letters

Pure nonsense

"Coding Nonsense, NOS" [October 2005] reminds me of my favorite example of ICD-9 nonsense: Code 874.9 is listed in the index as amputation of the head! How did we ever get to this place?

Christine S. Dotterer, MD
Selinsgrove, Pa.

Dr. Newbell's commentary on ICD-9 coding is a wonderfully humorous take on this bizarre task. My greatest frustration has been the index. Instead of just listing the code, or even a page number, one perpetually finds, "See... ." When you go to the "See ..." there is frequently another "See ... ." I would throw the book across the office if it weren't so heavy. I don't want to hit someone with it and be accused of battery.

Scott Helmers, MD
Sibley, Iowa

Homogenized lemmings, continued

In response to Dr. Sanford Brown's letter to Dr. Marissa Muscat [October 2005] about his use of the term "homogenized lemmings" to describe employed physicians: Many of the "large numbers of family physicians who claim they are unhappy practicing family medicine" that Dr. Brown referred to in his letter are practicing independently - with full-time management responsibilities on top of a busy patient care schedule. And the solo, part-time practice that Dr. Pamela Wible [Letters, October 2005] says produces income equal to the salary she earned as a full-time, employed physician just isn't realistic in many underserved areas. Uninsured or underinsured patients make up the majority of many practices in such areas, and a busy schedule is unavoidable if the needs of the community are to be met. I suspect that I am among thousands of very satisfied physicians who can focus on patient care while administrators manage the practice with our input. Divisive terms such as "lemmings" should be avoided in our professional discussions.

Chris Basham, MD
Big Stone Gap, Va.

EHRs and disaster management

Much has been written in FPM about the benefits and costs of electronic health records (EHRs). In view of the natural disasters that have affected many of our colleagues recently, I would like to point out a benefit of EHRs that hasn't been discussed much: disaster management. If I had to evacuate in the face of a hurricane, I could put in my pocket eight years of medical records for all 5,000 of my practice's patients. If there were a fire at my office tonight, I would not lose a single record because the back-up tape would be safe with me at home. This kind of security is priceless.

David M. Newman, MD
Brockport, N.Y.

Improving chronic care

"Improving Chronic Illness Care: Lessons Learned in a Private Practice" [November/December 2005] is a valiant and important article. As it demonstrates, good medicine is not cost-effective on the caregiver end. Dr. Phil Mohler's group must be making a far better living in Colorado than I did in Northern California to be able to sacrifice $1,800 a year to implement a diabetes management system. It's not just that payers reimburse short, symptom-focused care (sprains, colds and the like), but this is reimbursed far more than teaching, and getting patients with diabetes to cooperate for their own survival requires a lot of teaching. Just think, the efforts of Dr. Mohler and his practice don't even begin to address other chronic illnesses.

Matt Cushing, MD
Harwich, Mass.

The survey says …

I read "An EHR User-Satisfaction Survey: Advice From 408 Family Physicians" [October 2005] and want to know what EHR system co-author Dr. Kenneth Adler uses.

Amanda Sina
Boston

Author's response:

The EHR my practice uses is Touchworks 10.0 from Allscripts Healthcare Solutions.

Kenneth G. Adler, MD, MMM
Tucson, Ariz.