Stanley Feld M.D., FACP, MACE
Everything the Obama administration’s healthcare administrators do, to increase their control over the healthcare system backfires.
The Obama administration has not admitted that the new coding system (ICD-10) has not worked out as well as it should have.
The increase in codes from16,000 codes (in ICD-9) to 68,000 codes (in ICD-10) is a way to force providers to more fully document their diagnosis and treatment.
It is described as a way to improve patient care. I suspect it will be used as a weapon to decrease reimbursement.
The best way to improve patient care and decrease healthcare cost is to let the patients be responsible for their health and healthcare dollars.
A way needs to be developed to measure medical out as it relates to medical costs. These outcomes must be provided to patients.
The more codes there are the more the coding system can be gamed and abused by hospitals, physicians and other providers.
At this point the government is paying many other providers. These providers can also game the system. The increase in codes can result in a further increase in costs to the healthcare system.
Never the less the Obama administration seems to spin everything that backfires on it into a positive. The people are not accepting the spin anymore.
One example of the spin is the information paper CMS published about ICM-10.
ICD-10 provides an enhanced platform for physician practice. As of October 1, 2015, the ICD-10 coding classification became the new baseline for clinical data, clinical documentation, claims processing, and public health reporting.
The statement means physicians have to provide more documentation in order for the government and the healthcare insurance industry to have more control over physicians’ practices.
From proper observation and documentation to improved clinical documentation, progress notes, operative reports, and histories, the benefits of ICD-10 begin with enhanced clinical documentation enabling physicians to better capture patient visit details and lead to better care coordination and health outcomes.
It does not enable physicians to better capture patient visit details and lead to better care coordination and health outcome.
It enables government and the healthcare insurance industry to capture patient visit details. It does not necessarily lead to better care coordination and health outcomes.
Ultimately, better data paves the way for enhanced quality and greater effectiveness of patient care and safety. The benefits of ICD-10 will impact everything from patient care to each practice’s bottom line.
Better data might not lead to enhanced quality care or lead to better care coordination and health outcome. It can lead to more paperwork and more false data.
It also could conclude that the best physicians are the best documenters. It will not tell us which physicians have the best clinical judgment.
Reasons to prepare for ICD-10 can be broken down into four categories:
This section clearly defines the intention of the expanded ICD-10. It is an attempt to define physicians’ quality of care by computer and award or penalize physicians based on a potentially faulty definition of quality care. It could lead to quality care being defined by documentation, not by clinical judgment.
Physicians can interpret this category as a threat to their reimbursement and their clinical judgment.
Physicians might conclude that they should do what the government tells them to do or they will lose their livelihood.
The government’s healthcare policy wonks. They are not practicing physicians. They do not understand physicians’ potential reactions. They do not consider the unintended consequences of this policy.
Once physicians understand the goal is let the government control physicians’ medical judgment there is no telling what will happen to the quality of medical care.
Medical care is not a science or a social science that can be managed by computer. It is a learned process by physicians integrating scientific knowledge an art of personal relationships.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.