Lord of the Rings IV: Jumping Through Hoops
Written by: Dr. Michael Weiss
You’re Frodo Baggins.
Since leaving The Shire, you’ve been hunted by Orcs, stabbed by a Black Rider and stung by a giant spider. An octopus tried to eat you. A crazy wizard tried to bury you. Some creepy, froglike creature named Gollum keeps grabbing at your neck.
All you want to do is save Middle Earth from eternal doom. Yet your noble quest is fraught with perils you never foresaw, and you long for the haven of simpler, safer times.
Small wonder sleep eludes you.
Be encouraged. You’re not the only insomniac in town.
I don’t rest soundly, either, for things are no less perilous here. Though I’m not wading through smelly bogs or scaling jagged cliffs, the same Great Eye that searches for you makes me feel vulnerable, too.Welcome to the realm of health care, Frodo Baggins.
It’s a place where rules abound and where mercy for known rule breakers comes in scant measure. For that reason, I, like you, can be considered a sort of Lord of the Rings. The title fits. I’m always jumping through hoops.
When OSHA tells me to use a certain disinfectant to clean the office countertops, I use it. When the Department of Health and Human Services tells me to give every new patient a HIPAA privacy notice, I give it. When Medicare tells me that I need to document thoroughly for every code I bill, I’m not only thorough in my documentation, but I also employ a staff of several to make sure the documentation is thorough enough, just in case.
When my malpractice insurer tells me that I need to pay an implausible sum of money to the state’s MCARE fund, I pay it. When the state tells me that I can get a refund but will need to complete an endless process that starts online and continues on paper, I log on and start typing.
Like you, Frodo, I dutifully hold to the larger quest but also find myself yearning for the haven of simpler days. Even as I type, I think, "The state could easily condense this form to two questions: ’Do you qualify for the refund?’ and, ’If so, where would you like us to send the check?’"
How did it come to this?
Every rule in health care has a noble aim — to deter the occurrence of some undesirable effect. Yet when deterrence becomes the end, aiming eventually becomes the means. The target may be defiant rule-breakers, but it’s often sincere rule-followers who feel the most embattled and exposed.
In other words, no matter how hard you work to comply, it never seems like you’re working hard enough.
So it is here. In our practice, we’ve tried to foster a culture that seeks always to do right in both law and spirit, and we’ve implemented processes and controls intended to assure compliance across the spectrum of activities involved in delivering care. But for all our fostering and implementing, assurance seems harder to find. That’s because rules multiply, change, confuse, surprise and conflict. As they do, more of our resources are consumed trying to follow them. At times, the effort can seem paralyzing, even futile.
Can any provider ever be in total compliance with every rule that exists? If so, at what cost? If not, at what risk?
You don’t have to answer those questions, Frodo. You’ve got enough to do, what with saving Middle Earth and all. But I think I now understand what drives you on. You have only two options. You can hide under your gray Elvish cloak forever, where no harm will find you, or you can press on in spite of the Riders, Orcs and other obstacles.
Your choice is not so different from my own.
You press on. I continue to jump.
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