25. What Your Hospital Bill Isn't Telling You (A Nurse Explains)

You went to the hospital. You got care. You came home.

And then the bills started arriving, one after another, for amounts that didn't add up. And somewhere in your online patient portal was a diagnosis you had never been told about, for a condition nobody mentioned while you were lying in that bed.

If that has happened to you or someone you love, you are not alone. And you are not missing something obvious. The hospital system was simply never designed to explain itself to the people moving through it.

In this episode, Dr. Mark Su sits down with Amy Baut, a registered nurse with 28 years of experience across some of Boston's most demanding ICUs and critical care units, including Stanford Medical Center and a Level One trauma center in Boston. For the last three years, Amy has worked in clinical documentation integrity, the behind-the-scenes role that sits between your provider's notes, your diagnostic codes, and what gets submitted to your insurance company.

It is a role most patients have never heard of. And what Amy sees from that seat changes how you understand everything that happened during your hospital stay.

In this episode, you will learn:

Why your medical chart may include diagnoses that surprised you after discharge, and what those diagnoses actually mean for your care and your bill.

How hospital billing codes connect to the real resources used during your stay, and why capturing them accurately matters more than most people realize.

Why your doctor seemed rushed, why documentation sometimes falls short, and why that is not a sign that anyone stopped caring about you.

What happens behind the scenes when your insurance company pushes back on a claim, and why patients receive confusing bills while that dispute is still being resolved.

How to advocate more effectively for yourself or a loved one during a hospital stay, including one practical shift in how you bring your questions to the care team.

Dr. Su's perspective:

The healthcare system is not broken on purpose. But there are forces at play between your provider, your chart, and your insurer that nobody is walking patients through. This conversation with Amy is about closing that gap, so that the next time you or someone you love is in the hospital, you feel less like a bystander and more like someone who understands the terrain.

Providers went into medicine because they care. The system around them got complicated. Knowing that changes how you experience the care you receive.

Resources + Links:

🔬 Get your free Lab Results Guide, because what's in your chart outside the hospital matters just as much: https://labsoptin.rootseekhealth.com/labs/

📋 Have a question for Dr. Su about your specific situation? Book an Ask Dr. Mark call: https://go.rootseekhealth.com/askdrmark

🌐 Learn more about RootSeek Health: https://rootseekhealth.com/

📱 Follow us on Instagram: @rootseekhealth

About Amy Baut, RN: Amy Baut is a registered nurse with 28 years of clinical experience, including critical care and ICU nursing at Level One trauma centers in Boston and at Stanford Medical Center. For the last three years she has worked in clinical documentation integrity, helping hospitals ensure that patient charts accurately reflect the care provided and the resources used.

Disclaimer: This podcast is for educational purposes only.  Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Welcome And The Big Goal

SPEAKER_02 0:09

I'm Dr. Mark Stu and welcome to the Functional Medicine Reality Podcast. Join me and our community weekly as we bring you unfiltered health from inflammation to longevity. Real stories, real people, real solutions. Experience real life health changes from both patients and practitioners. And learn how to turn cutting-edge information into real results in your own life so you can feel better, live longer, live healthier, and be confident and clear in your healthcare choices. Let's get real and get results.

Dr. Mark Su 0:41

Hey folks, welcome again to the Functional Medicine Reality Podcast. I'm Dr. Mark Sue. I'm here today with my friend Amy. Amy and I have known each other actually for and our spouse as well, for probably close to close to 20 years, I think. Did we did we show either before we had our kids?

SPEAKER_00 0:58

No, I think they were just born maybe three months.

Dr. Mark Su 1:03

That's when we first met after they were born?

SPEAKER_00 1:05

Yeah.

Dr. Mark Su 1:05

Okay. Yeah, so they're you know, they're about 20. So yeah, it's it's a little over 20 years then.

SPEAKER_00 1:10

Yeah. They're almost 21. Crazy.

Dr. Mark Su 1:13

Yeah, so our kids are both on the uh western half of the U.S. in school, different schools. So today, um, I'm gonna let you introduce yourself in a second here, Amy, but um, you know, just putting a little setting the stage for us here.

SPEAKER_01 1:24

Uh-huh.

Dr. Mark Su 1:26

This is one in our series of uh chats and interviews and insights with colleague professionals. Our intent as always is to bring not just education, but insight and deeper and more unusual angles of insight into what we experience as patients and at times as providers, so that people have a better understanding and context of their healthcare experiences. And our goal is to help people make better decisions so that people are spending less time, money, and effort in getting better faster so they can live their best lives more efficiently, more quickly. So that being said, um let me just briefly say, Amy, so you and I, I don't know, about a month ago-ish maybe, we run into each other at Staples. We hadn't seen each other in it could be ten years.

SPEAKER_00 2:17

Yeah.

Dr. Mark Su 2:17

Possible?

SPEAKER_00 2:18

At least, yeah, yeah.

Dr. Mark Su 2:20

But um, first of all, just on a totally uh relational and human level, I I haven't said it yet, but I I just really appreciated who you are as a human that we, you know, like hadn't seen each other in freaking ten years, and like it felt to me like we just like reconnected like it was yesterday. It was kind of fun.

SPEAKER_00 2:34

It was really Yeah, I love that. Yeah. That's how you know it's a it's a good friend, right?

Dr. Mark Su 2:39

Yeah, and I think it's for me, it's just a testament to the kind of person you are that um, you know, just down to earth, grounded, and you know, just a good human, right?

SPEAKER_01 2:47

Thank you.

Dr. Mark Su 2:48

And I was glad to hear that you're um, you know, that your parents are well and and the rest of your family. So with all that being said, I'll shut up here. Let me let you introduce yourself. We knew each other initially. I think actually, last thing, did I know your mom first in the hospital?

SPEAKER_00 3:02

No. Right. She was working as a labor and delivery nurse.

Dr. Mark Su 3:06

Because I was delivering babies back then, like 22, 24 years ago.

SPEAKER_00 3:10

She might have been involved in one of your deliveries.

Dr. Mark Su 3:13

I'm I know I know we were involved in the same at least one delivery, so it's possible I knew her before you and you and your husband and my wife and I met.

SPEAKER_00 3:21

Yeah. So I think we I think we met through originally, maybe through Dr. Papanicolo, and I kind of arranged my husband to be your physician, and then you recognize that you both went to school in the Midwest, and there was that IUPurdue connection there.

Dr. Mark Su 3:39

Yeah, yeah. Thanks for bringing that around. I think, yeah, you're right. So I think in either case, it it was more than just us

Amy’s Nursing Journey And Perspective

Dr. Mark Su 3:45

meeting through kids. It wasn't through like a kid group thing, you know, baby, newborn babies thing.

SPEAKER_00 3:49

Yeah.

Dr. Mark Su 3:52

So yeah, let me let you introduce yourself. But you um you've been so your mom and yourself have been a nurse for a lot of years, and uh you've had now, as you were updating me just um about a month ago or less, you've had a change in your professional career, and I was just really stimulated and intrigued by what you were sharing about what you do for your work. And as I explained to you, I wanted to invite you to have this chat because a lot of what you do in the hospital now in a total different capacity than what you did for close to 20 years at the bedside has meaningful impact from my experience with patient care, from what I hear from patients with a experience in the hospital when they're in the hospital. And then certainly for me, the experience that um I'm l I'm encountering when having a post-hospital discharge follow-up visit with them.

SPEAKER_00 4:44

Right.

Dr. Mark Su 4:44

So, yeah, let me let you introduce yourself.

SPEAKER_00 4:46

Okay, sure. So my name is Amy, and um I'm originally from New England, born and raised here, and have spent most of my career here. I went to the University of Massachusetts in Amherst, Mass, and got my bachelor's of science in nursing back in 1997. I had to do the math today. I'm officially a nurse for 28 years. And when I graduated nursing school, I I knew I loved nursing. I knew I wanted to be in healthcare, but I didn't know what type of nurse I wanted to do. So I kind of worked my way up slowly. I started off at a pediatrician's office, then I went to a cardiac floor at a small community hospital. I went and did spinal cord injury at a rehab and learned how to take care of patients on ventilators and all the spinal cord issues that come along with that.

Dr. Mark Su 5:34

I don't I don't think I knew that.

SPEAKER_00 5:36

Yeah. And then I finally felt like I had a good base knowledge of nursing and I was ready to challenge myself even more. So I went to one of the level one trauma centers in Boston, a teaching hospital, and um got taken into their ICU consortium and was trained to be an ICU nurse and worked on their thoracic ICU that was just opening, which was an amazing experience. And then I took a pause and decided to go out and be a travel nurse. And I went out to California for some time and worked at Stanford Medical Center.

Dr. Mark Su 6:10

I definitely did not know that.

unknown 6:11

Yeah.

SPEAKER_00 6:12

Holy crap. That was that was before I settled down and got married. But it was great. It was it was great to be in a different part of the country. It was great to be at another level one trauma center teaching facility, and then I knew I wanted to come back to New England and and live, and I knew I wanted to be in Boston when I came back. So I was fortunate to to get a position in a medical ICU at another level one trauma center teaching hospital in the city. And I stayed there for over 20 years. Um two years in the medical ICU and then about 20 years in their post op anesthesia care unit, which is considered a like a critical care unit. We took care of patients that had craniectomies, bypass surgeries, transplants, traumas, everything, right out of the operation. Yeah. Yeah. So I loved it because every day was different. You know, you very rarely had the same patient the next day when you came in because the goal was to recover them, get them stable and get them to the floor, or if not, find them a place in an ICU where they could have more consistent care because it was a quick turnaround in the recovery room. But we had some really sick patients, but it was it was amazing. I loved it. So I kind of I stayed in that position the longest because it just met all my needs, right? I I got that ICU uh critical care on a daily basis, but I got to see patients do well and do better and move along. Um and I guess the funny thing is that leads into my new role is one of the things that I missed when I worked in the recovery room is that I never had time to read the patient's chart. It was stabilize them, get them what they need to get them to their room or where they had to be. And I I missed that story part about the patient. Like, what brought you into it?

Dr. Mark Su 8:01

I'm sorry, do you do you mean when you were working there you didn't have that story, or you're saying you miss not having that story now?

SPEAKER_00 8:07

No, I miss not having the ability to in the time to read the patient's chart and find out who this patient was, why were they here, what brought them here? It was so fast, you know, the turnover that you didn't have time to delve into all of their past medical history or, you know, psychosocial aspects of who this person was at the bedside. And um, after COVID, you know, we turned into a COVID ICU. And after that, I kind of was just re-evaluating where I wanted my career to go and what next steps I wanted to do. And I found it's fairly new. It's in its infancy stage, they say, because it's really only been around for about 20 years, but it's clinical documentation integrity. And we are a group of nurses that are hired by the hospitals, and we play a role, we're the bridge between the providers, the physicians, documenting, and when it goes to the coder that has to pick up the diagnosis and what's being captured before it goes to billing. So we're kind of like the clinical in between the provider and the coder, because coders don't have clinical background experience and we do. So I love, I love what I do. It's exciting, and I finally get to read the patient's story. You know, I go all the way back, sometimes to admissions before they were even came to this current admission that I'm reviewing. And I I get to read, you know, past medical history, psychosocial, you know, their concerns in the moments. Yeah, I love it. Among other great things that we do, but I can fill you in on that if, you know, you want to dive deeper into what it is.

Dr. Mark Su 9:40

Yeah. So you went from um bedside, direct patient care, hands-on, uh high acuity, even it's actually more much much more high acuity than I either recall or knew. Okay. Um I don't recall that it was full-time that level of uh yeah, of uh illness or acuity or surgical, you know, et cetera. Um and now you're you're basically effective essentially non-patient facing at all.

SPEAKER_01 10:10

Right.

Dr. Mark Su 10:10

Okay. So you went from then it's like all hands-on and didn't have much background because it was all hands on deck, and now it's don't really actually see the patient, but um you have a lot of information in front of you about the patient's story.

SPEAKER_00 10:22

Yeah.

Dr. Mark Su 10:22

What a flip.

SPEAKER_00 10:24

It is a flip. It is a flip. And people asked me, um, people were concerned when I was going to make this change, was I gonna miss it, you know? And you know, because you you don't go into nursing for the money, you know what I mean? You go in and you stay in because it's a passion and it fulfills you in so many ways. And so I think the timing was just right. I had done it for so many years, I'd given 110%, and I feel like I had made my impact. And so I I wasn't worried so much that I was gonna miss it. Um I knew I would, but I was excited for the challenge because what I'm doing now required so much relearning and almost learning a whole new career for me. And so I knew it was gonna fulfill me in a different way. It was more mentally and academically. And I think, you know, when you do something for so long, you kind of get into not a rut, but routine. And my day was becoming routine

Switching From ICU To CDI

SPEAKER_00 11:20

and I wasn't feeling challenged anymore.

Dr. Mark Su 11:23

Yeah. Um, that was one thing, you know, I certainly was really heartwarmed to hear. I I asked you some questions along those same lines when we reconnected recently about, you know, what your experiences, comparison, contrast, and and you seemed um, you know, very content and and fulfilled and challenged, et cetera. So that's a great segue. Uh, you know, one of the things I wanted to kind of just lead off with here, first of all, as we get into this, you know, I think where we're going, what we decided as a sort of all-encompassing take-home point here, right? This is um, yeah, we're gonna kind of get into a little bit of your experiences and and my experiences intersecting on other on the sort of front and back end of patient care in the hospital, but I think a lot of it is under the umbrella of information the rapidity and speed of information acceleration and overload and requirements and demands that our patients are assimilating, bringing to the table, including in hospital settings, which you can fill me in more on. I don't know that I hear about that much. But then all the impact that has on the providers in the hospital, and then all the back-end stuff that you're doing that the patients never see, providers, some providers may have some familiarity with, I don't have any familiarity with because I'm not in the working the hospital anymore, and then how that translates into patient experiences feeling kind of, in my opinion, dis disempowered or confused, fragmented uh upon discharge, and no judge, just that's just a common experience. And how do we manage all that stuff, right? Or just be aware so that we can start to have more patience with each other. Even though provider patients, or provider with provider, or provider with administrative staff as you're kind of in that role for you now. So all that being said, locking in here, what do you have any more meaningful reflections about a patient's hospital experiences from the patient side since you've undergone this transition? Because you've worked in this capacity now, what, but I think three years you said?

SPEAKER_00 13:19

Yeah. Three years, yeah.

Dr. Mark Su 13:20

Okay. So yeah, any kind of big reflections on how things have evolved over time with the patient's experiences being in a hospital?

SPEAKER_00 13:27

I think, you know, like I said, with access to AI and the online medical record now being at patients' fingertips, they are feeling more empowered and wanting to be more involved in their decisions and their health. I think there is a big shift I've noticed in people wanting to be healthy and being proactive, whether it's, you know, going on medications with a GLP one to lose weight, to, you know, help them overall have a better quality of life and decrease their risk of other comorbid conditions. I think patients are just, you know, finally able to get an inside picture of things that they probably never used to be able to get now. And I I think it's really eye-opening for them. I had a recent experience with a family member, and I was talking about what I did, and they said, Yeah, I just had my my physical and they gave me this paperwork, and on it it says I had chronic kidney disease stage three. She's like, I never heard that before. And I was like, Oh boy, here we go. This is exactly what Mark and I are going to be talking about.

Dr. Mark Su 14:27

And so And that one is a super common example, by the way. That's a super common example.

SPEAKER_00 14:33

Yeah. Yeah. And and and it kind of for me, I was like, whoa, CKD three, like that's you know, that's not stage one or stage two. But in my head, I'm like, is it really stage three? Or did you just have a lab level that was drawn on that particular day that put you in that reference range? Maybe you were a little dehydrated. Maybe you took your hydrochlorothiazide that day, you know? So it's f it's funny and not funny, but I am seeing both sides of it because what I'm trying to do when I'm reading the medical record, you know, from a clinical documentation standpoint, is I'm trying to make sure that when the patient leaves the hospital, that everything that's documented in the medical record is accurate and meets reportable criteria so that it can be billed for, but it has to meet criteria and it has to be accurate. And so that's my role. And so I'm seeing the job that I'm doing reflecting into the outpatient, or like you said, when you have patients that come and see you and how that affects them, right? Is it something that they should be aware of? Is, you know, and how much should we be divulging because we don't want to create anxiety. I know when that family member told me they had CKD3, that family member is also medically inclined and has a background and know what that means, right? So now you're at home and you're reading that and you can't just pick up the phone and call your doctor and be like, can you explain this? It's you know, seven o'clock at night and I just noticed it. So yeah, I'm I'm seeing it kind of come full circle. How online medical record, AI, access to health care is really affecting patients positively and negatively.

Dr. Mark Su 16:16

Yeah. Yeah. And I think um I'll I'll extend off of that example and then bridge us into, you know, a meaningful next thought question I have for you is so I don't want to go down this rabbit hole too much, but uh, you know, you say, hey, maybe that CK that chronic kidney disease stage three was listed sort of in direct response to a lab that might be an outlier lab for that person. Right. Right. Without going into detail about CKD as a condition, I mean, there's a a lot of people just by numbers who have CKD too. And you've already alluded to, like, okay, that may not be as big of a deal, even though we give a diagnostic name to it, which is a little bit of a paradox, right? But hey, if your number was low enough just for that one time that you list that you fall into category three or likely what we call three A, then what's the point of calling it that if that's not the baseline for that person, right? And here I will purposely sort of be a little provocative to say it's not unlikely that in some cases that's it could, if somebody chose that manually, it's not unjustified because the lab re value by definition is CKD3 or 3A, but that can have some reimbursement potential effect. Right. Right? Like that can have greater reimbursement. And again, as an outpatient, in the outpatient outpatient setting, I know from meetings that we've had, you know, because our office works through insurance and all that stuff, that it's a whole budgeting system, right? These insurance plans, I don't know if you know how much this is the case with inpatient or if you're even aware of this stuff, but for us, we know that insurance plans, especially you know, Medicare leading the way, and I I believe all plans are in the same, they when when we list certain codes, and I know this is applicable to you guys in the hospital too, because you've shared that. Yeah. When we list certain codes, then it not only has a sort of monetary financial value to it per se, but in the outpatient setting, I know it also sort of sets a budget for the next year.

SPEAKER_01 18:03

Correct.

Dr. Mark Su 18:04

Right. And so for so I don't know about the hospital, but for us, like it's we're always being told, and we we try to be mindful, but we're in our office, we're not set up to sort of like drill down on this stuff and you know, really overly focus on it. Maybe we should, I don't know, but it's a balance I'm, you know, I try to I try to do our part and be team players, yeah, but to the the system at large that we're part of, but you know, we don't we don't it's not like we're nailing it on each one. But it sets if we set those more specific diagnostic codes, as you and I talked about in Staples, then it's not even just for the here and now with the reimbursement for that visit or that hospitalization, but it sets a budget for the future so that that insurance pen says, okay, next year we'll set this kind of funding aside because based on last year, this is what we're holding aside

Patient Portals And Surprise Diagnoses

Dr. Mark Su 18:45

and kind of giving as a reservoir whereby you have to then, you know, you might be able to meet those criteria, you might not, but it gives you more opportunity, let's say. So the question now is if there's somebody listening, if there's somebody in the room with us here, the virtual room with us, yeah, and uh they're kind of jaded or skeptical, because I don't know about you, but I mean for me, I just it's it's a dime a dozen of people who are just skeptical about the healthcare system across the board these days, right? Since the pandemic, just uh other political, social political evolutions. If there's someone out here listening and going, like, yeah, the whole system is just all about money, it's all about like, you know, the system's kind of broken, it's all about trying to just generate more, you know, more of the green stuff. What is your insight on that? And, you know, with your background, with your position where that is your role is yes, it's integrity of the documentation. And some of that naturally inherently translates into reimbursement potential for hospitals. But um, yeah, do you are you, you know, I I kind of we talked about this briefly, but how do you feel about that? Are you okay with it? Like what do you say to the skeptic?

SPEAKER_00 19:47

I do. I actually feel really good about it because when I was a nurse, I thought that every IV tubing we used or every bag of fluid was a charge. And it's that's not the case.

Dr. Mark Su 19:57

Patients get um I I still think that today's day. I that's I know.

SPEAKER_00 20:02

We don't we don't scan everything that we use or you know, maybe the medications we do, but everything we take out we don't we don't scan. The number of sheets that we use or, you know, pads that we use and watchclass, all of that, like we don't we don't scan any of that. The number of urinals we go through, you know. That when a patient comes in, especially with Medicare and Medicaid, the reason for their admission after the workup, the diagnosis gets put into a group. And I'm not gonna get too complicated here, but if you get put into a group, say you come in with pneumonia, you're put into this group of pneumonia. But if you have, like I think I mentioned to you, a history of DHF or chronic kidney disease, right? Maybe you're on dialysis. Well, that particular patient has a greater risk of mortality and a higher severity of ill higher severity of illness because someone that doesn't have any other comorbidities that walks in with pneumonia and it you know, say maybe they just need some oxygen, a chest x-ray, and a little and some IV antibiotics, they might be out in two or three days, maybe two days at most. But if you have congestive heart failure and we gave you fluids we had to, um, and then maybe now we have to give you LASIKs because now you have some component of your heart failure kind of merging up. Well, now you're not just coming in with pneumonia. Because of all those other comorbidities, the care that's required to take care of you is greater. And so as healthcare providers, we want to capture all of that because it's resources, right? The provider isn't just taking care of pneumonia, they're looking at all the other indicators that they need to take care of that sicker patient. It requires more nurses, you know, they may need dialysis because they normally get it at home, you know, but now we have to do it in the hospital. We need to capture that. So it's not about to me, I don't feel it's about money. I feel it's about making sure that. That we are capturing all the resources that are being utilized in the hospital to quantify all that care that was given. Um, because hospitals it is but partly about money. You have to get reimbursed, you have to pay your providers, your nurses, and all of the equipment that you're using. Um and like you said, at the end of the year, hospitals and physicians are given sc and those scores depend on the reimbursement that the hospital will get. You know, poor scores. The insurance company might not pay a certain amount for that admission, or insurance companies might not want to extend their contract with that hospital because of poor scores. We need to show that we're taking care of really sick patients, you know, um, and the resources that go into it. It has to be a good thing.

Dr. Mark Su 22:52

So what are those what are the scores based on, real briefly there? I mean, when you say scores, we're thinking the scores based on the diagnostic codes?

SPEAKER_00 22:58

No, the scores I talk about are more like quality and preventable hospital acquired conditions. Brief, like just for an example, if someone comes in with pneumonia again, right, and they're otherwise healthy, right? But they unfortunately pass away. Well, if they didn't have any other comorbid conditions listed in their documentation, why did that patient pass away? Yeah. You shouldn't just pass away from pneumonia. If we're not capturing all those other comorbid conditions that increases that patient's severity of illness can risk of mortality, well, if they come in and we use scores one to four, right? So four and four is the worst. If they come in and their risk of mortality and severative illness is a four and a four and they end up passing away, well, it kind of shows that there wasn't much that there was a lot working against the providers in order to save that patient.

Dr. Mark Su 23:51

Yeah, there's less of a likely sort of like ding or penalty.

SPEAKER_00 23:54

Right. Exactly. Right. But you do not have penalized if that patient wasn't very sick and they, you know, leave sicker than they came in, right? So scores like that. So I don't necessarily feel like, you know, it's a it's a money thing and we're we're trying to go after the money. We're trying to quantify the resources that are being used.

Dr. Mark Su 24:14

Yeah.

unknown 24:15

Yeah.

Dr. Mark Su 24:15

And in the end, I think we talked about um, you know, I'll just throw in kind of on that side of the argument that uh it's a little I think it's not well appreciated by the public that I I sometimes wonder how the heck the healthcare system continues to function financially. Right. I mean, because when we look at those numbers on a sometimes yearly basis with the the proposals from the government Medicare first, how they want to cut back reimbursement rates, right? And it may not sound like a lot when they say we're gonna cut back by one or two percent. That may not sound like a lot, but when you scale across the country and then or even within a given office or a given hospital or a group of offices, and when you see when you know that there's either inflation or there's escalating, you know, nobody's getting people aren't getting pay cuts, at least I'm not aware. People don't tip it's not it's not expected or typical people getting pay cuts in the healthcare system, right? When you're employed in these systems. So who's hitting taking the hit, right? And so it's all it's almost like a constant fight back to stay afloat in the setting of decreasing reimbursements from from insurance plans. Like I sometimes it's just like it's a backwards phenomenon. The reimbursements are going down over the years, the numbers are staggering sometimes. We won't get into that right now. And yet the costs for salaries and for equipment and everything else go up. Like, how the heck do we function? Sometimes I don't really figure it out. So it's the money thing is real. It's real.

SPEAKER_00 25:33

It is real, yeah. And and I feel really good about what we do because I feel like we are the nurses in the clinical documentation integrity department are are really trying to find that money that could have potentially been lost to help the hospitals stay afloat. Because unfortunately, as you know, the third pir third party payers, the insurance companies, they also have nurses on their end and trying to wanting and will deny a diagnosis that a provider clearly documented and treated during the hospitalization. That's part of my job as well to make sure that it met the criteria to allow for billing. Um, that what we say is what we're doing with follow-up treatment and and monitoring, but the third party payers are coming up with their own criteria for what they think meets a diagnosis and they want to deny it, and that delays payment for that particular patient. The payment doesn't get to the hospital. It could be three, six months down the road. If they if third party payer sets up a denial, and then the hospital, someone in my team, will then have to decide whether or not we're gonna appeal it. And you only have so many appeals before it completely and then it's done.

Dr. Mark Su 26:48

Oh, really?

SPEAKER_00 26:49

Yeah.

Dr. Mark Su 26:50

Any idea how many appeals we're talking about?

SPEAKER_00 26:51

Usually I think two, one or two.

Dr. Mark Su 26:53

Okay.

SPEAKER_00 26:54

And and um if they don't agree with you, you have to pay that money back to the insurance company because they don't believe that it was um a diagnosis that should be justified. Yeah. But the problem where is it?

Dr. Mark Su 27:06

So so if I can frame this for a second, right, and just sit in this for a second.

What Coding Really Pays For

Dr. Mark Su 27:10

So um, because we started off at the beginning, you talked about, you know, defect of AI, okay, defect of information, right? So here we are painting a picture. A patient is, let's use your example. Patient has pneumonia, they have um a urine infection to go on top, a little bit of some heart failure, right? They're not in dialysis, whatever, et cetera. But um, yeah, it was more than just a straightforward 40-year-old with pneumonia on Ivy antibiotics for two days and they left. It's a little more complicated than that, okay. You gave me like a some kind of example when we were at Staples, like saying, okay, uh, yeah, if the ER is treating a person for even early sepsis, right, when they first presented, they're sick enough that there's some reflection of sepsis, but they caught it early enough, they never became full-fledged sepsis, they're not septic, they're not in shock, they didn't have to do a lot of work in the inpatient. I mean, yeah, they had to pay attention to it, but it wasn't like an act of they weren't in the ICU, et cetera. But you find, and so uh yeah, you if you find that in reviewing the documentation that when the person's discharged, then as you just alluded to, there's not enough documentation here that there was some sepsis at the beginning. That sepsis, it was something that had to at least be attended to. Right. If that's not in the coding, then that's a an a that's an impact on the sort of mortality morbidity scoring and severity scoring. That can affect reimbursement, that can affect the scoring for the hospital, the practitioners, especially if something goes south, you know, unexpectedly with that patient, et cetera, you know, unfortunately, not wanting the any bad things for anybody. But then you're saying that you're now painting a picture whereby we may submit stuff to all these all these claims to an insurance plan. In the meanwhile, what I experience is, and we've experienced ourselves in our own family as patients, okay, last year with our son being helicoptered down to Boston. We'll talk about that some other time. I don't think you know if you don't know about that. I don't think you know about that, so we'll talk about that soon. So and we dealt with this, right? So there's these outstanding bills that haven't been paid by the insurance plan. In the meanwhile, the patients are getting bill after bill after bill recurrently in the mail, and it's just like this trigger alarm, at least for me, and I know for a lot of patients. Yeah. You owe $3,000, you owe $6,000, you owe $10,000, right?

SPEAKER_01 29:17

Mm-hmm.

Dr. Mark Su 29:17

Because the bill is not resolved.

SPEAKER_01 29:19

Right.

Dr. Mark Su 29:20

And you're and what's happening in the back end is you guys are submitting this stuff, and then the insurance plan is going like, yeah, we don't agree with this. Um, and here's why. And then you got to send an appeal and it goes back and forth. In the meanwhile, the patients are like, uh, what's happening here? I was freaking sick as a dog. Like, I almost died. I felt like I almost died. Right. And you're sitting here like sticking me the bill, $10,000, and so and so on the phone's telling me it's fine, just let it be. And then someone else is telling me, like, if you don't pay in the next 30 days, we're going to collections and stuff, and like, what the heck's going on, right?

SPEAKER_00 29:47

Yeah. That kind of sucks. It does. It's stressful.

Dr. Mark Su 29:51

And then getting to the point here, you're saying, so our job is to try to do this efficiently, effectively, accurately, integrally. And yet the insurance plans companies, not, I'm not even saying they're purposely trying to find, I don't know, they're not purposely trying to deny claims or whatever. But yeah, it's like you guys are like, you have your opposite, like bizarro world, you know, upside-down world sort of alter ego, somebody who are there probably nurses also working for insurance plans, and they're kind of saying, Hey, yeah, this isn't correct. We know how you can fix that, but we're not gonna tell you. That's how I envision it.

SPEAKER_01 30:23

Yeah.

Dr. Mark Su 30:23

Right. We know that that's wrong, we can see the discrepancies, but we're not gonna point it out to you because that's on you.

SPEAKER_00 30:29

Right.

Dr. Mark Su 30:30

And we can save money. So we're just rejecting that. And then you gotta go figure out why. And so it's a game.

SPEAKER_00 30:35

It is. And that's where we that is accurate, and that's where we come in as the clinical documentation integrity is that we're trying to capture this up front to prevent that delay. So if we see a diagnosis documented in the medical record, it's not that we might send a provider a query that's saying, you know, there's there isn't sufficient evidence or documentation in this medical record to support that acute hypoxic respiratory failure diagnosis that's listed there. It's not meaning that it didn't happen, but it might not be in the chart. All of the descriptive and objective data just might not be in the chart. Doesn't mean it didn't happen, but what we are asking you to do is provide additional data up front to support that diagnosis because an insurance company, if they see a low oxygen saturation, is not gonna, they don't want to pay for acute hypoxic respiratory failure, which could have increased the the reimbursement to the hospital by thousands of dollars just because a patient had a low oxygen sat, right? They want to see respiratory rates greater than 20 and increased work of breathing documentation to help support it.

Dr. Mark Su 31:45

You're saying just a low oxygen level doesn't, it's not enough to justify that diagnosis and reimbursement. But if you support enough other information, then now there's a sort of a more contextual and justified case for it.

SPEAKER_00 31:58

Exactly. Yeah. And and and insurance companies are using AI and they're using other nurses. So, you know, hospitals need what I am doing on the back end because it's not going away on the other end, right? But like I said, it's more about the integrity of the chart. Did this person really have respiratory failure? Or, you know, do they live chronically low? Were they sleeping and they had sleep apnea and we captured that low oxygen saturation and those vital signs? And you know, there isn't enough descriptive information to back up the failure. We're just looking to make sure that if it was there, if it happened, that it's in the in in the record.

Dr. Mark Su 32:37

Yeah. So let me ask you this What is your observation about why that kind of documentation wasn't there to begin with? That you have to then go out go back and ask folks, hey, um, can you beef up your note, basically?

SPEAKER_00 32:50

Yeah. Providers are so busy. Honestly, I mean, especially That's what I'm assuming. The in the smaller community hospitals, it's just them and the nurses. There's not residents, you know, helping out with their caseload. And they're do they're they're talking to the families, they're assessing the patients, they're following up on lab results and imaging results, they're getting calls from nurses, they're changing medications, and they have to document all of this. And they have to document it in a way that can be captured by coding, which is a totally different language than what physicians are learning in medical school, even nurses, with the language and that some of the terminology I never used in 27 years as a nurse. And it's kind of a new vocabulary that I've had to learn for some of the documentation. Yeah. You know, we didn't use the term encephalopathic or encephalopathy, metabolic, stuff like that as nurses. We said they were confused or they had altered mental status, you know. But those are symptom codes. Those aren't diagnostic.

Dr. Mark Su 33:49

Yeah, so there's a you're saying certain words that might we they might mean the same thing, but it's like a catch-or-trigger word that justifies the the diagnostic coding and therefore all the other downstream ramifications of such.

SPEAKER_00 34:00

Yeah. And I just feel like, yeah, so I I I'm very sympathetic to providers' time because there's a lot of demands, you know. It's they didn't go into medicine to document appropriately. They went in to save lives and make a difference. And unfortunately, you know, just with healthcare the way it is, it it really has to be captured. Otherwise, all the work that they're doing is is not getting reimbursed. Um, but I do, I think some of the lack of information in the charts is just they have so much to document and they're doing they're multitasking. But some of it comes from nursing as well. You know, sometimes I'll have a a low oxygen saturation, but I won't have a respiratory rate to correspond with it. So how can I how can you justify respiratory failure if we don't know what the patient's respiratory rate was at the time the oxygen saturation was low? So some of it is, you know, it's it's teamwork, it's it's everybody. But a lot of education, go ahead. Oh, I'll say another part of what we do as our team is is we educate providers and we educate nurses too, is to say, like, you know, this is what this is and this is what, you know, kind of criteria that needs to be justified, or, you know, um, you know, can you put the patient's weight in the medical record because the nutritionist diagnosed them with severe malnutrition, but I you know, we need a weight in there to support that they had weight loss from their previous admission.

Dr. Mark Su 35:29

So Yeah.

unknown 35:31

Yeah.

Dr. Mark Su 35:31

Do you have a sense of um you know, going back to your comments about uh just the providers, and we're not just talking about the I know you said doctors, but a lot of hospitals have uh nurse practitioners and physician assistants also as part of that same team. So don't mean to slight them or discredit you know, invalid invalidate that or devalue their roles, certainly, but the providers as a whole. Providers. Do you have any do you have any insights as to observations from your personal experiences as to are providers busier, do they seem busier now than 10 years ago? If so, uh any thoughts on why? Or it just you know it's kind of the same. It's there's other reasons why they're busy.

SPEAKER_00 36:09

No. I I I think they're busier because patients are sicker and patients are living longer. It's n I feel like years ago, you know, my patients that I would, you know, they were sick and they were you saw a lot in their 70s, maybe early 80s, and now you're seeing so many of your patients are coming in and they're well into their late 80s, early 90s. You know, the longer you live, the more comorbidities, morbid conditions you're gonna you're gonna have, the greater increased risk you're gonna have of heart failure, um, arrhythmias,

Quality Scores Denials And Appeals

SPEAKER_00 36:40

renal failure, the longer you live. So, but I I think some of the initiatives too that have developed over improved documentation do require a little bit more effort on the provider's part because they're also trying to be proactive about some of these conditions when the patients are in the hospital. They're not just assessing the pneumonia and the heart failure. They're looking at everything, all your meds that you're on, all of your other, you know, things depression, anxiety, your housing situation, your social network. They have to address all of that. And a lot of that came into the forefront because of quality measures, how to prevent a patient from being readmitted to the hospital again. You know? So they're addressing everything. Whereas before, I feel like years ago it was you addressed what was the critical cr you know, what was in front of you, why they got admitted. But it's not simple, it's not as simple anymore. You know, there's a lot of fight family dynamics.

Dr. Mark Su 37:38

Yeah, I I hear you. I um I'll share with you. I I don't know if it's the same hospital, but I I knew some I've known I know somebody who just retired in the last less than a year from um high-risk OB work in a Boston hospital. And they were like, okay, no one's keeping I don't know, they're not keeping personal track and data here, but they said just subjectively, it's clear as day that these pregnant women, they're not in their 80s and 90s, like you say, or seven, you know, late 70s. They're they're pregnant women. The number and severity of those sick pregnant women who are high risk because of those comorbidities is is just overwhelming. Like the the doctors are like there's a a meaningful turnover, you know, constantly looking for doctors because people are leaving and the the nursing staff. It's just a it's it's it's chaos. They they said it's just chaos because there's they're so sick and it's just it's like taking care of ICU patients constantly instead of you know level down, they're not normal normal risk pregnant patients. There's one level up, but now they're all like two levels up.

SPEAKER_01 38:38

Yeah.

Dr. Mark Su 38:38

Right? So it feels to me like I I don't know what that's about. I mean, there's a lot of we could banter and contemplate on the various underlying issues there, but I I also agree with you that uh the whole metrics thing is just a whole nother animal, right? Right. I've told I don't know if you're familiar, I've told a lot of uh patients over the years that by some observations and some metrics, EMRs, those electronic record systems that had had an origin of purpose and intention and with good intention, they have been ranked as like the EMRs has been ranked as the number one cause of physician burnout, you know, more than one year in the last five, seven, six years. I don't know all the data, but I know it's been at least two years that it's attributed as the number one cause of burnout. And it's like you say, like, okay, I mean, I I joke with patients when they ask me, how come like I go to the office and I'm there for a cough and then they want to collect my urine for some other purpose that I'm not even there for? How come I go to the hospital and I'm like delivering a baby and I'm like in the middle of pushing and I'm being asked, like, do you have guns at home? And do you have, you know, I mean, literally, right? Like in the middle, in the middle of our in-between pushing, it's like, okay, uh, you know, all these other things that have nothing to do with the fact that I am having labor here. Like, are you even paying attention to the fact that I'm in labor?

SPEAKER_01 39:49

No.

Dr. Mark Su 39:50

It's it's like it almost feels like, what are we doing here? Like, uh, are you paying attention to me at all? And it that's very disconcerting to patients.

SPEAKER_00 39:56

It is. It isn't the fact that we're trying to take care of everything when that patient is there. Same thing when they were, you know, before they were going into surgery, I was asking them, Do you feel safe in your relationships? I felt so awkward. But that is just, I believe that they're somewhere down the line, there was a quality initiative that was happened that said if you can intervene at a certain point and you can find it when they're in the hospital, you know, it's easier to reach that patient in the hospital than it is in the community. So we're gonna ask these questions. So I believe a lot of things had good intent, but it is putting more burden on the physicians because, like I said, it's they're going head to toe, psychosocial, and having to try to capture all of that. Um office visit or in the hospital, and it just it's time consuming, you know. I agree.

Dr. Mark Su 40:49

And I again I I'm pointing out it's not even just the physicians or nurse practitioners or PAs, it's I know the nurses deal with that all the time, right? And they're the ones often in responsible for a lot of that intake stuff. I I saw it even sometimes, even way back then when I was delivering babies, and I hear patients tell me about it now, right? Because because as you said, like it's like you there's pressure from outside sources. If you don't get that info, then it has impact on whatever rating scores, maybe reimbursements, um metrics that have all this we don't we don't have enough data collecting and yada yada yada. It's all insurance um expectations, and I'm not even saying as a negative, it's just like you say, I'm with you. I think a lot of the stuff I like I'm strongly believing that it comes from a good place, but it's just out of out of hand and out of control. And we can't do it all.

SPEAKER_00 41:34

No, I know. I am hoping that between clinical documentation, online medical record, AI, that at some point this will all get cleaned up and a little bit more simplified. I love your optimism. I'm hopeful because I I do think an accurate medical record and you know, patients that are in tune with their diagnoses will eventually yield a positive outcome as far as health, you know, mortalities and longevity for patients. But right now, there is just such an influx of information overload and limited time for providers to to be able to catch up to it all. It's moving so fast.

Dr. Mark Su 42:19

Do you hear so this question then will loan the last question beyond that? Do you hear practitioners telling you, or do you hear scuttle butt or water cooler talk about patients in the hospitals asking providers or then or the the nursing staff or whoever about X, Y, and Z about their care based on stuff they've read online? Like in the hospital or their family members when, you know, overnight before they came back the next morning, stuff like that?

SPEAKER_00 42:43

Oh yeah. I feel like that, you know, i I feel like in the last 10 or 12 years or so it's it's gotten more prevalent with access in you know to the internet. And now I feel it's probably getting worse maybe with AI because you don't have to search as long, right? When you went to Google or Yahoo, it would you could hours trying to find the right article about something that you're inquiring in about yourself, but now you ask AI and it pops right up. Um so I do see a lot of patients and family members coming in and and questioning certain diagnoses or why we're doing something or why something wasn't done. Um and that, you know, while I believe it's good and I you know I feel like there should be an open line of communication. I feel like you should be empowered and advocate for yourself and for your family. It also takes the provider away from the patient itself, the one that they're caring for, and their other patients, you know, because they have to address all of those questions and concerns. And some of them, you know, not to downplay it, they're they might not be the focus of care at that moment. Yeah. You know, um, like you said, that the chronic kidney disease, you know, it's yeah, it's there, but we're more focused.

Dr. Mark Su 43:56

I'm totally with you. I I find that that's one of the biggest things I say. Like I I'm all for people digging stuff on the internet, but the internet doesn't help people or AI at this point, okay? Doesn't help people triage and prioritize what's important or what's not. And also, secondly, like what's more likely or not given your entire story. Exactly. I have a headache and like, you know, the people who, you know, no judgment, but people who are more anxious and worried, like, I just keep reading about cancer. I keep reading about cancer, right? And like, okay, well, the AI internet doesn't tell you. Yeah, you might find five websites that all say if you have a headache, you could have cancer, but it doesn't tell you, well, who's more likely that you have cancer or who's not. Right. So the person who's anxious is gonna pick up on that and say, I might have cancer. The person who's kind of more minimalist might be like, okay, well, that obviously I don't have cancer. Right?

SPEAKER_00 44:40

Yeah, it's true. And nurses are are culprits of that ourselves. We're always we've always been known to self-diagnose and uh, you know, like you said, us we see a spot on us and we're like, oh, I'm dying. You know, I'm gonna die.

Why Notes Miss Key Details

Dr. Mark Su 44:55

Real question here, like I s I, you know, we have patients all the time. I know uh uh everyone relates with this on some level, you know. I I had a symptom and I started doing digging online or on AI or whatever, or more more so nowadays, I threw my labs into Chat GPT to get like back report and ball and this is what I read, et cetera. My question is because I don't I don't hear yet right now, I'm not hearing patients tell me that live time while they're in the hospital or they're in the hospital like helping take care of their mom who's in the hospital or something like that, that they're actually like getting live time feed about their lab results from the hospitalization and then going home at night or in the hospital as a patient, feeding their info into Chat GPT live time and then saying, Hey, I just want to double check you because AI says this. Is that happening?

SPEAKER_00 45:39

I don't think so. Not yet, at least. All right. No. And I think partly because a lot of the patients in the hospital are tend to be a little bit older population, and so they're they haven't quite caught up to to that yet. And and I do feel the older population, the aging population, they still really trust their providers. There is still it's very, and I don't want to say it's old fashioned, but they they trust that their provider is doing what they need to do, and they don't necessarily feel like they have to ask those questions. I do feel like this younger generation that's had more access to online information is maybe questioning and maybe COVID had a a part in it too, but there's a little bit of lack of trust. And um all I can say is that I think if anything with all of this is to just really develop a good relationship with your provider, your primary care doctor, so that you have that trust because that's your job to take care of the patient. And while you want to be an advocate for yourself, you do have to have a level of trust in your provider that they went to school for this, they're constantly keeping up on the education, um, the research, and you know, that they're there for those questions, and they would certainly let you know if there was something that they were concerned about.

SPEAKER_01 46:58

Yeah.

SPEAKER_00 46:59

But again, going back to the online, going back to the medical record though, if you see something in your medical record that you don't think is accurate, I I do think that it warrants a discussion with the provider to say, you know, because an online medical record from one visit translates into the next and to the next. It carries over. There's a lot of copying and pasting. And you don't want a diagnosis on your medical record if it's not an act because it's gonna keep getting copied and pasted, you know.

Dr. Mark Su 47:25

Um Yeah, we hate that we hate to we hate to be, you know, to I hate to acknowledge that because I just but it is it's the reality.

SPEAKER_00 47:33

Yeah. And it's uh it's based on time constraints too, you know. Just for an example, I was reading a chart the other day and they said that the patient had chronic respiratory failure. Well, chronic respiratory failure, usually you have to be on home oxygen in order to have that diagnosis. And I during the patient's stay, I didn't see any oxygen being used during their stay. And so I was like, I don't think we should be capturing chronic respiratory failure. So I had to go back and dig to when this first diagnosis came up, and it was back around COVID time where they had post-COVID syndrome and were on oxygen brief, you know, for maybe six months or so, but they haven't been on it for a while. Well, I ha we I had to send a query to a provider to say, you know, this was a document the medical record. Is this still an active diagnosis? Because I I don't see the support for it.

Dr. Mark Su 48:18

Yeah. So that's a good that's a great um counterbalance because that's a that's an example of hey, this is a um overdiagnosis.

SPEAKER_00 48:26

Right.

Dr. Mark Su 48:26

Not just over underdiagnosis and billing in this to the skeptic, okay, more money, but this is an over-diagnosis and we need to take this pr this person off this off the person's chart.

SPEAKER_00 48:34

Exactly. Yep. That's another thing that we do because like I said, we want the integrity, we want it to be accurate. We don't want to be charging for you know someone that or increase someone's risk of mortality or severity of illness because we documented chronic respiratory failure when it hasn't been a diagnosis for three years, you know? Yeah.

Dr. Mark Su 48:53

So one one last question. And you know, this is um so it's been for me, it's been fun. It's been good. It's educational. Even though we sketched out some of this, you know, we try to keep this, these kind of more raw and whatnot, but this is um this has been good. So last question. So do you have any for your from your perspective as a bedside provider for over 20 years, and then now for the last three years on the back end and seeing things from a totally different angle, with the consideration of all the changes that have happened in healthcare and better recognizing the different pressures and forces at play that influence the provider behaviors and documentations, the patient experiences and behaviors, et cetera, the nurses and everyone else involved in between. Do you have any like top two or three recommendations that you would want the lay public, the patients to any patients to know about, whether for themselves or for their parents or in-laws, such that if someone's hospitalized, how might we best optimize our or our loved ones' outcomes and their care experiences in context of all this stuff?

SPEAKER_00 49:53

Yeah. Wow. That's great question. Well, that's a great last question. I think it's very important for, like I said, to trust the providers, to always feel like the providers want what's best for your family member and for you, to engage in active communication with the provider or even the nurse who's at the bedside that can have those lines of communication open, make lists of your questions and prioritize them. Like I said, patients are sicker and there's a lot going on, and we might not be able to address every single problem. But providers, like I said, they want the best outcome. They really do care. And sometimes I feel like because providers are so busy, yeah that that gets lost in translation. I love I love your commentary. Quick example. I had a friend of mine who had a heart attack recently. Wow. And he's okay.

Dr. Mark Su 50:50

Our age?

SPEAKER_00 50:52

No, about ten years older. But um, so he had he got excellent care at a smaller community hospital. They got him in, they put the stents in, he did great. Super happy with his care. But then when it came time for discharge, he called his wife to come pick him up, and they were there for quite a long time waiting to be discharged. And she was texting me and she was obviously upset. She had other things she wanted to do, and she thought she was gonna be able to take him home at that time. And I had to respectfully say to her, he's not the top priority right now. And she was like, What? What do you mean? I said, They got him better. They did what they needed to do, they were there, they did everything. He was priority A number one when he came through those doors and he had a great outcome. But now their attention is probably on the next sick patient that just came through the door. And while you are still their patient and they want you to go home and get better, they have to prioritize their day. So and she was like, Oh, I didn't think about it like that. And I was like, Yes, just be happy

How To Navigate Hospital Care

SPEAKER_00 51:55

that he's alive and he's doing well and you will go home today, but you have to be respectful of all the other pieces and parts that are playing that are going around. And so I think with AI and with all the technology, it's one thing that I think um the public, general public, is maybe not as attuned to is that providers are also prioritizing their care, right? There's only there might only be one of them or two of them for a wealth or a whole floor of patients, and they have to take care of the sickest first. So when it comes to your questions and your, you know, and wanting to be educated, timing is everything, right? And it it might have to be an outpatient follow-up where we can go through and discuss everything. But I think just knowing that the providers want the best for their patients is in and trust that we're all doing it for the greater good, you know?

Dr. Mark Su 52:50

I love that. Uh, number one, and first of all, that's not an easy thing to say to a friend. The messaging there, you know, even if you you know believe it, uh I think a lot of people, it's not fun to say that. So that's hey, that's that's another reflection of the kind of human you are. So because it's not being mean, it's just shedding light and trying to help uh reframe things a little bit. And I think that's what it is. So I tagging on your comments, uh I'll I was gonna say number one, when you say um trust your provider, I'd or or the providers involved, like in hospital setting, it's kind of harder, right? Because you don't know them, you've never met them. It's not like you have time to establish a relationship and you're in this kind of high crisis mode when you're sick, much less especially if you're in the ICU or really sick. So I was gonna modify, hey, for folks who might kind of go like, well, they're not trustworthy. Like they don't, they're not, they're not, they're not listening to me. They're they're you know, they're they're literally documenting the wrong thing or blah, blah, blah. Perhaps we could at least say, find someone in your hospital care team who you have the most trust with and build a relationship there and use that person as your point of contact at the least.

SPEAKER_01 53:50

Yeah.

Dr. Mark Su 53:51

And then I love the other piece you said was number two, like, yeah, I I'm I'm with you. Like people don't go, I don't I don't think people go into medicine, people don't go into medicine like especially nowadays, without having some altruistic bone in the body. Right. I think people people started somewhere with real genuine compassion and care for people. There's a reason, uh because otherwise everyone knows it's so hard. You can't go into it, you know, like half-halfing it.

SPEAKER_01 54:16

Right.

Dr. Mark Su 54:16

So, but unfortunately the way I see it is the the system is just it breaks us down, we get jaded, we get burned out, et cetera, et cetera. And so what a lot of people experience is the unfortunately the the rough side of you know, the practitioners or the care team or whatever, but it's not personal. And it's not that uh they care about you less per se. It's it's kind of unfortunately the way it might present or come off. So I love how you said that too. Like just know it's not intentional, right? Even if even if it's not the best. But people, they're still caring about your best outcome. Right. And then thirdly, I think last again, adding to your comment, hey, there's a lot of information out there. That's something we kind of touched on a lot in different pieces today. Uh something we talked to on all the time on the podcast. It's information overload in a lot of ways. I love what you said. Prioritize your topics. And maybe that prioritization is based on what the person thinks is most important to them, i.e., like this is an emotional thing for me. Or it might be, hey, if you're using AI and you're trying to, you know, figure out what's most important, then hey, use that, whatever it is. Or even ask somebody. Ask that care person that you feel you have the most trust with. What is mo these are three things I have you know concerns with. Like which one of these three should I be most concerned about?

SPEAKER_01 55:24

Right.

Dr. Mark Su 55:25

Or I have questions about all three of these. Which which one do you think is most important that I want to just grab your attention about for two minutes? Whatever. I love that. I appreciate that.

SPEAKER_00 55:35

I think with access to everything now in just our generation in general, we want answers quickly, fast. And um, and unfortunately in healthcare, you know, it it might be you might have to have some patience in that because there's so many of other moving parts going on around, you know, yeah. Um hospital at that time. And you will get your answers and you will be able to address them. It's just there are a lot of other factors coming into consideration in other people's lives that are being, you know, challenged at the same time and you know, prioritize. Yeah.

Dr. Mark Su 56:10

Yeah. No, it's been good. Um yeah, it's been good. I appreciate you as a we haven't touched space in a long time. I know we're gonna get together with the spouses.

SPEAKER_00 56:18

I know I'm excited to catch up. We sound like you have some stories for us.

Dr. Mark Su 56:22

Some fun things to talk about, yeah.

SPEAKER_00 56:24

Yeah.

Dr. Mark Su 56:24

No, but I but um again, I I appreciate you as a, you know, I've always seen you as just a real down-to-earth and relatable and an integral person of character, and just um so I appreciate the way you not only just articulately explain a lot of the stuff about your role and what happens on the back end from your observations, but also just your different angles and sort of balanced, um, you know, reasonable perspectives on life in this increasingly challenging healthcare landscape.

SPEAKER_00 56:51

It's a lot to navigate. And like I said, I recently had a family member that was in the hospital, and you know, I step in there and I feel like a fish out of water, even though I've spent most of my life in the hospital. But when it comes to being a family member, I didn't want to step on people's toes. I was trying to be respectful, but I had questions. So I've tried to navigate this myself from the other side, and I get it's stressful, it's emotional, it's overwhelming. But I, you know, just reach out to your colleagues and your peers and, you know, like you said, find that one person that you can trust. Because everyone's trying to do a good job. Everyone wants the best for their patients and full circle, real quick, when it comes down to the documentation that I was telling you about, all the other reason to capture all those severity of illness and risks or mortality, right? Because those help to

Final Takeaways And Next Steps

SPEAKER_00 57:40

secure our resources in the hospital, the number of nurses that are on per shift, the number of providers, and all of that comes into play because we the patients are sicker. We the families have more questions because the patients are sicker and there's so much going on. And so I think it's a it's just full circle. There's a lot going on. But I think eventually everyone will be on board and realize there's a benefit to everything. It's just it's we're in a very difficult time with technology right now and the cost of health care.

Dr. Mark Su 58:10

Yeah. Yeah, I think so too. I mean, um, you know, anything some anytime something's new, there's a lot of um there's a lot of waves that are they're they're they're big waves and until things settle down then and you know fall into a groove, then we're sort of just having to bear it until that time comes. So thanks so much, Amy.

SPEAKER_01 58:27

Yeah, thank you. I look forward to talking to you.

Dr. Mark Su 58:30

Yeah, and well, um look forward to seeing you on the on the social side of life, you know, in the near future here.

SPEAKER_00 58:35

It's been long overdue. I appreciate you reaching out to me. I wasn't sure I was gonna have much to offer you, but I told you.

Dr. Mark Su 58:41

I was like, I'm gonna ask you if I didn't think so. So I I appreciate you. Like I said, very articulate and a lot of insight. And you know, so uh yeah, as always, we're uh we're trying to provide uh service and hold space for um patients uh both in the conventional and functional, but especially in that functional medicine world. The conversation here with you today is uh much more on the conventional medicine side, but it all comes together, right? Because we can't exclusively operate in the functional medicine world. So I appreciate your time. And for anyone else, of course, as always, if you want to get a hold of us, first-time consultation, second opinion consultation, et cetera, or just to get a sense of who we are, how we may be of help or benefit to you, your family members, et cetera, rootseekhealth.com is how you can reach us and our team would be happy to be available. We'd be honored and privileged to walk alongside you in your journey, wherever that may be. And Amy, thanks again for your service to your hospitals, the the teams that you work with in the hospital, and to the uh the greater you know humanity at large.

SPEAKER_00 59:42

So thanks much.

Dr. Mark Su 59:46

Yeah, absolutely.

SPEAKER_00 59:48

Bye.