Brown Rice

This morning I woke up and was instantly excited. It was time for the Quarterly All-Staff Meeting!

This is exciting in the same way as Grand Rounds might be if we had it, or the way it’s fun to eat brown rice for a change.

I was not disappointed. The morning started off with “Hooray! Lucille has worked here for 29 years! And, here are some new people we hired for medical records!” Then we learned why OSHA hates us and wants us never to eat at work. Afterward several people asked the same question in a row about whether it was okay if patients brought food to eat during their office visit.

This was followed by a 45 minute lecture about HIPPA designed to make all of us paranoid about using our smartphones, and to create passwords which no one can ever remember. In a fit of anxiety I had to tune out the guy and check my email.

Next we lined up by birthday! This is called team-building, we were told.

Then, hooray! Off to Provider Meeting.

Provider meeting is when all the doctors, CNM’s, PA’s and NP’s sit in the board room with one of the nurses who is lost, and who quickly leaves when she figures that out.  There is an agenda that is pretty accurate if you multiply each time frame by a factor of 3.

Firstly, a nice lady always comes in and tells us how we are billing wrong. This is followed by several providers giving examples of well child checks in which you also freeze off warts, asking “so how do you bill for that?” Soon enough we start worrying that the complexity of our visits are not being reflected in our billing, and someone becomes impassioned about sometimes needing to undercode for self-pay patients and someone else fights them about ethics. And throws in the word “fraud.”

Then we have to talk about access. Access is how no one can actually get in to see us but we still have lots of space because no one shows up to their appointments either. Our medical director suggests we should just take care of more things over the phone, and also that we try not to fix people’s entire lives in one visit so that the visit doesn’t take 45 minutes. Someone fights him about patients who present with chest pain, suicidal ideation and scabies all at once.

By then enough people are arguing that I raise my hand and make a feeble and vague comment intended to bring us to common ground, using keywords such as Patient-Centered Medical Home, which is mostly tangential and confusing to everyone else.

This is a perfect transition opportunity, so then we talk about how we still have no medical director after July.

Next an update on how we still don’t have an electronic medical record!

Finally it’s time to talk about productivity. We are each given a small grid detailing the average number of visits per session of the various groups of people. Everyone immediately believes the numbers are not accurate. “Well, are you keeping track of when I see a patient for carpal tunnel and then after that I put in their IUD?” “No way. I see like 15 patients a half day.” “What if the patient escapes from the clinic without turning in their papers? Because that happens a lot. Do you count them?”

Then we’re done! It’s time for Morbidity and Mortality conference! And tacos!

After all that excitement, we finally get to see some patients. Which is nice.