Category: Physicians

Are Doctors Ready for 68,000 Diagnostic Codes?

Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.

icd10picture-resized-600Been injured in a spacecraft? There’s a new code for that, too.

Roughed up by an Orca whale? It’s on the list.

There are codes for injuries incurred in opera houses and while knitting, and one for sibling rivalry.

Next fall, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.

I.C.D.-10, with codes containing up to seven digits or letters, will have about 68,000 for diagnoses and 87,000 for procedures.

Andrew Pollack at the NYT.

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Jan 07, 2014 | 25 comments | by

Would the “Doc Fix” Allow the Feds to Tell Doctors How to Practice Medicine?

This database would eventually be used to identify “outlier ordering professionals.” These are doctors who show a “low adherence” to the “appropriate use criteria.” Starting in 2020, these “outlying” doctors would then be required to seek the advance permission of the government through a “prior authorization” process administered by a government website before they can order services for their patients.

docfixAll of these provisions are written to pertain to imaging services and radiologists. But language included at the end of this section of the legislation gives the HHS secretary broad discretion to establish an “appropriate use program for other Part B services.”

This includes everything doctors do outside the hospital. The legislation allows Medicare to apply the same regulatory framework to other medical specialties like oncology.

These provisions are part of a much broader, secular shift toward increasing control of the practice of medicine by the federal government. With “applicable appropriate use criteria,” Washington would have the tool to effectively control the practice of medicine for America’s senior citizens.

Scott Gottlieb in the WSJ.

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Dec 13, 2013 | 12 comments | by

Exchange Plans Paying Less Than Medicare?

brave-declining-reimbursement-ratesThe benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Source: Kaiser Health News.

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Dec 04, 2013 | 24 comments | by

Can We Pay for Value, Not Quantity?

Paying physicians:

By 20Kolb17, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.

But is this a good idea?

…[T]he practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care.

Read More » »

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Dec 03, 2013 | 13 comments | by

Why Don’t Doctors Take Sick Days?

A survey of British doctors back in the ’90s found that 87 percent of G.P.’s said they would not call in sick for a severe cold (compared to 32 percent of office workers who were asked the same question). In Norway, a 2001 survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home. Two-thirds of these illnesses were considered contagious. (NYT)

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Nov 25, 2013 | 12 comments | by

“If You Like Your Doctor, You Can Keep Your Doctor”

Many new health exchanges don’t yet let shoppers see which doctors accept which insurance plans. Where exchanges do post the so-called provider lists, they often contain inaccurate or misleading information, some doctors say, including wrong specialties, addresses and language skills, and no indication whether providers are accepting new patients. (Wall Street Journal)

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Oct 31, 2013 | 14 comments | by

Uwe Reinhardt Defends Free Market Medicine

And quotes Milton Friedman along the way:

An econonursetophysicianmist can understand that physicians refuse to treat Medicaid patients at low fees when the opportunity cost of doing so is treating patients at higher fees. But what is to be done for the patients whom close to 50 percent of California primary care physicians refuse to treat?

What if independently practicing nurse practitioners were willing to see Medicaid patients at Medicaid’s fees for the range of primary care services for which nurse practitioners are educated and trained? Would the California Medical Association contend that for patients whom physicians refuse to serve, the next best option is no care at all? Or that properly educated and trained nurse practitioners could render such care, as is done in 17 other states (see, for example, evidence from New York). (More)

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Oct 18, 2013 | 14 comments | by

Hospitals Cutting Staff in Response to Medicare Cuts

Nf1Ib_AuSt_74Researchers found that hospitals eliminate 1.7 full-time jobs for every $100,000 drop in Medicare revenue, and nurses accounted for one-third of those cuts. On average, hospitals do not appear to make up for Medicare cuts by “cost shifting,” but by adjusting their operating expenses over the long run, the study says. The Medicare price cuts in the Affordable Care Act will significantly slow the growth in hospitals’ total revenues and operating expenses.

Study here. We’ve previously reported that cuts affect patients.

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Oct 17, 2013 | 12 comments | by

Doctors Bidding for Patients

bidding[George] Law, from Chicago, requested a colonoscopy on Medibid, and doctors around the country “bid” to perform it.

The winner: Dr. Scott Gibson, practicing half a country away here in Oregon. Gibson charges cash customers about $800 for a colonoscopy, a bargain compared to the $3,500 price tags Law was finding around Chicago.

“You might say come on, you can actually travel from Chicago to Oregon, rent a car, stay in a hotel and pay for your medical services? Not only did I come out ahead, it was less than half the price [of having the procedure done in Chicago],” Law said.

KATU in McMinnville, OR.

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Oct 08, 2013 | 13 comments | by

Nurses Replace Doctors in Massachusetts

I have long advocated allowing nurses to perform whatever services the market is willing to bear. What is happening under RomneyCare is different. People are turning to nurses because they can’t find a doctor who will see them:

Liz D’Alesio has opened a primary care office for adults in Milford, Mass. [She] has 10 new patients. She prescribes their medications, orders their labs, performs diagnostic testing and provides wellness advice.

But D’Alesio isn’t a doctor. She’s a nurse practitioner who, thanks to a law passed last year, was allowed to open her own practice in Hopedale to provide primary care services last month.

D’Alesio, who is certified in critical care, adult and women’s health, has been working as a nurse practitioner for more than 20 years and felt now was the time to strike out on her own and fill a need for local patients.

Locally, D’Alesio said the wait time to see a new primary care physician is upward of nine months.

Source: The MetroWest Daily News.

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Sep 26, 2013 | 12 comments | by
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