January 13, 2015
Obamacare is forcing us doctors to send the government reports on our patients’ personal lives. To understand how this is done, one must understand how doctors are compensated.
Anytime you see a doctor, two codes are generated. One is a procedure code called a CPT (Current Procedural Terminology) code. The other is a diagnostic code called an ICD-9 (International Statistical Classification of Diseases – Ninth Version) code. There are literally thousands of procedure (CPT) codes that cover everything from routine examinations to ear wax removal. There are also thousands of diagnostic codes (ICD- 9), one for every known illness. Both of these codes are sent to the government agency and/or insurance company that pays the claim. No codes, no payment. It’s that simple.
Under Obamacare, doctors were offered $40,000 each to convert to electronic medical records (EMR). The theory was that the improved efficiency in data consolidation and analysis would result in improved patient care along with epidemiological evidence as to the best way to treat certain diseases. In order to make sure that doctors used the EMR software properly, Obamacare came up with the concept called “meaningful use.” This meant that doctors had to input all their patients’ data into the software program and send this data to the government. If the government decided you were using the EMR software properly, you got the 40 grand.
Many doctors who accepted this Faustian bargain no longer have time to speak to their patients. Instead they peck away on the computer entering irrelevant information. Those with better bedside manner may deign to occasionally grunt at the emboldened patient who has the chutzpah to ask a question about his or her health.
But Obamacare was not done. Another requirement was created that was given the Orwellian name PQRS (Physician Quality Reporting System). This requires doctors who participate in Medicare (the government-sponsored program for the elderly and disabled) to follow defined practice patterns for certain diseases. For example, let’s say you are given the diagnosis for depression. In order to be paid by Medicare, the doctor must use the ICD-9 diagnosis code for depression (296.21 in case you are curious).
Obamacare bureaucrats then enter your name into a database. The doctor caring for your depression must then enter information about the treatment of your depression. If not, the doctor will be penalized with a decrease in Medicare reimbursement. Furthermore, Obamacare is about to force doctors to use a new diagnostic coding system called ICD-10. Instead of a 5 digit code, the new codes will be 7 digits. There will be over 68,000 codes! The extra digits will be used to give the government bureaucrats very specific information. There are a plethora of codes to track you sex life. These codes are also designed so that the government can track diabetics, the obese, smokers, those involved in gun accidents, drug users and alcoholics. Big Brother is watching.
Many of you reading this may breathe a sigh of relief that you are not on Medicare. You are not safe. This is because Obamacare has set up what are called Accountable Care Organizations (ACO’s to friends). These are large groups of doctors, usually affiliated with a particular hospital. These ACO’s are going to garner many of the insurance company contracts in the near future, so any doctor who refuses to join the local ACO better have a rich and loyal patient base. ACO’s have similar PQRS and ICD-10 requirements. The government bureaucrats will have access to all this information.
There are those who feel this is a good public policy. After all, using the force of government to make people lead healthier lives can cut costs and prevent human misery. But it can also backfire. Government initiatives to discourage cigarette smoking are a major contributing factor to the epidemic of obesity we are now witnessing. But more importantly, it is a free country. And why should we doctors be policemen? Our patients should be able to come to us without fear of having their personal problems reported to some government bureaucrat.
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