Sunday, August 24, 2008

Reason for Consult: Old

You'd think our surgeons would get the hint. Particularly our uber-sub-sub-specialist surgeons. They bring a patient in for a routine gravy-train procedure, and on their ORDER SET... "Consult Hospitalists for Medical Management."

How can a consult be on standard order sets?

So when we find out it's from this particular group of surgeons, we have the nurses call the surgeon to make sure there really are medical issues for us to follow. Often... there are not.

Just so happens the other day this consult came during the day, and I saw the surgeon walking by.

"Do you really need us for this one?"

The response: "Yeah.... she's 75... ya know... not on any meds or anything but I think it would be a nice 0ne for ya guys... kinda frail."

Me, " ... uh... ok... I'll see what I can do."

What I really wanted to say was, "Really, asshole? Do you think Medicare is really going to pay for a consultation by me when the reason for the consult is 'frail'? I assume by 'frail' you mean 'old'. So does that mean there is an age threshold for consultation? Unless you're going to start sharing your revenues from your over-reimbursed procedures, you can manage 'old' all by yourself, big boy."

We clearly need to have a medical staff meeting. What a douche.


The Happy Hospitalist said...

I got a consult for "multiple sclerosis" in a patient admitted for an overnight discectomy. I looked at the vitals, circled their one home medication and I Indicated in one sentence that patient is stable and signed off. In this case, I chose not to bill. But usually it is a level 2 follow up visit and then sign off. I refuse to allow myself to be available for routine house calls. That's not what I do.

The Happy Hospitalist said...

I think I've already emailed you, but if I haven't email me at I can't find your email address