Thursday, July 2, 2015

ICD-10 lunacy

Medical websites, articles, and blogs have been full of examples of hilarious insane ICD-10 codes, new ones that many of us will (hopefully) never use in a lifetime of practice.

If there exists one for fall from nonmilitary spacecraft, does that mean that there are military spacecraft? Are we sending Marines into space?

I'm sure someone has a practice where their patients are frequently coming in after being bitten by Orcas, and it's nice to know there's a code to bill for that if I need it, but all of this leads to a level of mental exhaustion, that we're all being put upon, asked to do something else that adds no real value to our care of patients. And this time the troops got their hackles up.

One of my partners sent around an email after the meeting, a long diatribe about how we've allowed this stuff to happen to us for far too long, can't this be taken out of our hands, why are they bothering us, we have doctoring to do.

This is yet another example of the system getting ungainly and impractical around us, as government regulators and insurance companies demand we do stuff that doesn't help us take care of patients, and in fact steals our valuable time and mental energy from what could be real efforts to transform and improve the healthcare system in this country.

As part of the transformation over to ICD-10, our electronic health record (EHR) has created a conversion calculator so that if you put in plain old hypertension, the EHR presents you with all of the options necessary to get you to the granularity needed for final billing with the ICD-10 code...

Gout, that scourge of modern civilization and excess, leads the way, with 750 iterations, which joint, side, etiology, duration, etc. all for the sake of what?...

If this granularity of detail made it easier for us to take better care of our patients, then I would be all for it. If somehow being able to collect all the data on all of the patients with gout in their left elbow without tophi let us learn something about patients with gout or our practice of medicine, then maybe there's some worth to the system.

Otherwise, it seems like they're just wasting our time...

The medical chart was created as a communication device -- the way for us to keep a record of our interactions with our patients, for us to communicate with other providers about what we've done, and ultimately, a safe repository of our opinions and actions, which had utility in the larger scale of taking care of patients...

The advent of the electronic health record has in some ways made it easier to document, but I think we can all agree that it has not led to a better communication tool, a better medical record. I'm definitely not saying that our old handwritten illegible notes with minimal content were all that good, but the clunky redundant behemoths that we end up creating by clicking all these boxes clearly are no improvement...

Nietzsche said, "That which does not kill us makes us stronger."

Well, this stuff is killing us. And I feel no stronger.

See:  http://www.medpagetoday.com/PatientCenteredMedicalHome/PatientCenteredMedicalHome/52430?isalert=1&uun=g906366d4245R5793688u&xid=NL_breakingnews_2015-07-02

See:  Words, words, mouthy, mouthy  6/15/15

1 comment:

  1. Navigating the U.S. health care system these days reminds me of Alice’s dreamscape game of Wonderland croquet. A physician is given a flamingo mallet and a hedgehog ball and ordered — by the Queen at the risk of having one’s head lopped off — to go play, but the mallet won’t cooperate and the ball keeps unrolling itself and crawling away. Just like any day in a medical clinic, a doctor’s time is spent trying to manage their flamingo and the patient gets tired of waiting, so gets up and leaves. At least Alice gets a good giggle out of it, but the reality in health care causes more tears than laughter. We are playing a very difficult game of changing rules and equipment

    The flamingo in the doctor’s hands could represent the increasingly time-consuming requirement now to search over 68,000 ICD-10 diagnosis codes rather than the previous 14,000 ICD-9 codes. Or the requirement to search for a 10 digit NDC number for any prescription medicine sent electronically to a pharmacy. Or the meaningful use criteria that regulate mandatory data collection and reportage on patients to the Federal Government in order to receive full payment for Medicare or Medicaid billings. Or the newly updated HIPAA and HITECH electronic security requirements to ensure privacy. Or the obligations to the new accountable care organization that your employer has joined. Or the maintenance of certification hoops to jump through in order to continue to practice medicine. The exasperated and uncooperative “managed” flamingo keeps curling itself around and looking at us with a puzzled expression: Just what is it you were supposed to be trained to do? Is there actually a patient to pay attention to in all this morass of mandates?

    And the poor hapless hedgehog patient is just rolled up in a ball waiting for the blow that never comes, for something, anything that might look like health care is about to happen. Instead there are unread notices of patient privacy to sign, as well as releases to share medical information to sign, agreements to pay today’s co-pay and tomorrow’s deductible and whatever is left unpaid by Affordable Care Act insurance, passwords to choose for patient portals, insurance portals, lab portals and healthcare.gov. It might be easier and less painful to just crawl away and hide from that bumbling physician who can’t seem to get her act together.

    I wish I were laughing, but I’m not. As both physician and patient, it’s getting harder and harder to play the game that is no game at all. The threat of losing credentialing in an insurance plan, or getting poor ratings on anonymous online physician grading sites, or being inexplicably dropped from a provider list, or too unproductive to remain in an employer medical group, or losing/forgoing board certification is like a professional beheading. We keep trying to juggle the flamingo motivated by those threats, all the while ineptly managing the managed care system, and hoping the patient won’t walk away out of sheer frustration.

    It’s hard to remember why I’m in the game at all. I think, at least I hope, I wanted to take care of people, heal their illnesses and help them cope with life if they can’t be healed. I wanted to provide compassionate care.

    It is enough to make a doctor cry. At least we can meet our patients at the Kleenex box and compare notes, and maybe, just maybe, we’ll find enough common ground to even share a laugh or two.

    http://www.kevinmd.com/blog/2015/08/doctors-are-playing-a-very-difficult-game-of-changing-rules.html
    Courtesy of: http://www.medpagetoday.com/Neurology/PainManagement/53046?isalert=1&uun=g906366d4428R5793688u&xid=NL_breakingnews_2015-08-13

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