ICD 10: anticipated and unanticipated consequences of government mandate

ICD 10: anticipated an unanticipated consequences of government mandate

Craig M. Wax DO

October 1, 2015 ICD 10 was mandated by the US federal government department of health and human services (HHS). Their stated goal was to improve data collection and research but the consequences, both anticipated and unanticipated, are becoming clear. 

Even before day one of implementation, it has been costly in time, money, and work that needed to be redone. Laboratories and other testing facilities call constantly for new codes in ICD 10 before they will do testing on patients, even though the codes are for billing, insurance, and government bureaucracy purposes only. Patients are being turned away from labs and radiology facilities. 

Patient history and examination time is now squandered due to electronic health records EHR and chasing new ICD 10 codes. Insurance companies have required “referrals” since about 2000. Originally, referrals meant when a doctor recommends another doctor or facility and gave them an RX script to use that service. Initially, referrals become a paperwork game where a form was filled out for insurance to recognize the service. The insurance companies even said that the referral wasn’t even a guarantee of payment, so what was it for? Since, it has become an electronic online process with an Internet company owned by insurance companies called Navinet. Now, our staffs have to enter all the referring information and diagnosis codes in order for the insurance process to even begin or the patient be scheduled for the test at all. Now with ICD 10, the systems are not recognizing the codes and not allowing these insurance mandated processes that waste our time to even carry to completion so a patient can get the study they need.

Due to all these exogenous process mandates, patient care suffers. Less patient physician contact time is possible in the exam rooms. Physicians, and their staff, are designated data gatherers for insurance and government whims. Time and money are wasted by all parties that are gathering the mandated data. The data will be aggregated by government and pirated, patients extorted, and data lost, with no party responsible except for the physicians who entered it. Patients get frustrated because care is denied due to insurance not reimbursing for procedures due to flawed, complicated processes mandated by the insurance industry. All individual patients’ and physicians’ privacy, security, and care is lost. 

This is yet another government, and their industrial cronies, scheme to command the data and make money for themselves, while patients go without care and physicians suffer the unanticipated consequences. The medical community and its physicians must stop abiding by all the nonsense and get back to patient care with direct primary care; putting the patient first and responsible for their care. 

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Host of Your Health Matters

Rowan Radio 89.7 WGLS FM


Twitter @drcraigwax 

National Physicians Solution Forum | Let My Doctor Practice

Patients and doctors alike are being crushed by the current health care system, where government and insurers, instead of patients and medical professionals, make health care decisions. Check out the new letmydoctorpractice.org, national physicians town hall. This is not a membership organization. This is a solutions forum, to which all doctors and their organizations are invited. View all content free, add your voice.

  • 45+ Speakers
  • 30+ Hours of Solutions/Alternatives Content
  • 30+ Organizations Participated
  • “Key Ideas, Resources and Solutions” with links

letmydoctorpracticeBest to all,
Mike Strickland

The Wolves Are Leading the Sheep

Medical records were created by doctors for the use of themselves and their associates and their consultants…..AND FOR NO OTHER REASON

The purpose of medical records is to maintain quality health care for the benefit of the patient, to provide a doctor personal recall, and to simplify the sharing of information between the patient’s various doctors.

Sharing medical records with attorneys, government officials, and insurance companies, if tested, is probably illegal under the rules of medical privacy.

Many years ago, I proposed that doctors stop treating attorneys. I suggested that the medical malpractice problem would be rapidly solved if we did so.

Maybe if we stopped sending in all of these medical records, we could do away with the royal mess that has been created.

ICD-10 joins MOC and MOL as another nail in the coffin of medicine.

Unfortunately, with the apathy that exists, the wolves will continue to lead the sheep to the slaughterhouse.

Robert S Maurer, D.O., Edison, NJ

ICD-10 Basic Billing Code Sheet

I spent the last few weeks converting my old billing sheet to ICD-10 with as much specificity as possible. I’m sharing it with hopes it will be helpful to others caught in this new bureaucratic red tape. These codes were converted using the free application ICD10charts.com.*

Download ICD-10 Primary Care Billing Sheet by System: Excel File | PDF File

*This information is offered for general information purposes only and is not intended to solve all billing problems. The codes are not guaranteed in any way, shape, or form.  Good luck! ~Craig M. Wax, D.O.

Telemedicine in reality

“I see telemedicine as the way Government and third parties will short both patients and physicians the actual accuracy and feeling of presence and contact of the first-person therapeutic patient-physician relationship,” says Dr. Craig M. Wax. 

A Physicians’ Template for HealthCare Reform: An Eleven Point Plan

via AmericanDoctors4Truth

Revised Edition, September 1, 2015

There are those who say that ObamaCare is now the law of the land and citizens should accept it and proceed with compliance. However, the overt bribery with cloistered deliberations and the failure of Congress to read the bill before passage is an affront to every American citizen regardless of political persuasion. As we now begin to understand this takeover of one sixth of the private sector economy, we see a fundamental transformation of the relationship between the individual and the federal government. The profession of medicine has been politically commandeered to accomplish centralized power in bureaucrats who now have increasing potential to intercede in some of life’s most critical and intimate affairs. This has the potential to erode the personal dignity and worth of every individual and strip individuals of personal freedom in healthcare choices. Our healthcare system needed reform, not the further distortions to the system in the ACA.

These ideological considerations aside, many promises of ObamaCare have been shown to be false. Health insurance costs have already risen and individuals have lost their insurance, hospital access, and physicians with whom they were happy. Individuals now have an insurance card, but with the high deductibles and narrow networks they are unable to access care. Medicare, Medicaid, and the VA are existing examples of government medicine. Medicaid pays less than the cost of delivery of care for many services, and the VA scheduling delay scandal actually cost lives. The bureaucratic nightmare of compliance with Medicare mandates, not to mention the approaching ACA mandates, has prompted many physicians to restrict the number of these patients or opt out of participation completely.

Thirty-six states wisely rejected ObamaCare by not setting up state run exchanges. Of the fourteen that did, at least seven are now insolvent after over a billion dollars of federal tax dollars were spent to help set them up. ObamaCare has never been implemented. Rather, it has been changed by administrative or executive fiat at least thirty-five times. After the 2014 elections, there continues to be a window of opportunity for alternative solutions to fix our American healthcare system without destroying arguably the finest medical and surgical care in the world. Across the country physicians are joining forces to craft viable alternatives that fulfill the false promises of ObamaCare. Although the AMA has name recognition, it represents only about 12% of practicing physicians. In fact, the AMA supported ObamaCare because it has a monopoly on the coding books necessary for business with government insurers, an estimate $80 million a year revenue for them. Currently Docs4PatientCareFoundation, The American Association of Physicians and Surgeons, AmericanDoctors4Truth, The Physician’s Council for Healthcare Policy, and The National Coalition of Physicians for Healthcare Freedom, and United Physicians and Surgeons of America are leading activists in these endeavors. Most of the reform ideas share a common philosophy. Our system should be patient centered, physician guided, and free market driven leading to healthy competition, transparency, and free patient choice. Perhaps those in Congress and the presidential candidates who truly care about enduring reform will consider listening to the experts in healthcare, the boots-on-the-ground practicing physicians who take care of you and your family. The eleven points for reform are as follows:

  1. Get employers out of the health insurance business. Shift insurance purchase for the employee to defined contributions for healthcare purchases or to increased wages to place individuals in the driver’s seat selecting insurance options that fit their needs. Massive administrative costs for business would be saved and disruptions to existing physician relationships would be stopped. Insurance would be non-job specific, stable, and portable. The insurance industry would be forced to respond with a robust offering of individual policies that would form the risk pools. They would compete by virtue of their product, not contracts with third parties, i.e. employers or the federal government.
  2. Purchase of health insurance, health savings accounts, or cash payment for care should be with pre-tax dollars regardless of who makes the purchase.
  3. Once a robust individual market is established, liberate Medicare aged individuals by allowing them to opt out of Medicare without penalty. A defined contribution, like their social security check, would allow them to purchase insurance of their choosing like the rest of the population.  Retain Medicaid for the truly indigent or incapacitated of all ages.
  4. Medicaid would emerge as the only federal government health insurance program, except for the Military and the VA System. (Their reform is for a different discussion.) It could be also used as a stop-gap insurance for those between jobs who could not afford continuation of their insurance, as well as a “rider” for pre-existing disease added to conventional insurance for a specified time. States should receive block grants without mandates to decrease the perverse incentives to increase enrollment. This also promotes innovative ways to ensure access to quality care in cost effective ways.
  5. Return to indemnity insurance where there is shared risk for unanticipated medical or surgical expenses related to injury or illness. The notion that insurance is pre-paid routine healthcare cannot be fiscally sustained. Health Savings Accounts with a catastrophic insurance policy paid for with pre-tax dollars would transition to paying health care dollars, not insurance dollars. Many current insurance payments exceed the cost of routine care and a catastrophic policy. Patient controlled HSAs promote good stewardship of healthcare dollars.
  6. Encourage states to eliminate insurance coverage mandates, like acupuncture and message, to allow a cost effective catastrophic policy and HSA’s. Pre-existing could be covered with time-limited riders.
  7. Allow purchase and portability across state lines. States are the places for innovative healthcare solutions, not one size fits all central planning. Mistakes are more readily remedied as well.
  8. Total transparency across all health care entities is essential. No more third party contracts. There could be a state sponsored portal where hospitals, pharmacies, physicians, etc could post their individual fee schedules regardless of the insurance the individual carries. The insurance contract then becomes one between the patient and the insurance company. Insurance companies then could list what they will pay, not dictate what the physician can charge. This allows patients free access to whatever provider they chose. Cost shifting and horrendous administrative burdens would be eliminated. Hospitals would no longer have inflated “charge master” fees. Prices would fall as competitive markets emerge. We don’t walk into a grocery store and get charged different prices depending on what credit card we use and what deal that credit card has with the grocer.
  9. Fees and costs of all entities, like pharmaceuticals, surgery, devices, physician services, should reflect the cost of resources used and services rendered, not an inflated price upon which third party contracts base their “discounts” for individuals in their “network” nor the Medicare arbitrary price controls. This allows patients and physicians to make informed decisions regarding health care expenditures and choices, and helps to ensure adequate access to care.
  10. Encourage torte reform to save the estimated 30% cost of litigation avoidance for pain and suffering. Lost wages and disability compensation would still be recoverable.
  11. Allow charitable care delivered by the physician to be a tax deductible item with a yearly limit.

Jane Lindell Hughes, MD, FACS

Edited and Approved By:

Kristen Story Held, MD
Jane Lindell Hughes, MD, FACS

A Call for Physicians to Gather in Support of Dr. Carson and Plan to Save American Medicine

Guest Post by Kumar Yogesh, MD

Yesterday we attended Attended Gathering in Nashville and met Dr. Carson. What a great guy !!

I believe time is short and we the physicians need to come up with a short, to the point and precise plan the general public can understand and other fellow physicians can support.

This is what I propose

  1. Kill the CPT-based payment system and get the AMA dictatorship out of our lives. The board of each society in medicine such as ACS, ACP, ACC, ACCP, ACOS, etc should get together and come up with payment schedule that best fits their expertise.
  2. RVU can be used as base unit.For example, as a pulmonologist, I would be happy with setting 1 RVU for basic visit, 2 RVU for moderate visit, 3 RVU for a complex visit. For procedures, setting 2.5 RVU for bronchoscopy, 1.5 RVU for pulmonary functions, 0.5 RVU for chest xray, etc.Similarly, surgeons can assign “X” RVU for appendectomy, “Y” for cholecystectomy, and so on.Payment rate per RVU can be determined based on the level of training and experience of the physician. For example, a mid-level provider, a new physician with three years of training, a senior physician with five years of specialty training and 10 years of experience, all these groups can have different payment rates according to their expertise.
  3. RVU can be calculated at the time of service by a built in software program and payment rendered when patient leaves. I have discussed the possibility of this with a number of software engineer friends and this is doable. If this program is implemented, 10% of cost for billing/chasing insurance companies (which is becoming a very dirty and corrupt game) is gone for all clinics and entire healthcare system!! Savings of billions of dollars!!
  4. Let patients be the owners of their charts. Digital chart can be put on iPhone or any Smartphone, USB, or such device owned by patient. Such devices will be password protected and HIPPA compliant. This can be done virus free and HIPPA compliant according to the software engineers and consultants I have spoken with. This will save at least 10% of cost for the entire healthcare system. It seems that my nurses are making endless copies for other doctors or hospitals all the time or having to spend hours of time on the phone with either machines or nonmedical people who have no idea about patient care. This process not only consumes tremendous amount of human time and resources but it also severely distracts/strains very good nurses and doctors from their primary task which is “patient care “. This entire process will be unnecessary if we let patients own and carry their charts with them. All the information will be available instantly wherever the patient is. When doctor renders his services, he types his own note in his computer. At the end of the visit, physician can transfer his note to patient’s is digital chart device. This way, physician will always be in the possession of the original record. If the physician makes any additional notes later, it can be transferred to patient’s chart electronically. This will eliminate tremendous amount of absolute mental torture, worthless repeated paper work and redundancy that patients and medical staff have to deal with on a daily basis under current system. This will save A LOT of time, money, mundane paper work and best of all restore the sanity for the healthcare workers and doctors who are absolutely going insane by these tortuous process imposed upon us —all Wins for all sides. Again, savings of billions of dollars!! Much more simple and efficient system at a lower cost.
  5. Most of these savings worth billions of dollars should be passed to patients lowering out of pocket cost and premiums for all. Bottom-line for providers income will not be affected since overhead will come down significantly. In fact physician income may rise modestly since efficiency and morale of entire team will improve. Win-win for all.
  6. Kill CMS and its dictatorship. President can appoint an independent board that may consist of 6 to 7 reputable medical centers across the country and ask them to develop medical decision making and treatment protocols based on state of the art current evidence based guidelines. When a physician is evaluating patient, treating patient, performing a procedure on patient, ordering imaging or other studies, this physician has to follow one of the guidelines/protocol. Physician needs to do this in front of patient in real-time with the use of Internet and monitors. Once the medical decision and plan is made, physician can answer all questions of patient/family/guardian according to review of guidelines as discussed above. Final Orders are entered into patient’s digital chart.

This should be the end of the story of a patient visit. Once this happens, there should be no need for prior authorization, denial by any insurance or government agency, no need for waste of our nursing/staff spending endless time on phone or talking to machines. Simply put, we physicians should be done at this time as we have completed our service. Any problems that arise afterwards will be dealt by patient and insurance since these are the two entities that hold agreement with each other.

K.Yogesh, MD