflow that actually flowed; most “flowed” about as well as punch drunk’s vocabulary; well-intended, but stuttering, rambling, and often without apparent purpose.

BLAM! The vaccine reimbursement roundhouse sent him into the ropes. He had always tried to keep his guard up – and those of his patients – by offering immunizations to every paying customer. He was staggered when he discovered that one of his karmic good gestures had backfired: He took military insurance to help veteran’s families the way he felt they should be helped, only to find that he was bleeding money every time he gave a vaccine to one of them. The military insurance, it seems, didn’t feel obligated to pay him for the full cost of the vaccines. In fact, they didn’t even come close. The financial blood gushed out.

THUD! The ACA kidney punch was a powerhouse. When one of the largest state university medical centers decided they wouldn’t accept any insurance obtained through the Healthcare.gov site, he lost a major nearby referral base for his many of his families. The ACA had helped many of the poor and underpaid of his community – and he was grateful to see them helped – but why the politics of big institutions had to then slam other good folks was beyond his pugilistic fathoming.

He tried to work his way inside, to tie up his opponent with a clinch to stop this incessant pounding. His heavyweight counterpart pushed him aside as if he were a mere featherweight.

CRACK! CRACK! Despite his best bob and weave, he was struck by a right cross from the declining appointments that the changes in insurance coverage had wrought. Despite more folks getting covered, many now had such high deductibles that they put off doctor visits more and more. They previously might have been regulars, doing all the recommended follow-ups and such, but their pocketbooks now demanded putting off doctor appointments in favor of paying rent or buying food.

CRASH! The liver shot of ever higher overheads and staffing costs sent him reeling.

BOOM! The rabbit punch to his clouded skull of constant hardware and software upgrades, repairs, or replacements caught him off guard. (He briefly flashed upon days gone by when documentation upgrades involved new pens or nicer paper and when hardware repairs involved Scotch Tape.)

He staggered forward as the ref penalized his opponent for the illegal hit to the back of his head. The penalty was shrugged off by a smirk as his adversary closed in with a glint in his eye, that look of coming in for the kill.

BAM! The corkscrew punch of fellow independent providers leaving the fight and joining the Big Gym of ACOs and mass group practices sent sharp spikes down his spine and stars up before his eyes.

Just as it looked like there was no more room to hide within the seemingly shrinking confines of his four-sided ring, the bell sounded!

He had survived one more round.

Bleeding and bruised, he shuffled to his corner. He wondered just how many more rounds he could go. He was a gamer, pound-for-pound one of the strongest ever. He had a good set of whiskers and was known as a brawler. But, he was definitely shopworn. Was he also a faded fighter, past his prime? Could he bring enough to the canvas to go even one more round? Were the opponents of today too much for him?

As the cutman applied the enswell to his eye and his corner man jabbered on about some tactic he couldn’t quite hear because of his now bilateral cauliflower ears, he considered his options. Maybe he could try to play possum. Maybe try Ali’s rope-a-dope. He even though he might have to resort to a Tyson-eque ear chomping. Hmmm…

He gnashed his teeth as he glowered at his rival. He wasn’t yet ready to throw in the towel.

From the embattled trenches…

“No mas.” – Roberto Duran


Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

Comments 5
  • This sort of perspective, along with the recent predictions of extreme PCP shortages coming, make me wonder when we might figure out how to trust doctors. All of these forces that are beating us up are based on a fundamental mistrust of physicians’ motives. There are some doctors who commit fraud, no doubt. But do we ALL have to be treated like we are out to defraud everyone? There has got to be a better way.

  • Now I know, doc, why I wake up each day feeling like a bad hangover but I knew I hadn’t anything stronger than sweetened ice tea the day before in the practice.

  • This should be required reading for every med school applicant.

  • Yikes, that’s some powerful imagery. We can’t cure all that ails within the current health care system but we can work denials, provide audits to avoid them, and pick up your overflow coding. Just a suggestion.

  • While sympathizing with some points, I can’t fully make peace with the sentiment. Yes, there are extra processes and external rules. How is that uncommon or difficult? Every professional engagement has many (a load) of rules, regulations, processes, etc. Some are external (regulations), some are internal. We try to do best we can and improve what we can every day and come up on top. Yes, it takes more time then there is available. yes, it is stressful and difficult at times. Yes, we have more to do then the day before. Get to it or get out.

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