On the first of this month a Death Certificate was issued for U.S. Healthcare. Patient Healthcare was officially declared dead, and buried quietly in a giant mound of paperwork and red tape. Hundreds of thousands of grateful federal bureaucrats attended the ceremony. The immediate family – We The Patients – was not invited.
Photo: Shutterstock/Stuart Monk
International Statistical Classification of Diseases, 10th Edition
As of Oct. 1, 2015, all providers of health care (i.e. doctors and hospitals) are required to use a new, complex, almost incomprehensible billing and coding system called ICD-10. They do not have to use it–only if they want to get paid.
This numerical coding system financially connects patient, provider and payer. ICD-10 has over 16,000 medical codes, which is more than 10 times the number of all diseases that affect humans. These code numbers are used to verify and justify and complicate payment for goods and services that you need during health care. Many of the descriptions of these numbers bear no relationship to the services that the providers actually provide.
Costs of ICD-10
The cost of implementing is ICD-10 is huge, both direct and indirect. The direct costs include administration as well as verification processes, meaning massive amounts of money to be spent on information technology. Both providers and insurers bear these mandated direct expenses.
The indirect costs are even greater. Every medical computer in the U.S. must be updated. Every biller and coder must learn the new system and change their institutions’ or organizations’ IT systems and billing forms. New federal bureaucrats are being hired to implement and verify and to oversee compliance.
There are whole industries being created to assist providers in understanding ICD-10 and filling out the forms correctly. An example of one of the many email offerings I received offered a CD-ROM program titled, “ICD-10 Denials–Stop Them Before They Start,” for only $177. If every doctor bought one, it would cost over $140 million for this program alone.
It pains me and every other doctor to be forced to spend time on ICD-10 that we should be spending with our patients. That is the law. You either comply and pay no attention to patient, or lose your license. And without a license, what good are you to the patients?
Next are the costs of error, fraud and abuse. Virtually all healthcare fraud and abuse, a favorite whipping boy of Washington, occurs during the billing process. That is where people up-code (using a code for something more expensive than what was done); phantom code (you bill for something you did not do); or even down-code (giving services at a reduced rate), which, believe it or not, is illegal. The complexity of ICD-10 magnifies the costs of verification, oversight, remediation, and then there are the inevitable legal fees. Don’t forget all the consulting fees and the CD-ROMs, as advertised above.
Be very clear as to who pays these massive costs. It is not the government, the insurance company, or the doctor. They pass on those costs to you and me. We pay.
Value of ICD-10
What is the value of ICD-10, the cost compared to the benefits of this new system to the consumers, to all Americans as patients? The costs are described above. What are the benefits, to us? There are none. We get nothing for umpteen billions we are forced to spend involuntarily.
Death Of Healthcare
The article’s title claims that healthcare is dead. That does not refer to the system. Quite the contrary! The federal bureaucratic system for control of healthcare is alive, well, and expanding quite nicely. What is now officially dead is healthcare’s raison d’être – the reason why we have healthcare in the first place.
Despite what the media implies and what our politicians believe, saving money is NOT the reason for healthcare’s existence. We need a healthcare system for one reason: to protect and improve the health of all Americans.
Does ICD-10 serve that purpose in any way? Quite clearly, it does not. In fact, ICD-10 harms the health of Americans. It diverts money desperately needed to pay for care in order to expand an unnecessary bureaucracy. By its built-in complexity, ICD-10 increases the likelihood of error, fraud and abuse, thereby increasing the need for even more bureaucracy especially oversight and prosecution.
ICD-10 may be the Death Certificate for Healthcare’s true purpose but it is triumph for the cancer that has taken over Washington: an out-of-control federal bureaucracy.
Healthcare’s purpose can be resurrected. That will require something simple but extremely hard: get the government out of healthcare. A plan to do this has been released called Direct-Pay USA. By reconnecting the patient with his or her money, and returning control of care to the patient, ICD-10 will become irrelevant, and so will Obamacare.
If the Republicans are wondering what to “Replace” Obamacare after “Repeal,” the answer is Direct-Pay USA.
Dr. Deane Waldman MD MBA is author of “The Cancer in the American Healthcare System” (available Thanksgiving 2015); Professor Emeritus of Pediatrics, Pathology and Decision Science; and Adjunct Scholar (Healthcare) for the Rio Grande Foundation, a public policy think tank. Dr. Deane also sits on the Board of Directors of the New Mexico Health Insurance Exchange, as Consumer Advocate. Opinions expressed here are solely his and do not necessarily reflect the opinions of the Board.
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