Sunday, April 02, 2006

CPT Update 2007: (new codes)
100121 Intraoperative Intercession, first 90 minutes
100122 Intraoperative Intercession, each additional 60 minutes

picture credit: ronhudgins.com

[author's note: apologies for the gargantuan length of this thing. It's taken on a life of its own. And yes, I know this is not what the prayer study showed. That's the point. Enjoy!]


Dr. DeFACCto's friend was getting steamed.

"I'm sorry, Dr. Herzmesser, but your first pump case will have to wait till 10:30." The OR scheduling secretary looked apprehensive.

"Barb?" He turned to the senior OR nurse, who had been a fixture at Fictional Medical Center about as long as he. "What in the blue blazes is this about?" (He had been asked to 'tone down his language,' and goddammit, he was gonna try.)

"Well, Sammy, our backup PI, you know, the professional intercessor, called in sick." Barb alone among the nurses enjoyed first-name privilege with Herzmesser, a testament to her longevity or possibly to her knowing where the bodies were buried. So to speak. "Yeah, I know. Maybe he'll stay home and pray for himself. Anyway, the other one won't be freed up until the first case is done in room 5."

"The hell with prayer, Barb! This is crazy; I'm going ahead anyway." Now even the head nurse looked concerned. "If we don't start soon, we'll be here till effen midnight." So much for toning down his language.

"Uh, actually, Dr. Herzstenker -- by the way, I'm Phil Pinchpenny, the new cardiovascular product line administrator." An impossibly young-appearing guy in a suit, sporting a fine head of executive hair worn over a very earnest face had stepped forward. "It was decided in the cardiac prayer meeting last Thursday that, what with the big PR campaign by Downtown General and all, we would only do open heart cases without realtime intercession in life-threatening emergencies. I'm sure you remember their tagline: 'If you go to the wrong heart center, then you don't have a prayer.' Our CEO is determined that we'll outpray them and the sisters at St. Superior by next quarter, or else."

"Well, I'll be sure and order my wimple, but really..."

"I'm quite serious, Dr. Herzsenker, and that's why you should really start coming to the weekly prayer meetings. It's hard to demonstrate to the staff our committment to this new, evidence-based, therapeutic modality without the support of physicians such as yourself." He emphasized "evidence-based" as though to chide the physician: This isn't some touchy-feely BS; it's actual Science.

"Well, who's paying for these pray-ers, anyway? There's no third-party coverage."

"Actually, the Blues have promised to look into it in their next updates. That reminds me, would you be willing to accompany me, as our senior CV surgeon, to present our institutional data at the statewide Medicare Coverage Review meetings next week?"

Now Sammy really did feel like a Heart-sinker, picturing himself in a semi-darkened room saying, 'As you can see, this graph shows Reoperation Rates pre- and post-Intercession, with a p-value of...' or, better yet, 'As you can see, at least at our center, prayer has no effect on postop atrial fibrillation, but renal failure is a whole different story.' He shook his head.

It had all started with the publication of that study a year or so ago. Although many skeptics had challenged it, its methodology seemed to be ironclad. After investigators at a variety of international research centers had replicated its findings, the medical community had grudgingly come to accept its central conclusion: anonymous intercessory prayer reduced major postoperative complications following open-heart surgery by about 15%. That doesn't sound like such a big deal, but considering that the average major complication was estimated to cost hospitals and insurers $25,000, it didn't take a big decrease to make administrators sit up and take notice. First the faith-based hospitals, with their prayer infrastructure already in place, and then the university centers, pretty soon all the heart centers jumped on the bandwagon. There was a bit of a hitch at the government hospitals, but the ACLU publicly professed neutrality, so long as patients had the ability to 'opt out' from being prayed for.

Next came the first wave of outsourcing. Certain monasteries set up up Intercession Centers, which could serve dozens of clients at once and offer a truly professional level of service. All you had to do was fax the patient's billing information at least thirty minutes prior to surgery and they handled the rest, gradually weaning down the frequency and intensity of intercession over the next 48 hours or until the patient left ICU, whichever came first. Of course, here in the Southeast there was widespread distrust of any Catholic-affiliated prayer centers, but several multi-denominational, predominantly Baptist, centers had sprung up to fill the need.

Dr. Herzmesser still shook his head as he reminisced. He had always been a laborare est orare kind of guy, but he wanted to heed the message being delivered by his trusty tools, the randomized clinical trial and his own -- God-given, he presumed -- common sense. Here they seemed to be in conflict. He realized that Barb and Phil were still there, looking at him.

"Sorry, Phil, got a root-canal scheduled that day. Maybe another time, OK?" He turned to Barb, "Guess I'll see you guys back around 10:30 then." And he headed off to the doctors' lounge.

[to be continued]

1 Comments:

At 9:30 PM, Anonymous Scalissima said...

She was dreaming of flying again. But even as she dreamed, she knew she was dreaming. A part of her mind was trying to remember what the shrink had told her about this dream. It meant something, she was sure. Her dreaming self tried to look around and notice some details of the dream. All she noticed was a loud, recurring noise – bells, maybe.

Magda sat up with a start. It was her blasted phone. She reached for the phone, peering nearsightedly at the alarm clock: 3:33. Hmm, wonder if that means anything?

Still groggy, she just barely remembered to use her business voice, “Magda, PI. Pray tell.”

It was Barb from FMC, “We’ve got a bad post-op here, aortic valve replacement. You’re needed,”

“OK, give me the stats.” Magda pulled over the laptop on her dresser and opened the Prayer-Share screen.

“Patient’s name is Albert Beisenstein, age 56, Prayer-Share #6375289. I think he has on-site coverage.”

“Right, I see that. But what happened, anyway? I’m only on 2nd call for Cardio. Where’s your ORPI?”

“Called in sick. Wonder who’s praying for him? Anyway, I gotta get back to ICU.”

“Well, I’ll be there in 15 minutes. Looks like he’s Methodist, so I guess I don’t need to bring any special gear.”

She dressed quickly in her PI garb. It wasn’t really a uniform, but PIs were encouraged to dress in simple suits or pantsuits. Just once, she’d like to show up in her slinky scarlet dress, a vestige of her days as hostess at Oui-Oui, the top French restaurant in town. But she probably shouldn’t try that on a cardio case. So she wore the grey pantsuit instead, adding a bright pink scarf just to give her some sense of identity.

On her way out of her apartment, she grabbed her black tote bag. Magda had designed this bag the previous year. There were special pockets for rosaries (Catholic and Anglican), prayer beads, yarmulke (for male PIs), headwraps, crossifix (her 2-sided creation), and other items so necessary for the interdenominational PI. The bag was a hit with the PIs in her 5-hospital area. Four months ago, she launched her own website: HOLY TOTES ®. She did a pretty brisk business on the side.

But she’d never give up the real work, the important work. It was a vocation, not just a job, though that was hard to remember at 4 in the morning. By now, she was on Greenhill Expressway, heading for Fictional Medical Center. At least there was no traffic at 4AM. And maybe she’d get to see that hunky Doctor Herzmesser. Mmm… Dr. H.

As she exited the elevator on 5, she looked around for Barb. The nurse at the desk spotted her, noticing her PI badge, and pointed down the hall to the ICU. “Glad you’re here.” she whispered.

But as she neared the double door to the ICU, a tall thin man, goateed and dressed in black, approached her. She noticed that he clutched a stack of leaflets in his left hand. He started to speak, waving a leaflet under her nose.

“How can you continue this destructive work? Look, the statistics are clear: haven’t you read the STEP study?”

She could not avoid reading the large headline on the pamphlet: Drastic STEP – Say No to Prayer. She continued walking without a word. Some atheist nut, no doubt.

But Mr. Goatee was insistent, “Does the patient know? Please don’t proceed on this dangerous course of action if this patient knows you are going to pray for him. You could save a life!”

Madga hesitated just half a second. Of course, she had read the study. It had been the main topic of conversation at Monday’s SEPIA (self-employed professional intercessors’ association) meeting. This study contradicted earlier studies, which showed that 3rd party prayer benefited patients. But the STEP study was just the flavor of the month. Doctors could not even figure out whether estrogen caused cancer, they surely couldn’t come up with a definitive answer about prayer. No, she knew she was a healer.

She pressed the button beside the double doors, and they opened before her. She was greeted by Doctor Herzmesser’s welcoming smile, as she faintly heard “STEP away, STEP away” from the hallway behind her

**To Be Continued**

 

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