An Impending Government Imposed Medical Disaster Needs to Be Averted

Hal Scherz
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Posted: Jun 10, 2015 12:01 AM
An Impending Government Imposed Medical Disaster Needs to Be Averted

Editor's note: This column was co-authored by Dr. Michael Koriwchak, who's a practicing Otolaryngologist in Atlanta and the VP of the Docs 4 Patient Care Foundation.

In less than four months, patients across the country need to brace themselves for possible serious interruptions in their care caused by further government regulation of their doctors. On October 1, the government is requiring that physicians begin to use a completely different system to communicate with insurance companies, not because it will improve patient care, but because special interests, which stand to profit from this conversion such as insurance companies and information technology companies, have lobbied lawmakers in Washington to make this change.

The International Classification of Diseases, 9th revision (ICD-9) is a system of codes that doctors have used for decades to send data to insurance companies and Medicare/Medicaid. It is the central nervous system – the operating system – through which providers are paid. Although most countries use ICD for data collection, the U.S. is the only country that uses ICD to determine payments to doctors.

The ICD-10 – the new system- has been labelled as a revision, but this is categorically untrue. The ICD-10 coding format has been completely changed and the number of codes has increased from 13,000 to 68,000. There is no continuity between the 2 systems.

Doctors will be forced to spend huge amounts of money and time to comply with new regulations. Even if providers manage to adopt ICD-10 as required on October 1, it is unlikely that third party payers will immediately be able to process ICD-10 codes correctly and pay physician’s claims in a timely manner. Medical practices do not hold weeks’ worth of operating capital. If payments are delayed, there is a disruption of business and many medical practices will collapse. We have seen this before when Medicare payments were held by the government. This time, the stakes are much higher because it affects all third party payers. Patients, as a result of decreased access to care, will suffer the most.

Many doctors will be unable to absorb the additional costs associated with yet more government regulation. These costs involve converting their computer systems to accept an entirely new coding scheme, and spending thousands of dollars sending their employees to courses to learn how to implement the new system. This comes after being forced by the federal government mandate to adopt the costly electronic medical record, which has shown little to no value in patient care. Doctors who are unable to keep their practices open will either leave medicine or sell their practices to hospitals which have been all too eager to purchase them because they get paid higher rates for services rendered to patients than the doctors in private practice receive. The eventual collapse of the medical private practice system is ultimately bad for patients, who are always the big losers when more regulation is imposed on their doctors

This impending train wreck does not have to happen.

Rep. Kevin Brady, in a June 1 letter cosigned by a dozen other congressmen, urged that CMS take contingency steps “to avoid provider cash flow problems” caused by ICD-10 “that could lead to patient care disruptions.” Rep. Ted Poe has introduced the Cutting Costly Codes Act of 2015 (H.R. 2126) which prohibits the HHS Secretary from replacing ICD-9 with ICD-10. Even the American Medical Association has found the correct side of the issue, stating that ICD-10 “will impact most business processes within a physician’s practice…the timing of the ICD-10 transition could not be worse.”

In February, Congress held hearings on ICD-10 but this was just for show. Four of the seven witnesses represented companies that stood to benefit financially from ICD-10. Of the remaining witnesses, only one was an actively practicing private practice physician - Dr. Jeff Terry- representing the American Urological Association. He was the only witness who understood the true nature of the problem and the only one to offer an accurate perspective. None of the so-called benefits of ICD-10 have ever been proven. The decision to change systems is clearly political and driven by financial special interests.

Imagine if Microsoft coerced the government to require on a single day that everyone replace their existing version of Windows with the new one? The Internet would need to be reconfigured so that the old system could not be used. Software products compatible with the old system would no longer be permitted to be sold. The only winners would be IT vendors and consultants. After an all-at-once change over, business activity would grind to a halt. This is tantamount to what is about to occur with the implementation of ICD-10.

However, Microsoft learned a long time ago that radical change harms end users and is bad for business. In healthcare, the free market principles that companies like Microsoft rely on have been destroyed, replaced instead with politics and back room deals between legislators, insurance companies and health information technology vendors. The first round was lost with the electronic medical records mandates. We have less than 4 months to stop ICD-10.