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| How can a rock-head get hurt like this? |
It was a terrible tragedy. Aeschylus, first of the ancient Greek playwrights was out bebopping along, and his buddy Euripides was like, "Hey! Look out!", and Sophacles said, "Yo! Is that a turtle?", and whammo! A frikkin' turtle landed on his head (Aeschylus', not the turtle's). History doesn't record the fate of the turtle, but we can assume it didn't do well. They rushed Aeschylus off to the local emergency room, conveniently next to the Parthenon.
The real tragedy, of course, was that once they got there the doctors had no concise way to document the diagnosis of turtlecrainiotomy, and while they were looking for one, Aeschylus assumed room temperature. You see, those ancient physicians were stuck using ICD-9 diagnosis codes to document patient problems. Those 18000-odd codes aren't granular enough to describe Aeschylus' injury, so they didn't know if his injury was 854.10 (Intracranial injury of other and unspecified nature, brain NOS, with open intracranial wound) or 934.19 (imbalance of humors, black bile, unspecified).
Well, believe it or not, but it took 2500 years or so before humankind could fix this problem. The kind-hearted bureaucrats at Medicare have decided that the country needs to switch to the newfangled
ICD-10 codes. Now those 18000 inadequate diagnosis codes have been replaced with 155,000 codes that cover everything from L89000 (Pressure ulcer of unspecified elbow, unstageable) to Y92250 (Art Gallery as the place of occurrence of the external cause). And, thank God, there's not 1, but
*9* separate codes that deal with turtles -- everything from bites to strikes to "other contact" (
Gormogons, I'm sure you know what that means, wink wink). If only they had this in 500 BC Aeschylus could have survived!
This is all quite silly, of course, except for one minor issue: what good does it do, and what does it cost? The bureaucrats claim this is a cost-savings measure, of course, as if changing a few codes on a billing sheet will save money. Someone sat down and calculated how much this cost-savings would cost, and
it's a doozy:
The total estimated cost for a 10-physician practice to move to ICD-10 would be more than $285,000. These expenses include:
- Training expenditures are estimated to total $4,745
- New claim form (superbill) software $9,990
- Business process analysis $12,000
- Practice management and billing system software upgrades $15,000
- Increases in claim inquiries and reduction in cash flow of $65,000
- Increased documentation costs $178,500
For a small, three-physician practice, the total cost to implement ICD-10 is estimated to be $83,290, for a large, 100-physician practice the estimated costs to implement ICD-10 is more than $2.7 million.
Yeah, that's going to save us a huge amount in healthcare costs. It's almost like Government bureaucrats aren't helping things!
But lets not fool ourselves. This is exactly what the government wants: more complexity and bureaucracy in the name of lower "costs." One only needs to see how the government calculated their "cost" savings for justifying the massive increase in complexity to the coding scheme:
Benefit Assumption 2: Pended claims will be reduced by 0.28% (minimum) to 0.7% (maximum). Using the research and interviews, it was assumed that the pended claim percentage, currently 14% (Benefit Assumption 1), would be reduced through standardization.
Benefit Assumption 3: Reduced manual intervention will reduce the costs for providers by $3.20 per call and for plans by $1.60 per call. Manual intervention is required to resolve pended claims and both Healthcare providers and Health Plans incur these operational costs.
Benefit Assumption 2: Pended claims will be reduced by 0.28% (minimum) to 0.7% (maximum). Using the research and interviews, it was assumed that the pended claim percentage, currently 14% (Benefit Assumption 1), would be reduced through standardization.
Benefit Assumption 3: Reduced manual intervention will reduce the costs for providers by $3.20 per call and for plans by $1.60 per call. Manual intervention is required to resolve pended claims and both Healthcare providers and Health Plans incur these operational costs.
Benefit Assumption 3: Reduced manual intervention will reduce the costs for providers by $3.20 per call and for plans by $1.60 per call. Manual intervention is required to resolve pended claims and both Healthcare providers and Health Plans incur these operational costs.
Yep, there you have it. CMS has justified the most massive expansion of electronic coding so "providers" and massive health systems can get their money without having to pick up the phone.
Benefit Assumption 1: Based on the data provided in a recent AHIP report the percentage of pended claims was assumed to be 14% of total claims.
(snip)
My friends, soon we will see that the Beast has won. Independent stand-alone physician practices will soon be a thing of the past, brought to their knees by overbearing electronic billing and prescribing regulatory requirements. In their place will be physician-employees of major health care systems that are capable of purchasing computers, personnel and electronic reimbursement software upgrades annually, while they are subject to data-mining algorithms to assure "efficiencies" and "effectiveness" and "quality," all in the name of cost-savings.
depressing.
