Idiots in Charge

I’ve come to the conclusion that the people in charge of things like regulations and billing are some of the biggest morons in our industry.  Worse though, is that they just don’t get it.  They are so far removed from the bedside that they have no clue that adding an extra check box in itself spawns that many more things to click and chart under and then you multiply that by the number of patients you have and the number of times you have to do it. The single click quickly spirals into more than just one click.  That and the rules so often do not reflect the true nature of what we do.

Today while going over charge capture methodology for our Epic transition, one of the billing people said the following, “My clinical experienced is pretty limited, so let me see if I understand this correctly…”  So what’s wrong with that you ask?  She’s in charge of auditing charts for billing/regulatory compliance.  One would think that some degree of clinical expertise/understanding would be required to accurately understand the charts.

And the folks making the BIG rules, CMS, is suffering from such a case of rectal-crainio inversion it’s not even funny.  A perfect example we went over today was blood transfusion.  Simple right?  Drop a charge every time you enter a unit of blood into the computer.  But no, that would be too easy.  For CMS (and thusly everyone else) beleives that you should only get paid per instance.  In other words, per MD order, not number of units.  So if the order is for 1 or 6 units, we get the same thing, even though we do the exact same amount of nursing care for each unit.  Every time we have to double verify, take vitals, stay with the patient for the first 15…each time.  So if it is 6 units, you’re doing the same work 6 times, but really only getting reimbursed for the first.  Makes sense to me!

I still believe that every billing person, CMS regulator, TJC auditor and anyone who writes rules and regulations be required to spend at least a week a year, if not more in the trenches.  No cushy units, but units where they would have to work and be subject to the rules they have enacted.  Then they might not be so regulation happy.

One can dream can’t they?


  1. That is the main problem right there — they don’t do the work. I made a similar comment to our CEO in a meeting: it’s hard to truly understand unless you are there to experience it.


  2. You don’t get it: having competent people in areas of the hospital dedicated to regulatory compliance is a waste of resources. With few exceptions, the regulations and protocols are ridiculous, unrealistic, and irrelevant (if not detrimental) to patient care. Regulatory compliance is a government-mandated waste of resources, and everyone who makes their living taking care of sick people knows it. Consequently, hiring intelligent clinicians would be a costly way to accomplish nothing. A smarter business plan is to hire the least experienced, least capable people possible, pay them as little as possible, and let them accomplish nothing at the lowest cost to the patient care enterprise.


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