Thursday, January 22, 2015

Follow up on 'Ways you will be paid'

Follow up to PTE Speech in 2012: Ways you will be paid.

I said in that speech that "The people who need you the most might not be able to pay you the most."  I thought about that this morning, because several things that I did are not 'reimbursable.'

The idea of my talk to those students was to tell them that over the longer course of their careers that it is likely that they will make enough money to repay their student debt, but that it would be short-sighted to measure success in monetary terms because sometimes the ways you are paid can't be identified as a quantifiable amount in your Account Receivables, or it might not be noticed by the widget counters that reside in the Halls of Productivity, Outcomes, and Cost-Control.

This morning a mom called to cancel their appointment, and then asked sheepishly, "I have a question, and I hope that you don't think it is silly.  My son deleted his Minecraft world and do you have any idea how we might be able to get it back?  He is just beside himself and it is really a concern for us."

The reason why I loved this question is because somehow this parent received the message that I am in tune with children's interests, and she also received the message that I care about her child.  I don't consider her question silly at all; in fact, it might be the best question I have been asked in a really long time.

So I researched the Minecraft problem and provided a solution that I hope might work.  I spent an hour on the issue, because "Needs are an indispensable part of human nature, and imperatively demand satisfaction," and if she thought enough of me to ask that question then I have a responsibility to generate a top-quality response.  I also made a note to myself to check on the child's situational coping over this issue, because we have been working on coping skills in therapy.  There is no CPT code for this, but that is why I got to thinking about my PTE speech.

My second non-reimbursable task was writing a letter to a child's MD.  The parent brought the child to see me due to concerns with intolerance to clothing.  The mom carried the child into my office, and all the while the child was having an Epic Meltdown.  No developmental or sensory assessment was possible, and based on the whole interaction it was obvious that there were some acute contextual elements that were contributing to the Epic Meltdown.  After 30 minutes the parent was able to get the child back OUT the door, and the entire encounter that is not a billable encounter was a stressful event for both the parent and the child.  After they left I called the pediatrician and wrote a letter of my observations and recommendations.  I hope that they can help the family with those acute contextual problems, because they are clearly in distress.  There is no CPT code for this either, and that is why I got to thinking about my PTE speech for a second time today.

I write about this because I feel some frustration.  I am NOT frustrated about the parents or the children.  I am NOT frustrated with the lack of CPT codes or that these are not reimbursable activities.  I am frustrated because it bothers me to see our profession slip into the clutches of 'care' models that are all about accountability, documentation of outcomes, cost-savings, designated care pathways that are 'evidence based,' etc etc.  All of that is fine, and I don't really disagree with many of the conceptual values, but when we adopt those 'care' models we also generally lose our focus on the kind of caring that people needed in my office today.

Today I was not productive by the measure of my accountant or by Higher Powers that place quantifiable metrics on my activities.  But actually I was very productive by the measure of the people who needed help.

Like I told those PTE students, I have a Faith that the financial piece will all work out in the end.  And in the meantime, I keep reminding myself that "The people who need you the most might not be able to pay you the most.  Pay you the most money, that is."

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