Physicians have to deal with a 100 paper cuts each day. Implied threat of lawsuits, RAC audits, denied claims for reimbursement, EMRs designed by computer scientists who do not practice medicine, and more. While these distractions are time consuming, stress-provoking, and aggravating, they are generally manageable. That’s why I was surprised to hear from an ENT surgeon who said that ICD-10 will be the game changer, choking cash-flow. Here’s what he said.
ICD-10 requires an all hands on deck commitment to learn and implement. There will be tens of thousands of codes to enable “more accurate” documentation. Whereas before you could just document a simple description of diagnosis – you will soon need to include deep details. A laceration will no longer just be a laceration. It will include laterality, depth, length, and cause. Seems easy enough. But, given the unlimited panoply of choices, it will be anything but simple. And, don’t assume just because you were a good boy or girl and coded the diagnosis properly, it qualifies for reimbursement. That diagnosis might be excluded from payment. Or “improper coding” might be a convenient excuse to delay reimbursement.
And there’s the rub.
When the next paper cut chokes off cash flow, the life blood of a practice is drained. No cash means you cannot pay for rent, your employees, your vendors, and so on.
ICD-10 implementation has been delayed for the foreseeable future. A strong argument can be made that the cost far outweighs any perceived benefit. While rallying around the Kill-ICD10-Flagpole has limited sex appeal as an emotionally-charged issue, ICD10 might be the single most important issue separating success and bankruptcy for small practices in the future. Who knew?
It’s time for doctors to refuse en masse to comply with this, compulsory EMR, and other meaningless and onerous impositions upon them.
It’s time for doctors to refuse en masse to comply with this, compulsory EMR, and other meaningless and onerous impositions placed upon them.
we do not practice medicine any longer….we practice record keeping…the consequences of opening medical records as not allowed by Hippocratic Oath. The insurance/third parties should take over the medical schools.
The ICD-10 is tantamount to insane. All above statements are true and then some. I remember back when a socialist leader B. Kidric stated “whatever is done or thought of can be measured given proper metrics – go and create them” we know where that brought them to. In ideal world without malfeasance ICD-10 would be welcome to everyone. Our times are different though
ICD-10 is just another system installed by Government and insurers designed to delay or refuse proper payment after services.
SOMEDAY, healthcare providers will say ENOUGH.
On that day there will be a national membership organization of EVERY healthcare provider, no matter their degree or specialty.
They will then descend on Congress and say NO in unison.
Until that day arrives, Government and insurers will just pass more blocks and rules against us. They will continue to create new and creative ways to make felonies out of practices that every attorney and business owner has done (and still does) for years.
In order to accomplish this monolith, we have to be willing to toss aside our individual practice imperatives and co-operate with each other. We could become an unstoppable force.
Until that day they will just continue to laugh at us and divide and conquer. As much as I curse them, I also curse our unwillingness to take action.
Michael M. Rosenblatt, DPM
As the one who does the coding for the practice, I found the ICD 10 concept to be a welcome step in the precision of the medical communication process. I recall those first days of my orthopedic residency, the mental anguish with which I struggled when trying to describe a complicated fracture,using only accepted orthopedic terminology, to my chief, who at 3:00 am had very little patience with my novice stumbling. Decades later I appreciate the accuracy and how it renders power to the ongoing research and evaluation of various treatment approaches.
HOWEVER, to permit the non clinical bean counters to bastardize this information to DENY payment or diminish payment is a miscarriage of medical justice. There is no system of documentation that will ever tell the real story of the ingenuity and expertise required in the reduction and fixation of a fracture or any other procedure in medicine and surgery. We as physicians must stand together and refuse to continue to compromise our profession any further. We should have taken this stand when the insurers and government shoved DRG’s and managed care down our throats! This has been a subversive process that started slowly in the last 1980’s and has become increasingly more crippling to American physicians. I sense the future and it is far worse.
ICD10 is particularly onerous for primary care physician. We have to deal every diagnosis in the code. ENT may complain but they have a very limited number of codes to learn.
Word on the street is that we “need” PCP’s yet the government/insurance companies destroy our practice.
1. Higher deductible mean patients don’t seek care
2higher co-pays results in same loss
3. ICD-10 coding
4. PA’s & FNP’s allowed to practice without spending 4 years and big bucks to go to med school
5. Many mess are OTC which allows patient to circumvent PCP
6. Pharmacists practice medicine without a license when they administer vaccines
7. EMR costs at least $10,000 per year
8. Medicare reimbursement rate does not pay the rent
9. Family Practice board exam is expensive and has an unacceptably high flunk rate. I believe 46% of those who flunk it the first time, fail when they repeat
I have practiced primary care medicine since 1975. I can’t imagine why anyone would want to join the ranks
Patrick Harpole MD
I agree with the other commenters, the practice of medicine has been wrested from our hands and handed over to the dolts in the government and the rapacious insurance companies. What a lovely gift to the insurance companies to give them a complex, messy coding system that allows them to deny our claims because of “coding inaccuracies” so that they can keep all of the money. If you ask members of the general public what they think of a physician’s income they will unanimously state that doctors are filthy rich and just rolling in money. I am of the same vintage as doctor Harpole having practiced surgery in a small, rural community since 1976. In those halcyon days of old we were paid a reasonable amount and all that we had to do was send in the claim and we were paid. Since then the amount that we are paid has been cut by about 70% and still the public thinks that we are on a par with movie stars as far as our income goes.
The insurance companies look upon the dollars paid for insurance premiums as their money. Anything that is spent on medical care is called “medical loss” of their money. The only people that the insurance companies feel that they have a duty to are their shareholders. They could care less about the actual patients who need care. In addition to their penny pinching with payments to those who actually do the work they erect barriers to care at every opportunity. For example; before a patient may have the insurance companies blessing for either a gastric bypass or treatment for varicose veins they must undergo a period of “conservative therapy” which never works and is beyond worthless. As if this is not enough they include in their conservative therapy items that they don’t cover – such as a psychiatric evaluation before a gastric bypass or compressions stockings before definitive treatment of varicose veins. They insist on these two elements knowing full well that a goodly number of the patients can not pay for them and therefore the procedures never take place and the insurance company doesn’t have to suffer “medical loss.”
I am very, very glad that I am close to the end of my medical career. God help those who are just beginning. I keep waiting for that magical day when I get a letter from the government and/or the insurance company saying, “Dear Provider Baron, I records indicate that you have treat xx number of our patients over the past year. Your bill for this privilege is yyyyyyyyy dollars. Cough it up or suffer the consequences.” The end is near.
Norman “beating it for the timber” Baron, MD, FACS
I agree!! I just want to Know what is next, How can we get together, who do. I need to call so we can go on the streets or to Washington and protest.
How many of Us are willing to stop practicing for a week or two so they give us some credit .
I am ready .
The private practice of medicine was killed with OCare. Doctors who accepted “stimulus” monies from the 2009 $787Bil for meeting “meaningful use” with EHR have made their beds. Bad decisions.
The first insurance we opted out of was Medicare, since we had no desire to transition out of paper. Not to mention the Feds have spooked us, and we didn’t want to be government employees anymore. This was a liberating decisions that has left us with a real sense of accomplishment and relative freedom.
One solution – Opt out of Medicare first, then wait till the void in your practice fills – around six months for us. Then pick the lowest insurance carrier and drop it while it’s hot – wait for equilibrium and repeat till third party free.
Charge fair prices, and consider senior discounts and charity care.
ICD10 is sad. There are a few Sermo posts demonstrating the ridiculousness of the coding. It’s all about government control of the physician and the citizens of this great country. Hopefully the democratic socialists will stay out of the White House, but we have become such an entitlement nation, the Dragon Lady may be in our future. Unless BHO decides to use his corrupt DOJ to take her down.
May God bless America.
Thank you.
The political act of taking away Government control from physicians starts with an ORGANIZATION. This organization would encompass all licensed practitioners who receive Government coverage for anything they do.
So far at least it is NOT illegal to lobby Congress. It is illegal for physicians to do almost anything else. At some points in time, strikes may be necessary. The Press and Media will come down hard on this technique and you cannot expect any Media help.
If our present supposedly-national political organizations do nothing to help rid us from onerous Government and insurer controlled medical practice, then you must form your own organization and say the hell with them.
Nobody in medicine would elect an old retired podiatrist to take on that role, but this all starts with a pilot committee that would start to plant the seeds. Funds would then be raised and a charter developed, with the very first goal of REPEAL of all Stark legislation.
All organizations start out with a charter and tax exemption, wherever possible. It would be started out as an “educational foundation” for teaching practitioners how to do political action for the benefit of their patients.
Ironically, I don’t think that raising funds would be the biggest challenge. The biggest challenge is convincing physicians to secede from private insurers and Medicare. We are already seeing some of this. I think there would be a lot MORE doctors who would also secede if they were defended politically by a national organization.
Some conservative actors and performers would likely also speak up for us. The insurers would attack us like we were the devil incarnate. But a good subversive advertising campaign can also teach them that it might be time to “negotiate” with us…rather than control us absolutely. I think that would be a worthy goal.
Mothers against drunk driving started out on a shoe-string. We have far more resources than they had. All we need to do is start by taking that first step….a National pilot committee to allow physicians to practice medicine again without exceptional and unreasonable outside control.
Michael M. Rosenblatt, DPM
Aw to hell with it. Let’s just riot, loot and pillage. More rewarding and more fun.
Some great points here. Here’s hoping raising enough awareness of these issues will help them realize things need to change. Thanks for sharing!