Clear Stream
Thursday, October 13, 2011
Required Reading
I was given a heads-up about the existence of the Mises Institute, an economic think-tank/foundation in Auburn, Alabama. Fantastic Publications and a world of alternative economic thought, i.e the Austrian school, as developed by Ludwig von Mises. His book, "The Road To Serfdom" is incredible, written in the early 1940's after he arrived in Great Britain fleeing Nazism, where he was horrified to find the fashionable elites extolling the virtues of Hitler and Stalin. This happened. It is completely applicable to today. I am about halfway through it. In it he expounds on the confusion surrounding the conceptualization of socialism vs. totalitarianism, and the conclusion is, they are one and the same. FREEDOM FOR INDIVIDUAL THOUGHT AND ACTION IS DESTROYED AND THE COLLECTIVE, OR THE GOVERNMENT, MUST RULE AND CONTROL ALL ASPECTS OF LIFE. A must-read. The parallels for today are mind numbing.
CMS did it again
My manager and I decided to submit our claims online through a clearinghouse to ease the burdensome headaches with the "upgrade" (upgrade for whom, exactly?) for HIPAA 5010 transactions. So today I got a message that many claims were rejected by Medicare, in particular those claims submitted after Sept 30. Closer inspection revealed the ICD-9 codes, which are going to be replaced in 2013 by ICD-10, have been CHANGED FOR 2012 and THE CHANGES TAKE EFFECT OCT. 1, 2011 FOR 2012 UPDATES!!!! Who decided this asinine course? A bunch of codes for skin cancer were DELETED and simply given a 5th digit but the old codes were thrown out, like the baby in the bathwater. So the code for a skin cancer in the ear was 173.2 but on Sept. 30 this ceased to function, and now an ever more specific code, 173.22 or 173.21, must be used if you want to get paid when excising a skin cancer on the ear. The definitions of these codes and the assignment of the new codes is not being divulged by CMS. You have to buy a book for that. Or do a quick couple of searches on Google if you're savvy....
So now, dear friends, it is not enough to operate, educate, explain, empathize, and just in general be a doctor. Now(and since LBJ signed his stupid legislation way back when) we have to play the bureaucracy game by updating all software and all printed materials in the office that have these codes, and pay for it, and do it with a smile :-). And it must be done overnight, 3 months before the new year. I cannot imagine how big clinics or hospitals are dealing with this, because there are a slew of other, newer, more specific codes that will be valid for only 1 year before they ALL GET TRASHED AND REPLACED BY ICD-10. WHY?????
The AMA is doing this to justify its existence. The AMA, in cahoots with the feds, come up with the barrage of diagnostic and procedure codes, and of course one can purchase a book from the AMA where all of these codes are "updated" yearly. Membership is way down and most doctors in America place no value on what this organization does or says; it merely mails out flyers offering new disability or health insurance just about every month, otherwise the AMA is a completely impotent and useless organization.
It would be so great to just see a patient, do what has to be done and prescribe what has to be taken for the illness to get better, have payment rendered at the front desk, and that's it. Instead we have this giant back-office operation where codes, bills, data, procedures, modifiers, etc have to be entered into a portal (which we have to pay for and we can't charge for doing this, expressly stated in the CMS mandate), and then wait at least 3 weeks to be paid. If at all.
I guess all those new employees in DC have to justify their existence. Codes! Modifiers! YES! WE WILL BE NEEDED AND NECESSARY FOR THE FUNCTION OF MEDICARE!!!
So now, dear friends, it is not enough to operate, educate, explain, empathize, and just in general be a doctor. Now(and since LBJ signed his stupid legislation way back when) we have to play the bureaucracy game by updating all software and all printed materials in the office that have these codes, and pay for it, and do it with a smile :-). And it must be done overnight, 3 months before the new year. I cannot imagine how big clinics or hospitals are dealing with this, because there are a slew of other, newer, more specific codes that will be valid for only 1 year before they ALL GET TRASHED AND REPLACED BY ICD-10. WHY?????
The AMA is doing this to justify its existence. The AMA, in cahoots with the feds, come up with the barrage of diagnostic and procedure codes, and of course one can purchase a book from the AMA where all of these codes are "updated" yearly. Membership is way down and most doctors in America place no value on what this organization does or says; it merely mails out flyers offering new disability or health insurance just about every month, otherwise the AMA is a completely impotent and useless organization.
It would be so great to just see a patient, do what has to be done and prescribe what has to be taken for the illness to get better, have payment rendered at the front desk, and that's it. Instead we have this giant back-office operation where codes, bills, data, procedures, modifiers, etc have to be entered into a portal (which we have to pay for and we can't charge for doing this, expressly stated in the CMS mandate), and then wait at least 3 weeks to be paid. If at all.
I guess all those new employees in DC have to justify their existence. Codes! Modifiers! YES! WE WILL BE NEEDED AND NECESSARY FOR THE FUNCTION OF MEDICARE!!!
The Otter and The Cat
Welcome to my blog! I am an MD with a solo practice in the south. I have been employed by the government, academia, and HMO's in the past and have broken to one level of freedom by having my own practice. However, other challenges arise on a daily basis in this pursuit. This blog will attempt to chronicle them, and also provide a window into the harried, cumbersome, Kafka-esque level of regulation and government intrusion in my day to day life. I will also delve into matters personal, frivolous, and economic. I am a human being, too. "Doctor" is a faceless, anonymous, automaton-like term for who we are and what we do. We received a doctor in medicine degree after a painful, lengthy, expensive (more on that later) process. There needs to be a voice documenting what it's REALLY like "in the trenches".
I witnessed an act in nature along a river that I can't get out of my head. Standing on the riverbank one evening, I watched a river otter swimming, diving, and splashing about, in what looked like fun water-play. After a few minutes of losing sight of the otter, he emerged onto the rocky banks with a fat fish in its mouth. He perched on the side of the bank, proceeding to enjoy his catch, blissfully unaware of my presence. Then he moved a few feet to the right with his fish. Then he jumped into the water again with his fish and came up a few feet farther down the riverbank. I peered more closely and I spied a stray cat chasing and harassing the otter, jealous of the otter's hard-fought catch. The cat wouldn't leave him alone and it kept pacing to and fro, jumping and hissing. Finally the otter got sick of this and dove into the river with the fish in its mouth. He swam upstream for about 150 yards to the other side of the river, where he emerged looking weak and exhausted, and after crawling a few feet up the other bank, he was able at last to eat his fish in peace. The cat wasn't able to get at him, and it eventually crawled back into the rocky crevices.
I know how that otter felt. I know how it feels to swim upstream, dive, work, and then work some more, all the while having the "cat" chase you down for your "fish". I know what it feels like to spend thousands of dollars in compliance manuals, ICD-9 books, software, CME, applying for more and more unique ID numbers, etc. and have it all for naught.
I witnessed an act in nature along a river that I can't get out of my head. Standing on the riverbank one evening, I watched a river otter swimming, diving, and splashing about, in what looked like fun water-play. After a few minutes of losing sight of the otter, he emerged onto the rocky banks with a fat fish in its mouth. He perched on the side of the bank, proceeding to enjoy his catch, blissfully unaware of my presence. Then he moved a few feet to the right with his fish. Then he jumped into the water again with his fish and came up a few feet farther down the riverbank. I peered more closely and I spied a stray cat chasing and harassing the otter, jealous of the otter's hard-fought catch. The cat wouldn't leave him alone and it kept pacing to and fro, jumping and hissing. Finally the otter got sick of this and dove into the river with the fish in its mouth. He swam upstream for about 150 yards to the other side of the river, where he emerged looking weak and exhausted, and after crawling a few feet up the other bank, he was able at last to eat his fish in peace. The cat wasn't able to get at him, and it eventually crawled back into the rocky crevices.
I know how that otter felt. I know how it feels to swim upstream, dive, work, and then work some more, all the while having the "cat" chase you down for your "fish". I know what it feels like to spend thousands of dollars in compliance manuals, ICD-9 books, software, CME, applying for more and more unique ID numbers, etc. and have it all for naught.
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