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MarkHoofnagle's profile
Mark Hoofnagle
Mark Hoofnagle
Mark Hoofnagle
@MarkHoofnagle

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Mark Hoofnagle

@MarkHoofnagle

Trauma/Critical Care/Acute Care Surgeon. MD/PhD. FACS. UVa/UMD/UPenn. Asst Professor of Surgery at Wash U. Blocking is curating.

St Louis, MO
surgery.wustl.edu/people/mark-ho…
Joined March 2012

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    Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

    Oh no! It's Monday night, that means time for another thread on Fox's execrable medical show #theresident.pic.twitter.com/taSIzAbvGw

    3:46 PM - 29 Jan 2018
    • 6 Retweets
    • 58 Likes
    • Kirstin Morrell Madeline Pierce Pat (she/her) kfunk937 🐟 Stephen Fisher, MD Nick Genes the night is dark and full of covid Cedric Dark, MD, MPH, FACEP
    8 replies 6 retweets 58 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Oh man, they're gonna reduce an open fracture without pain meds.

        3 replies 0 retweets 13 likes
        Show this thread
      3. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Are new medical interns allowed to carry 30 patients? I thought only surgery residents had no caps.

        1 reply 0 retweets 12 likes
        Show this thread
      4. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Yes, do they ever round? How can they be #theresident if they never do #therounds.

        1 reply 4 retweets 22 likes
        Show this thread
      5. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        This is like the paranoid fever dream of a coding seminar. It's usually some exasperated chart reviewer saying, for the love of god, document what you do. Specifically saying to upcode? Is that a crime? I think thats a crime.

        2 replies 1 retweet 8 likes
        Show this thread
      6. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        The problem with our billing structure is you only get paid for what you document. We do lots of things, all the time, that represent medical decision making, but for the most part are tedious to document, like every repletion for hypokalemia.

        1 reply 2 retweets 9 likes
        Show this thread
      7. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Residents of course don't see any benefit to neurotic coding, just wasted time. Attendings are judged based on whether or not they contribute RVU, or billing capture for the hospital, because the admins need some measuring stick to see that you're treating people.

        1 reply 1 retweet 8 likes
        Show this thread
      8. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        So you could see it as an evil conspiracy to make money, or the necessary documentation to prove you did the work you did. All about perspecitve.

        1 reply 1 retweet 13 likes
        Show this thread
      9. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Oooh, now the coder is talking to a patient! That's a first. And after a "wallet biopsy" have determined no insurance, so she instructs them to violate EMTALA, you know, federal law. Because that's a thing.

        2 replies 2 retweets 16 likes
        Show this thread
      10. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        No ultrasound guidance on the pericentesis or even an ekg lead on the needle stuck in the chest, on the ground. Also instantaneous presentation of tamponade, also that needle was just stuck 90 degrees all the way into the chest blind! Yikes! Good way to kill someone.

        2 replies 1 retweet 13 likes
        Show this thread
      11. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        I think the commercials about a haunted house are about a more realistic show. A good way to cause an acute cardiac tamponade would be poking a hole in the heart with a sharp object, like a needle! Because you're all cowboy stabbing people in the hallway.

        2 replies 1 retweet 8 likes
        Show this thread
      12. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Sorry, Pulp Fiction isn't reality. Nor are accountants walking around giving instructions to doctors. This is a real issue but its more subtle, it's not an accountant standing in radiology yelling at doctors about MRI.

        1 reply 2 retweets 11 likes
        Show this thread
      13. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        EMTALA requires hospitals to treat acute medical illnesses despite insurance status. Ahhh! Now the coders are telling doctors too order MRIs for hernias! And insurance wouldn't pay for it! Total BS. This is fraud! If this happens you don't just get fired you go to jail.

        2 replies 3 retweets 16 likes
        Show this thread
      14. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Oh, now it's about immigration. Lets see how many hot topics we can cram into a single patient. Accountants literally can not do what this person is doing because of federal law. But lets pretend a 30 year old law doesn't exist because drama.

        1 reply 1 retweet 13 likes
        Show this thread
      15. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Read about EMTALA: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/ … Also known as the great unfunded mandate that requires access, overwhelms EDs with primary care, all without, you know, paying for it. It's not the hospitals greed, but our government's dysfunction that has made it such a kluge.

        2 replies 3 retweets 10 likes
        Show this thread
      16. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        The a more realistic evil is quality metrics tied to financial disincentives that make hospitals try to deny admission so their quality ratings don't take a hit (and they then lose funding). The best way to keep quality up is not to treat sick people.https://www.nytimes.com/2018/01/01/us/at-veterans-hospital-in-oregon-a-push-for-better-ratings-puts-patients-at-risk-doctors-say.html …

        1 reply 1 retweet 9 likes
        Show this thread
      17. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Hospitals often can deduct losses from treating the uninsured. One of the reasons hospital chargemasters inflate costs (besides antagonizing insurance payers) is to make it appear taking care of the uninsured is more costly than it is.

        1 reply 1 retweet 8 likes
        Show this thread
      18. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        I can't wait until the next time I meet with a coder and ask how they feel about being depicted as agents of Satan. Now the hospital CEOs are trading patients like baseball cards on Skype. Guess what, medicare patients are not exactly some economic boon to hospitals either.

        1 reply 1 retweet 11 likes
        Show this thread
      19. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        This might be the stupidest dramatization of a complex ethical issue I've ever seen. They probably think this depiction will result in some kind of reform, rather than seriously misinforming the debate.

        1 reply 2 retweets 13 likes
        Show this thread
      20. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Wait, I liked Dr. Okefor, now she's racing patients! This is so degrading. Now she needs to be fired and she was the only nonidiot.

        1 reply 0 retweets 8 likes
        Show this thread
      21. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        I love how #theresident is always looking over HODADs shoulder when he's popping pills, but he doesn't do anything about a drug-addicted, impaired colleague. Because he plays by his own rules. The rules of an irresponsible monster.

        1 reply 1 retweet 5 likes
        Show this thread
      22. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        You know, Americans could do with a good discussion about the rationing of healthcare, it's real, it happens. It doesn't look like this. This is just idiocy and conspiracy theories. Is Alex Jones a writer?

        2 replies 0 retweets 12 likes
        Show this thread
      23. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Dude IOs are easy. But why does she need access? She just needs an IV. She's young, she has veins.

        1 reply 1 retweet 7 likes
        Show this thread
      24. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Wait did they just put the IO in the lateral aspect of her right knee? I'm sure you'll get great flows with a fibular IO placement.

        1 reply 1 retweet 11 likes
        Show this thread
      25. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Wow, "I just need you to sign off on a surgery that isn't your specialty" is the best offense I've ever heard in a medical malpractice case or a licensure hearing. Next he'll just ask a colleague to stick a needle in his own eye, like "yeah sure, no problem."

        1 reply 1 retweet 7 likes
        Show this thread
      26. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Hey, will you let my trainee who doesn't know how to do this surgery, do surgery, under your supposed supervision, even though you don't do that surgery? Yeah sure. Can she use a chainsaw too? That sounds like a genius idea. Who wrote this garbage?

        1 reply 1 retweet 11 likes
        Show this thread
      27. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        MRIs don't rip metal out of your body. They may make it heat up. It's an issue with bullets we run into sometimes.

        1 reply 1 retweet 8 likes
        Show this thread
      28. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Most penile implants are MRI compatible. A few might cause discomfort with MR and wouldn't be recommended to do MRI unless medically worth the risk. But hey, why look up facts?

        1 reply 1 retweet 5 likes
        Show this thread
      29. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        I'm glad she interrupted that MRI that no insurance company would pay for in an attempt at fraud led by a non-physician dictating medical care for a reason that isn't physically possible.

        1 reply 2 retweets 8 likes
        Show this thread
      30. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        If the hospital CEO knows your name, something has gone terribly wrong in your residency.

        1 reply 1 retweet 16 likes
        Show this thread
      31. Mark Hoofnagle‏ @MarkHoofnagle 29 Jan 2018

        Ok, nonmedical point. Hawkins is asked if he and Nic are still a thing and he says, "she doesn't think so." Hey buddy, if she doesn't think so then no, you're not a thing you creepy rapey monster.

        1 reply 2 retweets 22 likes
        Show this thread
      32. Show replies

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