The
Affordable Care Act has forced insurance costs higher, encouraged many
employers to bail out of providing health plans for their employees or cut
employees or reduce hours to below the full-time threshold to avoid the higher
costs, and has unleashed thousands of pages of new regulations. But intrepid
federal bureaucrats charge ahead with even more requirements for providers, one
of which is a revamping of the codes used to identify the medical services that
providers use to bill insurers.
Currently,
there about 18,000 such codes and one might be fooled into believing that is
enough. But the devoted folks who get paid to generate new codes have been hard
at work revamping the code system and the new list contains nearly 8 times the
former number, checking in at 140,000 medical codes. The feds reason that more
specific information is needed to adequately communicate what doctors and
hospitals do for their patients, as well as what patients may have done to
require a visit to a provider.
New codes
describe precisely what bone was broken, or which eye was blackened, and tell
insurers whether your injury occurred in, for example, an opera house, an art
gallery, on a squash court, or in one of nine locations in and around a mobile
home.
Some of
them push the limits of propriety. Code R46.1 is for "bizarre personal
appearance," while code R46.0 is for "very low level of personal
hygiene." Others tell insurers whether an injury caused by walking into a
lamppost was the "initial encounter," or a "subsequent
encounter."
There is a
group of codes that clarify whether you were injured while sewing, ironing,
crocheting, doing handcrafts, knitting, or my personal favorite, playing a
brass instrument. (Brass players are now churning out imaginative scenarios for
how these injuries might have occurred.) There is also a code indicating that a
patient's injury occurred in a chicken coup.
Speaking
of birds, there are 72 codes for patients who have run afoul of these
creatures, and being bitten by a parrot has a different code than if said
parrot flies into you, or if you are bitten or flown into by a macaw or a
goose. There are nine different codes for each of the six different species of
bird.
The folks
that developed the system—generally known as ICD-10, for International
Classification of Diseases, 10th Revision—say "the codes will provide a
more exact and up-to-date accounting of diagnoses and hospital inpatient
procedures, which could improve payment strategies and care guidelines,"
and their use is scheduled to be required in two years. Pat Brooks, senior
technical adviser at the Centers for Medicare and Medicaid Services explains
that "It's for accuracy of data and quality of care."
As a side
note, healthcare reform, known more commonly as Obamacare, is deemed so
important that the furloughs that befell air traffic controllers did not extend
to Obamacare regulators and code generators, according to Gary Cohen, director
of the Center for Consumer Information and Insurance Oversight, who said that
his office has not cut its workers’ hours and pay as a result of the automatic
budget cuts that went into effect in March. This information should help
convince doubters that the pain of the sequester is a conscious political
choice of the administration, and not a requirement of the sequester.
While
federal bureaucrats are busy, busy, busy improving the healthcare system with
mountains of new regulations and charge codes, some of the people who actually
provide care are taking different approaches, some of them good, and some not.
A recent
Deloitte Center for Health Solutions survey of over 600 doctors reveals that 6
in 10 may retire earlier than they had planned, and will do so in the next
three years, due to the effects of the Affordable Care Act on how they practice
medicine.
Further,
many providers will leave the private sector to work for hospitals or
accountable care organizations, and others are fighting back against massive
government interference in the doctor-patient relationship by reverting to an
older direct primary care model that eschews health insurance in favor of
fee-for-services, such as an office visit for $20 or a house call for $100.
Some offer a membership plan where patients pay a set fee per month for
physician services.
Getting
away from health insurance, government regulations and other requirements
reduces costs substantially, allowing doctors to provide services at affordable
prices, and has the further advantage of allowing doctors to escape
"assembly line medicine," all of which may benefit the relationship
between providers and patients. In contrast to Obamacare, this is a real
improvement in the system.
Finally,
even supporters of this Rube Goldberg-like contrivance are starting to realize
its boundless weaknesses. Senator Max Baucus, (D-Mon.), one of the Affordable
Care Act’s designers and strong backers, told Health and Human Services
Secretary Kathleen Sebelius during a Senate committee hearing that he sees
"a huge train wreck coming down."
It's a
shame Sen. Baucus and the other blind supporters didn't do their homework
before the measure passed the Congress, and save the country much pain and
suffering. But perhaps it’s not too late to reverse course.