Anyone has any update with UTSW?

[wavygravy99]

I was just informed by another person while discussing the rank list thats coming up, and the UTSW PM&R department fraud investigation/lawsuit currently going on is brought up. Just wondering if it is a big deal within the PM&R community and if the residency will be affected by it. thoughts? has anyone heard about this. because during my interview they only mentioned they are in the process of getting a new chairman/woman and the previous chairwoman stepped down.

here is the link to the dallas morning news report I found online
http://watchdogblog.dallasnews.com/tag/pmr/

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[MedBronc23]

All I can say is wow. I really liked that program when I interviewed. Does anyone know who the suspected guilty party is?

 

[Louisville04]

Wow is right!
I don't think this that uncommon.
Back when I was in residency, the criteria for rehab was a pulse and good insurance

 

[wavygravy99]

yeah, i was kinda bummed about it. UTSW is my favorite texas program and I really like the city of Dallas. just sux that the rank list is due tomorrow night. just don't know what to think of it, there maybe nothing too that came out of this investigation/lawsuit. it was one of those whistle-blower thing from past resident. While i interviewed there, it was just a typical day, and i didn't sense any tension, problem within the dept.

 

[RUOkie]

Reading that lawsuit filing shows one of the pitfalls of academic medicine. I hope that every single academic physiatrist studies it. Most academic programs regularly commit medicare fraud (as defined by the letter of the law) every time they allow a resident to do ANYTHING and then bill CMS for it.

When I was an academic in an ortho dept, we covered the county hospital once every 11th week (there were 11 dept members). When I covered, the only people where we generated a bill was when I walked in the room and examined the patient. Since the clinic would see 150-200 patients I could not see everyone. SOME of the ortho staff generated bills for everyone. I would not.

 

[RooAgg14]

This happened a while back. I live in Dallas -- this made the front paper of the Dallas Morning News when the story broke, but since then there hasn't been much hoopla. The people involved have left. I don't think it should affect your rank list. The residents now have good supervision and appropriate autonomy with procedures -- they all seem to love it there. Hopefully this info puts you at some ease for tomorrow!!

 

[Taliesinrk]

Not to nit-pick, but if the OP is asking for info, the people involved have not left - that, to my knowledge is false information (please correct me if im wrong here). The chair is stepping down, but will still be on faculty, and at least one of the other 4 named is still VERY involved with the program. I don't have all the details, but just searching those named in the suit will tell you the above statement is not accurate.

 

[RooAgg14]

It seems like there were a lot of people involved. I was going off of what someone told me -- that the DoJ had requested records of a handful of faculty, but that they are all now former faculty. Just did a Google search and found a whistle-blower Parkland blog (easily searchable) that shows this is the partially the case. However, as Taliesinrk mentioned, there are some that are involved that are still on faculty. Sorry for any confusion! Thanks, Taliesinrk for the info

 

[Taliesinrk]

I hope I didn't sound rude... Just wanted to clarify since the OP is turning in his list tomorrow

 

[Xardas]

Not to nit-pick, but if the OP is asking for info, the people involved have not left - that, to my knowledge is false information (please correct me if im wrong here). The chair is stepping down, but will still be on faculty, and at least one of the other 4 named is still VERY involved with the program. I don't have all the details, but just searching those named in the suit will tell you the above statement is not accurate.

Qui tam (whistleblower suits) often involve a very disgruntled former employee. This case seems no exception. Of course that has no bearing on guilt. The article does menton

She “issued an executive directive for residents and fellows [doctors in UTSW training programs] to see all potential patients as early as possible during their Parkland inpatient stay, including while in the ICU.” This “placed many medically unstable patients in jeopardy for further injury and serious harm.”

The directive’s purpose, according to the lawsuit, was to have the trainees “systematically be able to record on Parkland medical forms that a rehab consult was performed.” The forms “would be used as support to cause false billings” to Medicare and other federal insurance programs.


Having worked at an academic PMR institution the bolded statement is kind of ridiculous in my statement. PM&R consults do not place patients at harm, its not like you are doing procedures on them, and it is not at all uncommon at major level 1 trauma centers to have severe brain injuries and SCI's with PMR follownig them very early for a variety of valid physiatric reasons.

The whole issue of generating consults is a totally different story. If the 'consults' were called in by the referring MD's and the residents sees, then attendign staffs then no problem.

IF the allegation that it is a generic 'rehab' order that is an automated check box for example every time a stroke or TBI rolls in that is a major problem. A consult should originate from a physician only.

So the consult allegations are fairly serious. I don't know how much supporting data the plaintiff has but for it to get to this level is pretty big.

Interesting tidbit. The attorney general for Tx in this case is Greg Abbott. If you don't know him you should know he is a SCI patient who is heavily involved at TIRR historically. Yes, that TIRR. I know this should not play a role in this case but you can bet he probably knows quite a few of the big players in the PM&R community in TX.

 

[Louisville04]

The whole issue of generating consults is a totally different story. If the 'consults' were called in by the referring MD's and the residents sees, then attendign staffs then no problem.

IF the allegation that it is a generic 'rehab' order that is an automated check box for example every time a stroke or TBI rolls in that is a major problem. A consult should originate from a physician only.

Does the attending have to see the patient on the same day? For example the resident does the consult at 3pm and the attending sees the patient the next day at 9am.

I think in some nursing homes/SNF's have standing orders for a rehab consult on all admissions.

 

[Xardas]

Does the attending have to see the patient on the same day? For example the resident does the consult at 3pm and the attending sees the patient the next day at 9am.

I think in some nursing homes/SNF's have standing orders for a rehab consult on all admissions.

No you get 24 hours. Think about what happens on medicine services all the time.. ER admit, intern and resident sees patient at 11PM, attending is never going to come in at that time.. they staff the admission next day. Unless you have some sort of situation where the attending sleeps overnight at the facility (only attendings I know who sleep overngiht are critical care, anesthesia, certain surgical specialties etc)

As long as you make an honest attempt at seeing the patient, reviewing the resident's work, and performing anything else you want then you are fine.

Where academic MD's can get into big big trouble is signing off on resident's work without even laying eyes on patient or stepping into room. You must see the patient.

CMS just wants to make sure the patient is seen in a timely manner.

The whole standing order thing is risky in my opinion. I may be a stickler for this but I believ compliance is important, even if the rules sound stupid we have to play by them and just make the ppl who work for us (Academy etc) fight for us.

Let's face it there people at SNF's that are really more there for nursing care and not rehab issues.

Now, if the attending MD consults you on every single one with his own pen/key stroke on keyboard etc then fine you can see htem. If they have no issues you probably should sign off. But you have the right to see them and do an eval.

But, if you are not sure you can probably check with AAPMR or AMA on what the proper practice is.

 

[RUOkie]

No you get 24 hours. Think about what happens on medicine services all the time.. ER admit, intern and resident sees patient at 11PM, attending is never going to come in at that time.. they staff the admission next day. Unless you have some sort of situation where the attending sleeps overnight at the facility (only attendings I know who sleep overngiht are critical care, anesthesia, certain surgical specialties etc)

As long as you make an honest attempt at seeing the patient, reviewing the resident's work, and performing anything else you want then you are fine.

Where academic MD's can get into big big trouble is signing off on resident's work without even laying eyes on patient or stepping into room. You must see the patient.

CMS just wants to make sure the patient is seen in a timely manner.

The whole standing order thing is risky in my opinion. I may be a stickler for this but I believ compliance is important, even if the rules sound stupid we have to play by them and just make the ppl who work for us (Academy etc) fight for us.

Let's face it there people at SNF's that are really more there for nursing care and not rehab issues.

Now, if the attending MD consults you on every single one with his own pen/key stroke on keyboard etc then fine you can see htem. If they have no issues you probably should sign off. But you have the right to see them and do an eval.

But, if you are not sure you can probably check with AAPMR or AMA on what the proper practice is.

That is NOT true. The attending must see AND examine the patient AND document independently what his examination showed. If he does all the history and physical exam and just signs the resident's note, the staff doctor CANNOT bill CMS for that. If you do, you are double dipping (since the resident's salary is being paid by CMS). That is what got UPenn in trouble in the late '90s. That is why the efficiency of academic physicians is so poor. Everything needs to be done twice.

 

[Paddington]

I was just informed by another person while discussing the rank list thats coming up, and the UTSW PM&R department fraud investigation/lawsuit currently going on is brought up. Just wondering if it is a big deal within the PM&R community and if the residency will be affected by it. thoughts? has anyone heard about this. because during my interview they only mentioned they are in the process of getting a new chairman/woman and the previous chairwoman stepped down.

here is the link to the dallas morning news report I found online
http://watchdogblog.dallasnews.com/tag/pmr/

Looks like they were having residents see patients (and billing for it) without having attendings staff them. If guilty, I hope they get punished.

 

[Xardas]

That is NOT true. The attending must see AND examine the patient AND document independently what his examination showed. If he does all the history and physical exam and just signs the resident's note, the staff doctor CANNOT bill CMS for that. If you do, you are double dipping (since the resident's salary is being paid by CMS). That is what got UPenn in trouble in the late '90s. That is why the efficiency of academic physicians is so poor. Everything needs to be done twice.

Just to clarify for those who are not attendings yet,, I think RUOkie and I are agreeing on the same point. Attendings must see the patient before they can bill; they can do it with the resident or without they just have to see the patient.

When I meant 'see' the patient I meant see the patient as an encounter, i.e. seeing includes all the work associated with 'seeing' a patient.

Sorry if this got anyone confused.

 

[Paddington]

Have you noticed that they've gotten more strict about that last decade, and perhaps rightfully so.

When I was in medical school, I don't think I saw an attending ever even touch a chart, except to perhaps write his name at the bottom of a page. Hell, even the residents barely documented. It didn't matter if it was the university hospital or one of the community hospitals that took residents/med students. All of the notes, H&Ps, consults, etc. were written by medical students, signed off by the residents and then the attending. If there was to be a single day when the medical students weren't in (which was pretty much only clerkship exam day, and the weekend that followed), the doctors acted like the whole world was coming to an end.

When I got to residency, the attendings said that medical student notes were not billable, so even if they wrote one you still had to write your own. Which I suppose was great for the lifestyle of medical students, because now no one cared if they showed up or not, whereas a couple of years before we were being made to split weekends and even university holidays amongst ourselves so the free labor was always around. And then when I got to the end of residency, I was surprised to find that after my H&P, the attendings were now documenting their own mini H&P's.

Big change in just a couple of years.

 

[Xardas]

Have you noticed that they've gotten more strict about that last decade, and perhaps rightfully so.

When I was in medical school, I don't think I saw an attending ever even touch a chart, except to perhaps write his name at the bottom of a page. Hell, even the residents barely documented. It didn't matter if it was the university hospital or one of the community hospitals that took residents/med students. All of the notes, H&Ps, consults, etc. were written by medical students, signed off by the residents and then the attending. If there was to be a single day when the medical students weren't in (which was pretty much only clerkship exam day, and the weekend that followed), the doctors acted like the whole world was coming to an end.

When I got to residency, the attendings said that medical student notes were not billable, so even if they wrote one you still had to write your own. Which I suppose was great for the lifestyle of medical students, because now no one cared if they showed up or not, whereas a couple of years before we were being made to split weekends and even university holidays amongst ourselves so the free labor was always around. And then when I got to the end of residency, I was surprised to find that after my H&P, the attendings were now documenting their own mini H&P's.

Big change in just a couple of years.

Yes I have noticed that as well. It is a combination in my opinion of increased financial pressures on academic dept's due to the fact many university departments see the worst payer mixes or new payer source, and increased focus on compliance as enforcement gets tighter.

There have also been some exposes in recent years, such as 20/20 showing a VA surgeon on the golf course while the resident was in the OR with the book cracked open trying to figure out how to do a surgery.

But go to hospitals where there is literally no payer source, i.e. no medicaid/medicare and taking care of illegal aliens or self pays ineligible for federal services and you'll still see the old model quite a bit.