CryptoMD

Freedom ₿

[John Mandrola, MD @drjohnm]

Typos are back in!

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Writing notes for clinical care is often completely different than writing notes for billing and coding.

Take “brain compression” as an example. No neurosurgeon ever uses that term. It’s imprecise and clinically meaningless. We say things like “midline shift” or “uncal medialization” or “compressed basal cisterns.” These terms relay accurate, actionable pathology.

Yet the coders need us to write “brain compression” to increase hospital reimbursement.

So you have this clinically meaningless term thrown into notes. That creates note bloat and confusion. It does nothing to actually describe the severity of a brain injury. Its inclusion in documentation is simply because it’s a financially valuable buzzword that gets the hospital paid more.

In other cases, you’re forcing doctors to comment on conditions for which they really shouldn’t be responsible. The hospital won’t get paid for the patient with heart failure unless you describe it in detail. The same goes for the diabetes and malnutrition.

But asking your neurosurgeon or orthopedic surgeon to document details about diabetes or heart failure or malnutrition is completely inappropriate. It leads to errors in the patient chart and even more useless bloat.

So I see good clinical documentation as mutually exclusive with good coding documentation.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Hospital admin: “we know you booked your surgery as an anterior-posterior case. We need you to cancel that booking and book a separate anterior case and a separate posterior case.

Yes, we know you’re doing it all as one surgery and yes we know it is how this case is always done.

No, your prior booking can’t be modified by our OR staff.

You, doctor, need to stop what you’re doing, find the patient chart, cancel the old order, create a new encounter, go through the preop order set, then do it a second time for the second case, and then we will give you your OR time back. But hurry or we will give away your block time.

We attached a tip sheet to this email.”

[Danny Farkas @dannyfarkas]

@DrDiGiorgio I get a message to my inbox when at 2am a patient requests a routine appointment through the portal.

I cant even make the appointment if I wanted to. I don’t have registration access. But that’s how the system thinks it’s best route appointment requests.

[CryptoMD @realMattDeen]

@DrDiGiorgio Cerner

[Gregg Fonarow MD @gcfmd]

First-in-class, novel-mechanism agents tested in Phase 3 CV outcomes trials have <20% success rate

It is very challenging to incrementally/meaningfully improve CV outcomes

Yet, tragic when there are proven therapies, but not implemented, and preventable events allowed to occur

[Kevin Friede, MD @kevinfriede]

I kept track of the compliance modules I was required to complete @UNC_SOM over the last year. 45 modules, including several modules completed more than once for different hospitals *in the same health system* …

1/2

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

I’m struck by how many hospitals have gone from treating physicians as professional colleagues to treating them with outright disdain.

Emergencies happen and surgeries get bumped. Everyone understands that.

What is harder to understand is the complete absence of basic professional courtesy. A simple notification, an apology, or an acknowledgment that you’re asking someone to rearrange their entire day goes a long way.

Instead, physicians are often expected to simply wait. Many surgeons receive no additional compensation for doing emergency procedures on weekends. They leave their families, assume significant medicolegal risk, and make themselves available because patients need them.

The least a hospital can do is communicate honestly, provide updates, and acknowledge the burden. Professional respect should not be too much to ask.

[Bill Ackman @BillAckman]

One of the most important speeches you will hear this year on why we are at war with Iran.

Worth five minutes of your time.

[dnap @dnapway]

David Friedberg says the greatest lie of the 20th century was putting all your net worth in your home

"When you do that, then the only way to keep Americans wealthy and to keep the middle class stable is to keep the price of homes going up, because that’s the only asset."

“So if you want your net worth to go up every year, they need to have policies that drive the price of homes up every year. That ultimately leads to a point where we're at today where young people can’t afford those super expensive homes."

“Back in the day, 30, 40 years ago, you got a good job, you could buy a home. Today, because we made everyone put all of their net worth in their home and we had to keep home prices going up, people got screwed."

“So these are the fundamental issues, the mistakes that were made over the last couple of decades that lead to this great socialist wave that’s underway right now.”

[John Mandrola, MD @drjohnm]

It’s hard not to see this as comedy

Whilst LAAC, tricuspid valve interventions and coronary CT scans act as bank machines

Reducing low value care would likely shred the AHA, ACC, HRS and likely ESC too

[bodila @51bodila]

JPMorgan CEO invited Elon Musk for a private talk with 3,500 of his top investors - everyone applauded at the end

- he bet his last money on SpaceX in 2008 - now if the company goes public he will become the world's first trillionaire

18-min workshop from an absolute genius sitting next to the greatest banker

he answered:

• How does he use AI in a $350B company?

• Why is SpaceX going public now?

• How will SpaceX make cargo to space cheaper than a transatlantic flight?

bookmark & watch - this is an exclusive video of two of the greatest people in their fields

[The Vigilant Fox 🦊 @VigilantFox]

Bill Maher urges Trump to “cut and run” on Iran, says we “took the shot” and it “didn’t work.”

“Six weeks ago, we thought it was the right thing to do to take this shot now to deal with Iran once and for all.”

“We just don’t think jihadists and people who believe in martyrdom can have nukes.”

“Six weeks later, I think we’re at a different place.”

“You [Douglas Murray] think we’ve got to finish this no matter what it takes.”

“I was never on that page. I was on the page, ‘This is a great opportunity. Hey, we see them all in one place, we can wipe out the whole leadership at once. It looks like they’re ready for an uprising. Take the shot, Mav. Take the shot.’”

“We did it, and it didn’t work. Now what?”

“I hope [Trump] does what America has always done… We always cut and run.”

“We did it in Vietnam, we did it in Iraq. We did it to the Kurds. We did it in Afghanistan. Now we did it in Beirut. That’s us. No lifeguard on duty. If you get in with us, we are going to f*ck you.”

[CryptoMD @realMattDeen]

@ItsTheEnforcer So politically charged, yet again

[CryptoMD @realMattDeen]

@ItsTheEnforcer Why are you guys so anti trump? The political aspect of your content is becoming not only extreme but highly unfavorable due to your obvious political bias

[CryptoMD @realMattDeen]

@DouglasAdlerMD ACS PCI with aspiration thrombectomy, PTCA and DES placement and restoration of TIMI 3 flow..

[CryptoMD @realMattDeen]

@NoLimitGains @grok is this true

[Roger Steele @RogerSteeleJr]

Rarely give swing advice but this feel has been one that I have gone back to all season. Works wonders. Hope it helps.

[Bsheridangolf @bsheridangolf]

#Swingsequence of #tigerwoods with a driver in slow motion. #golflessons #golfswing

[CryptoMD @realMattDeen]

@jasonryanmd Big picture sounds concerning. However, why should the tax payer be responsible for funding childhood COVID vaccines? Where is the science supporting improved outcomes with continued pediatric COVID vaccines? There is no evidence.. which paradoxically dismantles the argument