Friday, February 17, 2012

Kicking Cans

The government is remarkably good at kicking cans down the road.

This is the single reason is why government-run health care costs so much.

For instance, we continue to kick the can down the road for the doctor pay fix. Time and time again, we see the Sustained Growth Rate formula fail to be overturned, and instead, Congress vote a few-month reprieve to pay cuts for doctors until they can find another way to either pay those who do the work, or cloak these paycuts in another, less visible and acutely painful way. Look, we all know it's coming: paying a few paultry percent more for primary care while slashing specialists payments 40% was lost on noone.

And now their kicking the ridiculously complex and overly obsessive medical coding scheme called ICD-10 down the road. This morning we hear the purveyors of this money making scheme, the AMA along with their co-dependents at the Health and Human Services claim they will:
“announce a new compliance date moving forward,” the agency says.

“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” HHS says.
As if they really care. Better yet, it's as if doctors were on really okay with this coding scheme, but just a little "administratively burdened."


Let me clear: doctors are NOT okay with ICD-10. We never have been. Nor will we ever be. It provides NO value to the patient experience. And let me be even clearer: the REAL reason this can is being kicked down the road is because there are not enough programmers in the world capable of debugging and writing the mounds of computer code accross the scores of information systems out there in the time allotted, nor personnel capable of training all the medical coders and the various permutations of "medical providers" out there on how to use this system.

The delay in implementation of ICD-10 and the inherent costs associated with its implementation and delay of implementation has NOTHING to do with doctors.

Yet this coding scheme and bureaucratic delays of things like the doctor pay fix and the implementation of ICD-10 has EVERYTHING to do with how expensive our health care system has become and how expensive government health care is in general. But you will never see the huge costs of all these delays and hand-wringing accounted for in a non-partisan budget office.

Yep, the reality of these inefficiencies within government-run processes are the poster children for why our entire US health care system is so expensive.



Keith said...

I would challenge any private insurer to offer care at the same average price per participant that Medicare currently pays. We have Medicare because of the inability of private insurers t offer an affordable product to peole over 65. Medicare HMO products administered by private companies required a premium to be paid to them, so how do you state that Medicare is so expensive? Expensive relative to what?

DrWes said...


Expensive as to what?"

A cash-only practice.

Also, many of the costs of our health care system going forward are cloaked in agencies outside of the HHS and not "counted." For instance, collections for our new government-run health care system are conveniently cloaked in the markedly expanded budget of the IRS.

Further, all of this bureaucracy and delays in implementation going forward were never "budgeted" in cost estimates for this program either. The longer the things are delayed, the more they will cost: just ask any homeowner in the midst of construction.

But I suppose in reality it's a fool's game to challenge what this all costs, especially when our own beloved Department of Health and Human Services agency continues to promote preventative evaluations like colonoscopies as "free."

Anonymous said...

The AMA makes a killing off the CPT system. How will they get a cut from the conversion to ACD 10?

Keith said...


Not fair to compare to a cash only practice. Otherwise what you do for a living would not likely even exist. No one would have developed these ever more expensive pacemakers and IVCD since the market would be only limited to the extremely wealthy and the cost of development would be difficult to spread over a smaller number of patients. Kind of like developing a specialty drug that only has utility for a rare disease, and as a result cost hundreds of thousands of dollars for a course of treatment.

The fair comparison is to private insurance, and the reason Medicare exists is that private insurance could not provide a reasonably priced product for people over 65.

Both private insurance and goverment funded insurance undoubtedly have waste asosciated with each, but the bottom line is what does it cost to provide the insurance, and Medicare wins hands down even with all the bureaucracy you claim.

I agree that a cah only system would be the most efficient, but this is not a realistic solution for patients or most physicians. Why else do we all have health insurance? Because we know how easily we could be wiped out by a serious illness with us or our families. It just isn't a reasonable option with the health care system we now have.