Thursday, March 13, 2014

Innovation Versus Regulation:  The Case Against Coding

Wherefore do you spend money for that which is not bread? And your labor for what which satisfieth not?

Isaiah, 55:22

The growing bureaucratization of medicine presents a serious threat to physicians’ ability to provide quality care.

Grace-Marie Turner, “Government  Bureaucracy Will Stifle All Innovation: Room for Debate, “ New York Times, March 5, 2014

Readers of this blog may wonder why I call it “Medinnovation” when I devote most of my posts to ObamaCare.   ObamaCare is more about regulation (It contains more than 2000 pages of new regulations) than innovation (though it gives lip service to innovation by creating an inactive  subdivision called Centers of Innovation).  When "government innovation" is shaped solely around government policies,  "innovation" becomes an oxymoron.

According to Grace-Marie Turner of the Galen Institute,

“ The pain (of bureaucratic regulations) will be especially acute for independent practices specializing in primary care.  They operate with the narrowest of margins and have the fewest of resources to adjust to the mountains of new regulatory demands imposed upon them.”

Primary care physicians say they already spend more than 20% of their time dealing with paperwork and cutting red tape. And on October 1, they will be confronted with a  massive new coding system (ICD-10).  ICD-10 will require them to master the ins and outs  of over 150,000 new codes.  

Now physicians must assign a code to virtually all conceivable clinical situation they might encounter. Many physicians, anticipating mandatory coding and other onerous regulations,  have either retired, changed careers, or gone to work for hospitals. They presume hospitals will relieve them somehow of the burdens of coding.

So much for the bad codification news.  Unwittingly ObamaCare, by raising premiums and deductibles for many Americans, has given an opening to primary care physicians.  Consumers have realized insurance no longer useful in paying for routine primary care services,  so they are turning to direct pay for these services.

Primary care physicians are cognizant of this shift in the payment landscape, and they are switching to direct pay practices (also dubbed concierge or retainer practices).   To simplify payment many of these physicians are asking for a monthly retainer of $50 to $100 covering a variety of routine services, supplemented by quick access  to physicians and more time spent with them.

These new practices are insurance-free and coding-free. Physicians  find they have more time to spend with patients and less time with the coding handbook.  For primary care physicians, coding has become the bane of their existence.  Not only  does coding waste their  time, but it wastes their income too, for time spent with patients is their income.   

If codes are deemed inappropriate, physicians face fines and possible imprisonment  for frad.   Not only that,  coding indirectly questions their clinical judgment, honesty, and integrity and drives up expenses by compelling them to hire scribes or coding clerks to look up codes and enter them.

Time and money are  terrible things to waste.  Codes create haste when dealing with patients.   Time and money spent on coding is time spent away from patients.  This waste creates haste with patients,  for time is a limited resource and time is money and there is only so much of each  to go around.

Tweet:   Many primary care physicians are turning to direct pay practices free of insurance and free of coding  to spend more time with patients and to maintain their income.

No comments: