20 or so years ago while working for a Startup in the Home-Health EMR Space - it was my job to develop and integrate the proper processing of incoming visit forms. After an outage, I performed an audit of our incoming forms and noticed some anomalies in the billing patterns of doctors belonging to one clinic. In other words, these doctors either had the highest concentration of extremely sick patients - or they were committing Medicare fraud.

At the end of the post mortum with the CMO, as I was getting ready to leave I decided to bring this to his attention. I’ll never forget the change of mood preceding the dressing down I received: “do not ever put yourself in a position to make clinical decisions.”

3 months later, the charting anomalies were so egregious that the CMO’s spot-checks led him to sit the medical director of that physicians clinic down for a chat. They were good doctors, but they were over-billing. A year and a half later their practice goes under pre-payment review, and four years after I wrote a script that noticed an anomaly - the head MD of the practice was sent to prison for 4 years after collecting millions of dollars in over-billed house calls.

I loved working in healthcare, and I still miss it to this day. I don’t know where I am going with this, but right now I believe there is a diagnostic technology out there that is being used in veterinary science or piloted in some other country that could save a statistic level of lives …. However, due to the fact that doctors practice medicine and we don’t, as a group they act as defacto gate-keepers (which they are entitled to be as clinicians), the best thing you can do is to incentivize them with money (like Obama did) with Medicare bonuses for using an EMR that logged CCRs and alerted the doc if the patient didn’t have certain vaccine information in the elderly.

If the first guy to wash his hands was seen as a lunatic, the first geriatric practitioner to give over an iota of their clinical practice to automate Rx dispersal while navigating poly pharmacology concerns will go to jail for a narcotics crimes or will be labeled to heretic until Medicare pays them all for it.