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My New Hero


Like most superheroes, it is best to worship him from afar.  In fact, I don’t know his name and do not want to because I like a world full of possibilities.  My new hero is a physician in Florida and because he remains anonymous, every doctor in Florida could be him.  Florida is even sunnier and warmer with all those potential superheroes in white coats.

There are some heroic physicians who save lives or invent new procedures.  For the longest time, I was leery of the Whipple procedure because I was unaware that it was named after Allen Whipple.  I thought the term ‘Whipple’ referred to a technique and I didn’t want to know anything more.

Other heroic physicians travel to countries far and wide taking care of patients that have no one else.  These docs and other healthcare providers also have my undying admiration.

My new hero is a different breed, though.  I know of him by a client’s report that he documented homebound status on a Face-to-Face encounter with the following:

He is.  This is a stupid question.

Many of you may think that compared to Christian Barnard or Allen Whipple, this isn’t really such a big deal.  You could be right but I don’t think so.

In order for Drs Whipple and Barnard and the like to be of value to society and their chosen field of medicine, three things must happen.   The first is that the patient must live long enough to have the procedure done.  The surgery must be performed on a candidate well enough to undergo the procedure.   The patient must receive nothing short of excellent care after hospitalization.   Sadly this involves money.   (Average operating room time alone, without physician charges costs $147.00 per minute.)

Meanwhile, home health agencies are being denied daily because the physician does not document how the patients condition confines them to the home.  Claims are denied even when patients are recently discharged from the hospital with a serious illness or surgery to replace something like a hip or heart or whatever.

When home health care agencies don’t get paid, they are faced with choices that eventually result in providing care that is substandard or closing their doors altogether.  That means a poor outcome for the replacement parts.

We have all tried, in our own way, to gently hint to Medicare that the F2F encounter document is stupid.  NACH has even filed a law suit full of big words spanning numerous pages.  Medicare responded that they may relax the requirement in the distant future but no further word has been forthcoming.  I suspect they just wanted to minimize the importance of NAHC’s lawsuit.  I could be wrong, though.  Never let it be said that I am always right.

My hero, the unknown physician, has described in five words, why Medicare is getting so little compliance on the F2F matter.  Please note that the physician wrote two complete sentences with both verbs and nouns and I hope he gets partial credit for writing a grammatically correct narrative that doesn’t simply restate what is written in the manuals about homebound status.

Like most docs our superhero probably saves a few lives here and there and makes other people feel much better about being alive when he isn’t answering stupid questions on a stupid form verifying that he saw a patient he just discharged from the hospital.

Luckily for my diligent client, the claim had not been dropped for the patient yet.   I hope they make a photo copy of the original document before they go waste another hour of their time and the doctor’s time by once again explaining what an expensive comment that was and asking for a do-over.  If this chart is ever summoned by the payor sources, I  think I would include the original and the Do-Over.  You know, just a subtle little message – because I am all about being subtle.

Will everyone please bow their heads and give my hero  a moment of silence in honor of his insight into our daily struggles.  It is the least we can do for a physician who has contributed so much to so many.  Hopefully there are more waiting to come out of hiding.

9 Comments Post a comment
  1. Debbie Mazzola #

    thank you:)

    October 6, 2014
  2. Pamela Willey #

    Yes, it Is stupid! And it’s a frustrating struggle for home health agencies to get the “proper” documentation, but the end result for us is a possible denied claim that we can not afford! You would think a patient that had a hip replacement and just discharged from the hospital AND you had all the hospital documents would be enough! I would like to see the folks writing these stupid rules sit in our seats for a day and see how far they got with a F2F, bet they would change their tune!

    October 6, 2014

    • I would like to sit in the seat that makes up their rules.

      October 6, 2014
  3. Sahily #

    I so agree with that Dr. This is the stupidest regulation they have come up with.

    October 6, 2014

    • I obviously agree with the doc as well but I am not sure that is the stupidest regulation they have come up with. Gonna keep a list in my notebook and when I get enough, I will put them out for a vote. There’s some pretty dumb stuff out there. Feel free to add to my list at any time.

      October 6, 2014
  4. Kasandra Wylin #

    Julianne, I read the physician’s FTF and I honestly burst out laughing! Then I continued on with your tongue in cheek commentary and found it totally delightful and so very honest. Thanks for making my evening after a very stressful day! 🙂

    October 6, 2014

    • Thank you for your kind words. It made my day, too. The people downstairs from me must have thought I was nuts laughing out loud all by myself in my office. I wonder if that’s why they are moving.

      October 6, 2014
  5. Carol #

    I have been in home care a very only time….boy I’m am aging myself….not easy to face. I agree with your superhero….F2F is STUPID. it is so un-necessary…The 485 is and has always been the document that the physician certifies that the patient qualifies for home care and is homebound. Correct?

    October 7, 2014

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