Our Problems With Codes

Oh, that clever Center for Public Integrity.  Look what they've gone and done now!  My, oh my.  According to the article, doctors are much of the the problem, billing "billions" of Medicare upcharges according to the center.

But what if the medical coding game itself is flawed?  Stop for a moment and imagine what it would look like if lawyers billed like doctors.  Suddenly, we see how bizarre the world of government billing codes and chart-completion mandates has become.

Not long ago I asked the blog-o-sphere what my time is worth on a per-hour basis.  Collectively and independently, the blog-o-sphere settled on a number of about $500/hr (see the comments).  Now look for a moment at what Medicare pays, even at its highest level of billing for a physician's time for evlauation and management of a medical problem: for 40 minutes of a physician's time, it's $140 (or $210/hr) before taxes.  Again, we see another disconnect as to how doctors are valued in our current system.

Doctors are working long hours to collect these fairly low fees from Medicare while jumping more hoops than ever to do so.  They have become pseudo-experts at the coding game, trying to get as much money for their extra efforts as legally possible.  But these fees paid by Medicare do not cover payments for time spent on phone calls, e-mails, and working insurance denials.   These services are still considered by our system as gratis. To partially counteract this coding problem, doctors realized (and the government insisted) that doctors use electronic medical records.  But when independent doctors set out to implement these records they quickly discovered that the expense and long-term maintenance costs of local office-based EMRs could not compete with more sophisticated systems already in use by their neighboring large health care systems.  Because of ever-increasing cost-of-living and overhead costs, not to mention the threats of large fee cuts, doctors have migrated to large health systems faster than ever.  With the fancier electronic record at those systems (streamlined for billing, collections, and marketing) fields required for higher billing codes (but not always material to the problem at hand) are completed in less time.  So are doctors really the problem?

It depends on who's looking.  Since every medical test and order is tied to a doctor's name, then of course it looks like doctors are the problem.  And yet it's the government who has mandated the codes, the requirements for chart completion, and the electronic records to which our electronic signatures are attached.  But we should ignore these facts; in the eyes of the Center for Public Integrity, of course its the doctors' and hospitals' fault. 

And what do you think the government's response is to all of this? 

Why, get get ten times the number of billing codes, of course!

So take a moment and imagine a world without codes might look like.  A world where doctors are paid for their level of expertise, time with patients, time with communication for those patients, and time their connected to the EMR to enter codes, document, e-mail, and care for patients.  No codes, just time-based billing at a level of commensurate with their skills.  If we can track billing codes, we can track doctors' time.  Gosh, it's sounding sane isn't it?

If we really want out of this coding and billing conundrum, we should stop the coding schemes.  Pay doctors for what they are worth in today's market.  Pay doctors for their time as well as their productivity.  Throw away the codes, the consultants, the code licensure fees, and the nonsense.  Compared to current administrators of these coding schemes, people might actually discover that doctors and hospitals are the path to salvation for excessive health care costs rather than the instigators of coding fraud.

-Wes