What has meaningful use done for you lately?
I first heard the term when my son was trying to share what he did at work. He’s in nursing informatics and I was curious. It’s a field I had spent maybe five minutes considering.
What he said came across as gibberish to me. I’ve been retired from nursing for almost a decade. You don’t forget what you know, but it’s a dynamic profession and things change rapidly.
Though I didn’t quite grasp what he said, I didn’t question him about it. I just let myself enjoy the moment of conversation with him. I figured it had nothing to do with me anyway.
Well, color me wrong.
This past November I had my usual rheumy work-up done prior to my visit. Other than having my arm bleed out because I lugged in groceries immediately after, nothing out of the ordinary happened and I gave it no further thought.
In January, I received a bill from the lab. My insurance had denied the claim.
Remember the chasm that Indy has to cross in Indiana Jones and the Last Crusade? There is no visible bridge, but he has to believe that there is so after steeling himself, he puts out his foot to take the first step into nothingness.
That’s exactly how I felt when I picked up the phone to speak to my insurance. When I finally got to a live person, I was told they’d denied it because they did not cover treatment for obesity.
They also mentioned coding for high white blood cells, pneumonia and some other diagnoses, but by then I’d tuned them out and was patiently waiting for my turn to speak. Obviously, I’d been mistaken for another patient.
But, no. There was enough evidence pointing to me. Talk to your doctor they said.
I called the office and he himself called me back. At 8 p.m. The only time doctors ever called me back at such an hour was when I’d been on shift. I was surprised by the late callback and I was even more surprised that it was him.
I quickly explained what was going on. The man has RA as well; he needs to not work so late.
“It’s Meaningful Use,” he said. “We have to put the weight down and then they go by the BMI.”
My son’s words rang in my ear: “Now we have what’s called meaningful use.” I didn’t realize at the time that the words took capital letters.
Before I spoke with the doctor, I’d been a little mad at the nurse practitioner who, per the office, had added the “obesity coding” to the lab order. We’d never discussed my weight, or any issues related to it.
I felt that I had been diagnosed (misdiagnosed) behind my back. I’d been betrayed, judged, found lacking, or rather overabundant, and worst of all, billed for $250.
But now I understood what had happened and my options raced through my mind:
Option #1 – Refuse to be weighed.
Option #2 – Refuse to let the office add the “obesity coding” to my lab order
Option #3 – Get my BMI within normal limits.
Option #4 – Do all of the above.
At my next appointment, we discussed the problems and options we faced in dealing with this new facet of going digital. I well understand the hiccups that come with changes, the fits and starts of instituting a new way of doing the same old thing.
BMI is not the most useful way to determine weight status. Muscle weighs more than fat, so that alone skews the numbers. With a present BMI of 29, I fall into the “overweight” category.
The BMI formula takes into account your height and weight. Per last year’s bone density study, I am still 5’ 2” in height. The office has my height listed as 5’ 1” tall. That one inch is probably what threw me into the obese category. Shorter = fatter.
What would be truly meaningful is if the whole picture of the patient was taken and not just a couple of numbers. My primary, documented diagnosis is Rheumatoid Arthritis. And part of the treatment for it is the use of corticosteroids, which tends to affect weight.
Of course, that is not the only reason I am carrying around some extra baggage, but still, it seems unfair, or at least not well thought out, to devise a system that singles out one statistic and ends up penalizing a patient for their very illness.
Perhaps this quirk in the system can be revised or overwritten. At this point all it’s done in my case is cause confusion and aggravation, plus adding to the workload of all involved.
My doctor is now working his magic to retroactively code the November lab order appropriately so that the insurance will cover it. For this latest appointment, I crossed the chasm in good faith that he had indeed revised the coding for February’s labs. I suppose I will find out in a few weeks whether or not the bridge materialized.