By Zack Steele
There are times in my day when I wish my life was about seeing patients and helping them see well. One would think that is what a health care provider is supposed to do. These days, we are inundated with codes, procedures, and minutia created by the federal government and insurance companies.
I read an interesting column recently by a doctor named Jeffrey Singer. He’s a surgeon who lamented in his column that the government broke the health care system with the introduction of a coding system back in the early 1980s. Doctors of all specialties know these as ICD and CPT codes.
The codes had honest intentions. By coding specific diagnoses and procedures, confusion could be minimized along with better tracking of specific diseases.
The problem came along when Medicare and Medicaid began paying doctors and hospitals more for specific codes grouped together. Once hospitals and physicians figured out that certain codes paid more, then everyone began to chase the almighty dollar.
Add that to excessive testing and procedures caused by the fear of being litigated against for missing a diagnosis, and you have a cash flow problem in all directions in health care.
Patients are now forced to pay high premiums with higher deductibles. Physicians now wait, often impatiently, weeks to be paid for a service by an insurance company. Medicare and Medicaid are huge drains on federal budgets.
At a recent optometry convention, I had the displeasure of sitting through a lecture in which the expert was telling me all the hoops to jump through to make extra money. I honestly felt sick. His conclusion: Do more tests, make more money. Do I need to run more tests? I already feel like we do a pretty good job of maintaining “standard of care.” But in his opinion, yes, more testing is always better. Go ahead and fleece Medicare while it’s still somewhat solvent.
A few years ago, providers were incentivized to convert all their patient records to electronic vs. paper. The thought was that this would lead to better communication between providers, reducing errors that inevitably come from paper records. By sharing data online, we could streamline the process.
The problem with this grand idea is that regular electronic communication is not compliant with HIPPA patient privacy laws, so there is no way, five years into the electronic age, for me to legally communicate about a patient other than by fax or regular snail mail.
Health care providers have spent millions collectively and thousands upon thousands individually (including yours truly) to communicate the same way we did when we wrote down everything on paper.
In October, those dreaded ICD codes are changing completely to a new system with 87,000 new diagnosis codes. Right now, we have to navigate through a measly 13,000. Why so many new codes? Well, we’re told we have to be more specific. For instance, struck by a duck, initial encounter is actually a new code. So is injured in a pool in prison. Who knew prisoners had it so good? And my personal favorite, Code Z63.1: Problems in relationship with in-laws. Do any of you not have this ailment?
Anyway, my point is, things were a lot simpler when doctors, not the government and insurance plans, could determine how much something should cost, and were in control of their own treatment and diagnostic decisions.
Dr. Zack Steele is a 2003 graduate of the UAB School of Optometry. His practice, Trussville Vision Care, is located on Chalkville Mountain Road in downtown Trussville.