By Abby S. Van Voorhees, MD, April 02, 2013
I've come to really appreciate the color grey. Grey catches me time and again since it is neither black nor white. I like that place between two extremes that takes something from both sides. This central place is where I can explore nuances. I find that quite compelling, this zone of compromise and subtle arbitration. And unlike the two extremes, which are often single-minded, this middle place requires more thought and understanding. I wish that Congress would share my point of view and work for some of these in-between considerations instead of the harsh party-hackneyed views that don’t really work but are easy to spout.
This month’s coding column reflects this nuanced thinking. Now you might say, whatever is grey about coding? The billing compliance officer at Penn is nothing but black and white. While you’ve not met him, you know the type. I either can bill as he thinks appropriate or it’s the highway. Alex Miller’s column takes us to the next level of coding ... the grey zone that reflects the reality of seeing patients. Understanding the nuances of these codes requires that we know what our intentions are, how deep our scalpels are going, and what kind of margins we are aiming for when we are performing our procedures and then billing for our biopsies, shaves, and excisions. I hope that you’ll share my enthusiasm for this column, and learn a lot as I did from reading it. [pagebreak]
Our international column this month focuses on South Africa. As we peer into the world on the southernmost tip of Africa I’m struck by the issues we have in common. We hear our peers in that country talk about the “haves” and the “have-nots.” Those with resources are able to get dermatologic care, while those without have a much more difficult time. Working in a city may skew my perspective, but as the economy stumbles along here in the U.S. it seems to me that I see many people in the same predicament. Economic inequalities that are then coupled with medical care inequities exist in all societies. Perhaps our colleagues in South Africa can lead us to a few solutions as they work through their pilot projects and public health initiatives.
Patient portals are here to stay, at least if Washington has any say about it. Again, not a grey mandate. Meaningful use requirements coming up in the near future will mandate their existence and our reluctant participation. Patients seem to be in favor, at least theoretically, although we find in our practice that few patients actually sign up when given the chance. Nurses like patient portals since less time is spent trying to reach patients who are not home. Physicians fear this technologic tool, feeling that our precious few off hours will be further eroded. Whether this goes forward or not, best to learn about it and be thinking about its possible implementation while there is time to mull over the options. Gilly Munavalli raises many important issues to start considering.
I guess we don’t have too many answers this month, just lots of things to ponder. Sort of that grey zone. But all is not grey, at least from my perspective. My husband planted hundreds of daffodils in the yard last fall. I wasn’t sure what was driving this mass planting, but the sweet little flowers are now cheering up the landscape with their optimistic hues. Speaking of bright hues, the logo for the SPOT campaign is almost as bright as the flowers!
Enjoy your reading.