Case A 17-year-old girl returns to the rheumatology clinic for scheduled follow-up for systemic lupus erythematosus (SLE). She is accompanied by her mother and father. She has a history of autoimmune cytopenias and Class III lupus nephritis. She has responded well to treatment with mycophenolate mofetil and hydroxychloroquine and was successfully weaned off of prednisone…
After extensive research and careful deliberation, you have finally made the exciting but daunting decision to purchase a healthcare practice. You know that in the next couple of months you are going to need to examine the practice from a different perspective—one of a future owner. You also recognize that in order to facilitate the…
When patients enter the rheumatology office of Ernie Katler, MD, FACP, FACR, in San Pablo, Calif., they’re transported to a galaxy far, far away. Hundreds of toys, props and figurines of Yoda, Darth Vader, Jabba the Hutt and other characters, as well as three original Star Wars movie posters, greet patients. If they’re lucky, patients…
Executing evidence-based medicine in the U.S. is challenging, especially utilizing high-cost medications in rheumatologic care. As patients trust their clinicians to be their medical experts, clinicians must trust their care team members to be experts at implementing the care plan. A clinician’s knowledge of human anatomy and physiology is the foundation to understanding pathophysiology. From…
A 50-year-old man with history of superficial bladder carcinoma presented to our rheumatology clinic for a three-year history of symmetric polyarthralgias. He had undergone multiple transurethral resection of bladder tumor procedures and bacillus Calmette–Guerin (BCG) treatments. Prior to receiving BCG, he was fully functional and employed. Days after receiving his second BCG treatment, he developed…
Amir Atwal* is a 76-year-old man who had a knee arthroplasty six weeks ago: He wonders how he is doing in comparison to other individuals of his age at the same stage of recovery. Will you be able to provide him with an answer? If you are looking for a one-stop shop to help you…
Humpty Dumpty sat on a wall Humpty Dumpty had a great fall All the king’s horses and all the king’s men Couldn’t put Humpty together again. —Mother Goose I feel like a female Humpty Dumpty. Recently I took a great fall, and now I am in the process of being put together again. I was…
For people in whom symptoms of Lyme disease persist beyond the standard course of two to four weeks of antibiotic therapy, longer term antibiotic treatment provides no additional benefits beyond the shorter term course. This is the conclusion of a recent study published in the New England Journal of Medicine that builds on a number…
It has been 11 months since the implementation of the ICD-10 diagnostic code set on Oct. 1, 2015, a change from the previous ICD-9. Most practices can probably attest that the transition came and went without the predicted doomsday outcome: Claims were still processed, the confused alphanumeric coding was applied, and patients were not deprived…
The ACR is searching for practicing physicians interested in coding and reimbursement issues to represent the ACR on the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) Committee. The RUC and CPT Committee comprise physicians representing the national medical specialty societies who advise the CPT Editorial Panel on matters concerning…