Archive for October 16, 2015

Eight Ways Physicians Know They’re Overworking

Overwork is not pretty, and in some cultures it’s deadly. In Japan, “karoshi” or death from overwork, annually claims anywhere from 10,000 workers to 30,000 workers. The range is vast because, without autopsies, it’s difficult to accurately assess the cause of death of people at their desks, slumped over.

Karoshi does not appear to be a significant phenomenon in the U.S. Still, among over-workers and the highly fatigued, high blood pressure and heart disease are exceedingly common.

Danger ahead

Given that you work very long hours — why can that be dangerous? When you encounter stressful situations by working longer and harder, your muscles contract, your blood thickens, your heart pumps blood faster, and your arteries narrow. You’re prepared for fight or flight. If you actually did fight or flee, the situation would largely take care of itself.

Instead, your internal “engine” is revving for eight hours to 10 hours on end. You arrive home, where more stressors may emerge. You cannot sleep as many hours as your body requires, or if you do, it’s fitful sleep with tossing and turning. As a result, you’re being worn down and your immune system is becoming weaker. Thus you’re more susceptible to illness.

Some researchers believe that consistently having too little sleep could impact your whole life, to your detriment. Combined with too much work and too little sleep, any illness that you might contract can be more troublesome.

Beyond tired

You feel tired, but when are you bordering on danger? Among many signs, here are a few:

1. Lack of appetite or indigestion. You normally look forward to meals, but when highly fatigued, you have trouble getting them down. Maybe, you’re eating less. Your fatigue is prolonged.

2. Extra sleep doesn’t help. Getting many nights of extra sleep in a row or sleeping for an entire weekend doesn’t seem to diminish your fatigue. Perhaps worse, you feel as if you’ll never “catch up.”

3. Excessive sleepiness. You doze at inopportune moments, such as during an important meeting, or when driving!

4. Loss of sex drive. This isn’t obvious because decline in libido usually occurs a bit at a time and you don’t notice, although your partner likely will.

5. Interrupted sleep. At night, you wake more often or toss and turn, and then, worse, you spend the rest of the night overly concerned that you’re not attaining good sleep.

6. Persistent fatigue. You feel tired upon arising even after a full night’s sleep. Realistically, if, by 9:30 a.m. or 10:00 a.m., you can hardly keep your head up, it’s time to take heed.

7. Poor concentration. Your focus on the task at hand is poor. Your concentration is diminished and is not due to your aging.

8. Feeling ineffective. Finally, you feel that you’re no longer in control. In many ways, this can be the most worrisome of all signs. Roll back your number of working hours as soon as you reasonably can.

If one or more of these has been a lingering issue for you, it’s time to take a personal inventory and make some decisions about how you are going to change things


The Power of Big Data

Harnessing and capitalizing upon the monstrous amounts of available healthcare information

By Peter Edelstein, MD, Elsevier

Big Data. Population Health Management. Patient Engagement.

Healthcare reform churns out buzzwords at an alarming rate.  But at least big data has a more defined meaning, having come to linguistic life long before the Affordable Care Act was a gleam in President Obama’s eye presumably.

Today’s world runs on big data.”  It’s big data that allows millions of us to almost instantaneously receive insurance quotes online; creates your credit score; select a mortgage; and pushes pop-up advertising that just happens to be exactly what you were looking for yesterday.

As is our healthcare industry’s history, big data is yet another capability that has entered the medical arena long after becoming an integral part of non-medical sectors.  That said, big data is (finally) here to stay, in our hospitals, our pharmacies, in our insurance systems (where it has been the longest), and in our ambulatory care centers.

Big Data Goals

And like population health management, patient education, and other buzzwords, understanding our specific big data goals and how to achieve them is critical if we are to maximize the success of healthcare reform.  So the first question is, What Are Our Healthcare Goals for Big Data?

If an underlying goal of healthcare reform itself is to improve the quality and cost efficiency of care for populations and for individual patients, then we must turn away from reactive care provided in the acute, inpatient facility and strive for proactive, preventative, and maintenance care provided in the ambulatory world (both the outpatient physician office and in the place where patients spend virtually 100% of their time:  their homes and workplaces).

Linking to this goal, Big Data can drive the identification of individuals and populations at risk of suboptimal quality and/or cost of care and then to guide intervention to reduce or prevent the realization of the identified risks.

Already, Big Data is playing a foundational role in the first part of this goal.   Monstrous amounts of claims data serve to feed clinical analytics models, including predictive models.  Such powerful tools allow us to predict which patient populations and individuals are at risk of specific forms of clinical deterioration, high cost care, and/or unanticipated hospitalization and Emergency Department visits.

And recently, the incorporation of public records Big Data (including moving, home ownership, eviction, lien, and property value history; estimated annual income, wealth index and financial stress; and accident, fraud, burglary, and criminal history) along with health claims data has allowed for the development of even more powerful predictive analytics models.  (For example, inclusion of such non-medical data may more accurately predict risk of early post-discharge hospital readmission and/or risk of failure to pay).

Big Data Expansion

Today, non-clinical Big Data is expanding from the clinical analytics world into site of health care delivery.  The Institute of Medicine is recommending the inclusion of social and behavioral data within the EHR, where (as with analytics) this expansion of Big Data is projected to more clearly and accurately guide patient care.

Whether empowering clinical analytics models or more clearly defining individual patients and populations from within the EHR, the ultimate impact of our evolving Big Data is in guiding evidence-based content and clinical decision support tools which are targeted to meet the specific needs of an identified patient population, subpopulation, or individual, content which can be pushed to every point of care (hospital, ambulatory setting, patient home, etc.) and delivered in a format appropriate for the specific provider (doctor, nurse, patient, etc.).

As we widen the net of data sources and types included within our analytics models and electronic information systems, we are increasing our ability to hone down, to fine-tune our understanding of specific and populations’ and patients’ risks, needs, and opportunities to improve both the quality and cost efficiency of their care.  To provide the most appropriate evidence-based content wherever it needed, whenever it is needed, for whoever needs it.

Peter Edelstein is chief medical officer, Elsevier Clinical Solutions

ICD-10 Code Set to Replace ICD-9

ICD-10 Compliance Deadline: Oct. 1, 2015

The ICD-10 (International Classification of Diseases, Revision 10) is in effect as of Oct.1. The American Medical Association is focusing on steps to ease the transition and mitigate potential disruption in claims processing, physicians’ workflow and patients’ access to care.

Problems with Medicare Claims?

Some physicians may experience problems in the processing of their Medicare claims and other administrative transactions after the ICD-10 implementation. The Centers for Medicare & Medicaid Services (CMS) has named William Rogers, MD, an emergency medicine physician and the head of CMS’s Physician Regulatory Issues Team, to be its ICD-10 ombudsman, who will receive and triage physician and provider problems. The AMA offers an ICD-10 complaint form by email, where you can register complaints with the ombudsman, as well as a list of suggestions for further steps you can take. CMS is also establishing a communication center that will begin monitoring ICD-10 issues beginning at the end of September 2015.

Please note: Forms will be sent directly to the Centers for Medicare & Medicaid Services (CMS). The AMA will not provide individual responses to each complaint.

CMS and AMA Flexibility for ICD-10 Medicare Claims

On July 6, with less than three months remaining until the Oct. 1 deadline, CMS and the AMA announced efforts to continue to help physicians prepare for ICD-10. Read CMS’s guidance in response to the AMA’s concerns, as well as a set of questions and answersPDF FIle.

ICD-10 Educational Resources and Implementation Tools

These educational resources and implementation planning tools will increase your understanding of ICD-10 and help you prepare for its transition.

News and Updates on ICD-10

AMA Wire has the latest articles and viewpoints and a special ICD-10 series focused on timely tips and information to help physicians prepare for the Oct. 1 deadline. Also, read the latest press release on the code set.


The updated Frequently Asked Questions page summarizes the differences between ICD-10 and ICD-9, details who needs to upgrade to ICD-10 and recommends steps that you can take to prepare for the conversion to the new system.

Medicare Payment

Medicare continues to update the National Coverage Determinations (NCD) and Local Coverage Determinations (LCD). Learn more about ICD-10 payment.

AMA’s Efforts to Ease ICD-10 Transition

The AMA has advocated for physicians during the transition to ICD-10 by voicing physicians’ concerns to powerful stakeholders and policymakers. Read the most recent advocacy letters, calls, responses and testimonies that best represent the AMA’s concerns about ICD-10 and illustrate its commitment to removing barriers to a satisfying and sustainable practice.

AMA ICD-10 Products

The AMA Store offers for-sale training materials and other resources to help you understand and implement the new codes. Choose from among the following or view all of our ICD-10 offerings:

ICD-10-CM and ICD-10-PCS codebooks with official guidelines to help you stay up-to-date on all of the latest codes.
ICD-10 resources for in-depth guidance on anatomy and physiology, code mapping and documentation.
Specialty-specific coding cards and ICD-9-CM to ICD-10-CM mapping cards to reference quickly codes related to different specialties.
Data files that allow facilities to add ICD-10 codes to their software