“Your productivity is not satisfactory,” Kelley continued. “You are in the lowest percentile in the whole CMV organization according to the number of patient visits per hour. Obviously you are spending entirely too much time with each patient. To make matters worse, you are in the highest percentile in ordering laboratory tests per patient from the CMV lab. As far as ordering consults from outside the CMV community, you’re completely off the graph.”
“I didn’t know these statistics were gathered,” David said lamely.
“And that’s not all,” Kelley said. “Too many of your patients have been seen in the Bartlet Community Hospital emergency room rather than in your office.”
“That’s understandable,” David said. “I’m fully booked out for two weeks plus. When someone calls with an obviously acute problem needing immediate attention, I send them to the ER.”
“Wrong!” Kelley snapped. “You don’t send patients to the ER. You see them in your office provided they’re not about to croak.”
“But such disruptions throw my schedule into a turmoil,” David said. “If I take time out to deal with emergencies, I can’t see my scheduled patients.”
“Then so be it,” Kelley said. “Or make the so-called emergency patients wait until you’ve seen the people with appointments. It’s your call, but whatever you decide, don’t use the ER.”
“Then what’s the ER for?” David asked.
“Don’t try to be a wiseass with me, Dr. Wilson,” Kelley said. “You know damn well what the ER is for. It’s for life-and-death emergencies. And that reminds me. Don’t suggest that your patients call an ambulance. CMV will not pay for an ambulance unless there is pre-approval and pre-approval is only granted in cases that are truly life-threatening.”
“Some of my patients live alone,” David said. “If they’re ill . . .”
“Let’s not make this more difficult than it need be,” Kelley interrupted. “CMV doesn’t operate a bus service. All this is pretty simple. Let me spell it out for you. You must seriously increase your productivity, you must lower your use of laboratory tests drastically, you must reduce, or better yet stop, using consults outside the CMV family, and you must keep your patients out of the ER. That’s all there is to it. Understand?”
David stumbled out of the CMV office. He was flabbergasted. He’d never considered himself extravagant in the use of medical resources. He’d prided himself on always keeping the patient’s needs to the fore. Kelley’s tirade was unnerving to say the least.
Reaching his office suite, David limped inside. He caught sight of Kevin disappearing behind a closed door with a patient and remembered his prophecy about the utilization evaluation. Kevin had been right on target; it had been devastating. What also bothered David was that Kelley had not made a single reference to quality or patient approval.
“You’d better get hopping,” Susan said the instant she saw him. “You’re getting behind again.”
Midmorning Angela ducked out of the lab and went to check on Nikki. She was pleased to find her doing as well as she was. The fact that she wasn’t running a fever was particularly encouraging. There was also a definite subjective decrease in Nikki’s congestion following a prolonged visit by the respiratory therapist. Angela used a nurse’s stethoscope to listen to Nikki’s chest. There were still sounds of excessive mucus, but not nearly as much as there had been that morning.
“When can I go home?” Nikki asked.
“You just got here,” Angela said, giving Nikki’s hair a tousle. “But if you continue to improve the way you’ve been going, I’m sure Dr. Pilsner won’t want to keep you long.”
Returning to the lab, Angela went to the microbiology section to check on Nikki’s sputum swab; she wanted to make certain it had been plated. It was crucial to determine the mix of bacteria in Nikki’s respiratory tract. The technician assured her it had been done.
Returning to her office, Angela hung up her white coat in preparation to read a series of hematology slides. Just before she sat down she noticed the connecting door between her office and Wadley’s was ajar.
Angela went over to the door and peeked in. Wadley was sitting at a double-headed teaching microscope. He caught sight of her and waved for her to come over.