Government Watch / Health & Wellness

Congress Is About to Impose Another Unfunded Mandate on Doctors

from – The Daily Signal – by John Grimsley & John O’Shea, M.D.

Doctors in their day-to-day practice already face a mound of federal regulations.

Now, starting Oct. 1, doctors will face a new unfunded mandate as they will be required to transition to a costly and complicated coding system for payment.

While the International Classification of Diseases (ICD) system was originally designed specifically for disease classification, since the 1980s, public and private payers alike have required that health care providers use the ICD-9 system when they file reimbursement claims. If, for instance, you go to the doctor’s for treatment for the flu, the doctor’s office will use the ICD code for flu when billing your insurance.

But unless Congress acts, the current ICD code will be replaced Oct. 1 by the vastly more complex ICD-10.

Last week, the House Energy and Commerce Subcommittee on Health held a hearing to examine the implementation of the upcoming ICD-10. Most of the testimony focused on how the health care IT community is ready for implementation.

However, what about private practices, hospitals, state governments and the Centers for Medicare and Medicaid Services? Are they ready?

A recent Government Accountability Office (GAO) report has been referenced as providing evidence that Centers for Medicare and Medicaid Services has undertaken a number of efforts to prepare for the October transition and therefore implementation should proceed as planned.

What seems to have been ignored, however, is the twenty of 28 stakeholders contacted by the GAO that had serious concerns about the Centers’ outreach and education efforts as well as the lack of adequate testing.

According to the congressional testimony of Dr. William Jefferson Terry, a practicing urologist in Mobile, Ala., as many as 25 percent of physician practices are not ready. Although this is a numerical minority, they cannot be ignored. Many of these practices are small, independent practices in rural locations with narrow operating margins. If faced with substantial reimbursement disruptions due to ICD-10, they may be forced to close their doors and they will not be easily replaced.

Moreover, as of November 2014, only two Medicaid programs had tested the system and another 23 are still updating their systems and not yet able to begin testing, according to Robert Tennant, director of health information technology policy for the Medical Group Management Association. If a state government isn’t ready for the transition, doctors will not be reimbursed for seeing Medicaid patients.

Although a more detailed disease classification system may sound like a good thing, there are significant costs and tradeoffs. Most importantly, the majority of the burden of transitioning to ICD-10 will fall on health care providers, especially doctors in smaller, independent practices.

So, the benefits are vague and long-term, while the financial costs of investing in software programs, hiring and training new staff and productivity losses are real, immediate and quite large.

The reality of medical practice is that doctors do not treat codes; they treat patients according to the individual clinical condition. A doctor gets far more meaningful information from talking to the patient and consulting their medical record than they could ever get from the most detailed coding system. Therefore, doctors, who will bear the majority of the burden of transitioning to ICD-10 will see little, if any, benefit in treating patients on a day-to-day basis.

Given the disastrous roll-out of Obamacare, the already burdensome impact of the reams of federal rules and regulations imposed on doctors and other medical professionals, and the fact that many medical practices are not ready, Congress should be careful when considering imposing another unfunded mandate on the medical profession.

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Billie Devlin
8 years ago

I have worked in a medical laboratory in a 250+ bed hospital which is part of a larger hospital system in the Midwest for almost 40 years. ICD10 like ICD9 before it are only as good as the operators entering the codes into their billing systems. In my experience all these “improvements” create more jobs because more staff are required to interpret and enter those codes. More billing is rejected and additional filing is required in order to receive reimbursement. From what I have read in regards to laboratory test billing, the doctor has to have a diagnosis before ordering testing to prove his diagnosis. This is backwards. The physician should be able to order tests to aid in differentiating and making a diagnosis. The garbage in/garbage out adage still applies. I see no improvements to healthcare in our future. The VA on steroids is in our future.

Wade Jeffords
8 years ago

And more doctors will opt out of the system. Can’t blame them at all.

Just sayin
8 years ago

Lets call the A.C.A. what it really is . It was the biggest insider trading ,stock manipulating
law ever perpetrated on the American public by a corrupt congress and Supreme Court. Passed on a whole set of lies and fabrications that is against the foundation of the Constitution and Bill of Rights. What was promised to be the most transparent administration ever, has been the most opaque.

The political affiliates were allowed to break every law and rule of the Sherman antrust Act.
Rigging mandatory minimum coverage, dumping patients, buying up other companies, creating
monopolies and increasing prices. There is no $2000 savings, no one kept their doctor or insurance.

Lets give the A.C.A. or owecommieKare the name it really deserves instead of misleading as
affordable it should of been given the name of A.A.P.P.

The Aetna Astronomical Profits Plan.
Comps of the top ceo’s after Obamacare became law of the land in 2012.
Bertolini, CEO of Aetna: $30.7 million —–$90,029 per day—–14 W Hill Dr West Hartford, CT
Swedish, CEO of Wellpoint: $17.0 million —–$49,853 per day—–0996 Blue Ridge Rd Silverthorne, CO 80498
Neidorff, CEO of Centene: $14.5 million —–$42,560 per day—–
Cordani, CEO of Cigna: $13.5 million —–$39,589 per day—–
Hemsley, CEO of UnitedHealth: $12.1 million —–$35,484 per day—–
Broussard, CEO of Humana: $8.8 million —–$25,807 per day—–
Health insurance stock prices .
Owebama repealed the stock act as soon as it hit his desk.Law of the land?? Government guarantees that a private business will not lose money.?

United Health group 237%, Anthem 118%, Aetna 118%, Cigna 196%, Humana 210%, Centene corp 361%
Health Net 120%

Funny if this program is so good why aren’t the Federal employees jumping on the band wagon. Any other businesses. Why aren’t business employees ? Why did some peoples insurance get canceled even after they were guaranteed that they could keep their insurance. their doctors, Bunch of lies to the citizens of the U.S. Socialist democratic plan.

Servitude is created when some people are paying double for their insurance so others get
subsidies or exemptions. This takes your private property for public use without any compensation.
Nothing in the Constitution gives the government the authority to demand you buy anything from businesses or how you spend your disposable income. If you require no medical care for the year, will this be considered as giving your money to charaties?

Is there anything uniform with this corrupt ,unconstitutional law that didn’t even make it through
the house.
Article one section 8 of the United States constitution.
The “Congress————— not the insurance companies————— shall have Power To lay
and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common
Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall
be————— uniform————— throughout the United States;”

Socialism is right around the corner .. What’s the next mandated purchase? The affordable car act where you get a choice of 3 different vehicles? No you can’t keep your old car, ,your mechanic or even your parking spot. Because no one looking for a job should have to walk to their interview, Some people get subsidies off of those who are forced to pay double the price..

Impeach the socialist pig and the party that passed this bill into law without even bothering to
read it first.

8 years ago

Another part of Obamacare that has been part since the law was enacted in 2010, but was only reported sporadically by a small portion of the mainstream media. Thus this information may come as a surprise to a majority of the public, who still, for some reason probably related to either apathy or sheer laziness, rely on getting their news from the likes of ABC, NBC, CBS or PBS and others. All of whom are nothing more than the propaganda arm of the Democrat party and who only relay information deemed “appropriate” to moving the Progressive agenda forward.

As to the AMAC conclusion that ICD-10 will likely result in a further erosion to the delivery of quality health care to the public, I have to completely agree with that. The more time doctors and hospitals devote to filling out electronic forms for some nameless and unelected bureaucrat in Washington, who likely has no actual medical background to properly understand the data provided, the less time doctors and hospitals will have to provide care of their patients. Of course Obamacare isn’t about patient care or any of the other lofty goals the administration and Democrat party promised. It’s all just about exerting more and more control over the public and re-distributing the private wealth of this nation towards the favored constituencies that comprise the Democrat voter and donor bases, while at the same time pushing the sheep to where the Progressives want them. Hopefully the majority of this week’s posts won’t involve beating this horse to death yet again.

That ICD-10 will also likely be implemented as poorly as the Obamacare web site was is pretty much a given. Government does very little well, but I’m sure any problems that are reported will be blamed on doctors and hospitals rather the government. However this time around, unlike the launch of the Obamacare web site, I’m sure the mainstream media will under-report or completely ignore almost all hiccups that do occur.

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