Once again, Congress pretends to have fixed the unfixable: The way Medicare pays doctors. An earlier blog entry describes how Medicare pays physicians by using a method that puts the old Soviet Gosplan to shame.
The simplest description is that a government-authorized committee determines how much time it takes a doctor to do a procedure. For example, a session of psychotherapy for a patient with panic attacks takes 45 minutes. A hysterectomy takes about twice as much time as the session of psychotherapy, plus 3.8 times as much mental effort, and 4.47 times as much technical skill and physical effort, as well as 4.24 times as much risk. Needless to say, negotiation over these estimates consumes a lot of energy in a zero-sum game between specialist medical associations.
The outcome is a “relative value” for every single thing doctors get paid for by Medicare. A highly complex and time consuming procedure earns a high relative value. Each relative value is adjusted for geography (e.g., Manhattan is more expensive than Dallas) and multiplied by a conversion factor to determine how much Medicare will pay a doctor.
Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.
Roughed up by an Orca whale? It’s on the list.
There are codes for injuries incurred in opera houses and while knitting, and one for sibling rivalry.
Next fall, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.
I.C.D.-10, with codes containing up to seven digits or letters, will have about 68,000 for diagnoses and 87,000 for procedures.
Andrew Pollack at the NYT.
- Virtual Care: Doctors in remote ‘command centers’ are increasingly keeping tabs on vital signs of patients in intensive-care units.
- Medical Detectives: Got a hard-to-diagnosis ailment? Patients can now post their symptoms online and offer a reward for a diagnosis from a host of doctors.
- Doctor on Demand: You can have a virtual consultation with a physician for nonemergency medical issues.
- Personal Care: Bedside tablets let hospital patients text the nurse. Patients can check their own charts and lab results.
- Transparency: New insurance tools let patients compare the price of care between hospitals and calculate out-of-pocket costs.
More on the WSJ.
Thousands of people are cramming in tests, elective procedures and specialist visits before year’s end, seeking out top research hospitals and physician groups that will be left out of some 2014 insurance plans under the new health law, health-care providers say.
Health insurers are especially focused on paring academic teaching and research hospitals from their networks because they generally charge more than community hospitals for similar services. [See chart]
This database would eventually be used to identify “outlier ordering professionals.” These are doctors who show a “low adherence” to the “appropriate use criteria.” Starting in 2020, these “outlying” doctors would then be required to seek the advance permission of the government through a “prior authorization” process administered by a government website before they can order services for their patients.
All of these provisions are written to pertain to imaging services and radiologists. But language included at the end of this section of the legislation gives the HHS secretary broad discretion to establish an “appropriate use program for other Part B services.”
This includes everything doctors do outside the hospital. The legislation allows Medicare to apply the same regulatory framework to other medical specialties like oncology.
These provisions are part of a much broader, secular shift toward increasing control of the practice of medicine by the federal government. With “applicable appropriate use criteria,” Washington would have the tool to effectively control the practice of medicine for America’s senior citizens.
This is from a Health Affairs study of nurse practitioner-run retail clinics in 27 states:
Compared to settings such as physician offices, urgent care clinics, and emergency departments with a per episode average cost of $704, retail clinics had a cost of $543 with no NP independence; $484 when NPs can practice independently; and $509 per episode when NPs can both practice and prescribe independently.
The authors estimate an added potential savings of $810 million nationwide in 2014 if all states allowed NPs to practice independently. They refer to predictions of 5,000 retail clinics being in operation by 2015 and recommend that scope-of-practice laws permit NPs to operate to the fullest extent of their abilities to improve care and decrease costs.