by Caroline Fife, M.D. | Feb 26, 2015 | Don't Miss This
This patient is undergoing HBOT for soft tissue radionecrosis of the oropharynx. He developed a rash on his ear and the side of his neck including a necrotic eschar on his left ear lobe. The rash even extends into his scalp on the left. What is it? Yes, it’s shingles....
by Caroline Fife, M.D. | Feb 24, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
Package pricing is only the beginning of the changes to outpatient payment. There are new global periods going into effect, and there will be other changes that take us toward some sort of outpatient “DRGs” (diagnosis related groups) or capitation—or reimbursement...
by Caroline Fife, M.D. | Feb 23, 2015 | Do the Right Thing: Thoughts on Quality, Quality Payment Program
I just finished a chapter on quality measures for the 2nd edition of the Wound Care Certification Study Guide. I tallied up the penalties that a clinician who is not participating in any of the various programs will incur in 2015 and it’s about 5.5% of their Medicare...
by Caroline Fife, M.D. | Feb 19, 2015 | Health Information Technology and Wound Care
In the early 1990s we had a form for our wound care patients to document the wound size and the dressing we used, etc. It seems to me that the templates inside most EHRs are no different from those old forms. Unless you have an EHR that can process data and actually...
by Caroline Fife, M.D. | Feb 17, 2015 | Cassandra Chronicles: Regulatory and Coverage Policy
It’s time for some straight talk on patient insurance since the Affordable Care Act. Am I the only one who has noticed that things have changed? I’m practicing in an affluent community but more and more patients with private insurance walk into the clinic and say, “I...
by Caroline Fife, M.D. | Feb 12, 2015 | Do the Right Thing: Thoughts on Quality
A longitudinal study in the United Kingdom of 370 patients with diabetic foot ulcers performed over 31 months showed that 33% of patients never became ulcer free. In other words, the healing rate for DFUs was about 66% in 2005. What is the healing rate of DFUs overall...
by Caroline Fife, M.D. | Feb 11, 2015 | Don't Miss This
This is the ulcer of a 55 year old man who has had diabetes for 14 years. It started when he scratched his leg during a construction project 6 months earlier. You can see from the photo of his leg that he has almost no edema, no hemosiderin, and no...
by Caroline Fife, M.D. | Feb 10, 2015 | Pressure Cooker: Rethinking Pressure Ulcers
It’s time for some straight talk about the pressure ulcer staging system. I don’t have much hope that anyone will make the changes that need to be made, but let’s at least be clear about a few things. Stage 3 and 4 pressure ulcers form from the inside out, the way an...
by Caroline Fife, M.D. | Feb 9, 2015 | Health Information Technology and Wound Care
I heard on the radio recently that Presbyterian hospital in Dallas reached an undisclosed settlement with the family of the man who died of Ebola. His death might have been avoided if he had not been sent home from the ER the first time. According to news reports, the...
by Caroline Fife, M.D. | Feb 6, 2015 | Fight the Good Fight, Health Information Technology and Wound Care
Good morning and Happy Friday! Friday’s on the blog are reserved for “Ask the Physician Friday.” If you have any questions for me please feel free to leave them in the comments below, ask on Twitter (@carolinefifemd), or on Facebook (Woodlands Wound...