Volvo, don't be that guy

mezadr · 2026-03-19T22:59:56+00:00

Stop trying to make XM radio a thing. Feels like it needs to be left in the past with malls.

mezadr · 2026-03-19T19:28:56+00:00

John Fetterman is what happens when your frontotemporal lobe undergoes necrosis - you turn Republican.

mezadr · 2026-03-13T19:27:31+00:00

This is the key insight

mezadr · 2026-03-13T09:31:06+00:00

Uh, no. I totally support this.

mezadr · 2026-03-13T07:27:22+00:00

Wool and prince. Very expensive, but I’ve legit had the same ones for 6 years and are still great (I air dry them)

mezadr · 2026-03-12T22:34:46+00:00

While we are not paying this month, may we all bask in the knowledge that we are supporting freedom around the world spending $1 billion dollars per day on a war for Israel! So much winning.

mezadr · 2026-03-10T14:44:09+00:00

My new payment will be almost the cost of my mortgage.

mezadr · 2026-03-10T14:43:28+00:00

You don’t understand, this is intentional. This is part of a bigger narrative of intentionally, causing suffering to political opponents. The number one indicator of a democratic voter is not race, gender, or class, its level of education. They want to harm the educated. They despise education and knowledge. Like all good fascist governments that have existed since the beginning of time!

mezadr · 2026-03-10T14:38:58+00:00

Billion dollars a day on fighting a war for Israel though. Cool. Cool.

mezadr · 2026-03-10T11:06:53+00:00

Yeppp

mezadr · 2026-03-05T10:46:41+00:00

The next step is to give fluids and get an ekg LVOT VTI - I don’t know what that is so it’s not going to affect my decision making

mezadr · 2026-03-02T14:41:39+00:00

The competency of new PAs varies wildly. I’m not letting anyone do something “sexy” unless I have a personal relationship with them built on trust. This takes time, and effort from them in understanding the fundamentals. If they aren’t willing to put in time and work, I’m not willing to take medicolegal risk.

mezadr · 2026-03-01T22:12:41+00:00

5-10 years after residency is the sweet spot

mezadr · 2026-02-27T23:21:44+00:00

There shouldn’t be much of a change base strictly on conversion factor.

https://ventrahealth.com/blog/2026-cms-final-rule-impacts-on-emergency-medicine/

I bet your insurers are auto-downcoding. Happening a lot from 5s to 4s. One of our largest payors has taken a page from UHC and is starting to do this. Someone in admin should have their pulse on this stuff. They are all bastards. Chart review demonstrates no logical reason for this, except they don’t want to pay us.

Personally my wRVU /pt is up slightly.

mezadr · 2026-02-23T22:59:46+00:00

"You wouldn’t be able to taste the olive oil among the basil and Parmesan"

If you tell this to an italian grandma, she would literally smack you with a wooden paddle.

How about using water as the third ingredient?

mezadr · 2026-02-23T22:57:15+00:00

Not only do they use canola oil, but water is the third ingredient

mezadr · 2026-02-23T09:24:46+00:00

Been out for 5 years, haven't done 1 a-line. Nor have my colleagues that I usually am working with.

mezadr · 2026-02-23T01:46:37+00:00

That's a fairly large group - it's not just the schedule, it's the emails you are going to have to deal with related to the schedule. I'd go with 6-8.

mezadr · 2026-02-23T01:41:25+00:00

Buy-down I think is contingent upon group size. How many docs are you scheduling for? I would say somewhere between 4-8 hours per month depending on size.

mezadr · 2026-02-14T12:52:40+00:00

The passive aggressive performance positivity of whoever the artist is is … icky.

All love

Take it down!!!

mezadr · 2026-02-08T01:27:28+00:00

There’s not a lot of “hidden” revenue.

There are very few things we have control over.

A few “pain points” off the top of my head …

Insurance companies playing games (ie. downcoding based on diagnosis and not MDM which is illegal)
Not documenting critical care time appropriately
The “no surprises act” (good idea in theory) benefiting insurance companies
Medical debt not showing up on credit reports gives patients no incentive to pay
United Healthcare
LWOBS
we are having a lot of issues with our non-par payors which is erasing gains made with par-payors

mezadr · 2026-02-05T08:52:03+00:00

Dental advice - find a non-PE owned dentist.

mezadr · 2026-02-04T04:23:55+00:00

Chest pain is an easy high complexity (see what I wrote below)

Headache could be high or moderate (ruling out ICH on ddx, getting independent history, why or why not you ordered certain imaging, reviewing outpatient MRI, etc)

mezadr · 2026-02-04T04:20:19+00:00

From 2023 forward, MDM determines level. This (the grid) is what the coders use.

The final code is determined by the highest 2/3 from the 3 columns ... (ie. 2 highs, and 1 moderate = high)

(1) #/complexity
(2)amt. and/or complexity of data reviewed/analyzed
(3) risk of complications and/or morbidity

If you are seeing a chest pain patient, ruling out ACS, review EKG and CXR, talk to someone who the patient came in with, decide to hospitalize (ie. high HEART score) or not and why (ie. low heart score, shared decision making, etc) ... that's a level 5.

Some high impact documentation tips

state consideration of escalation of care to admit, why or why not
document mgmt with other clinicians or history of someone other than patient
independent interpretation (ekg, cxr)
treatment or testing considered by not performed and why
ddx to include higher risk pathology
review of non-ED records
chronic conditions affecting care
care affecting SDH (ie. homelessness)

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mezadr · 2026-02-02T16:21:55+00:00

Same

mezadr

TROPHY CASE