I was recently involved in an email exchange involving one of our elected representatives about the governmental stresses being borne by physicians nowadays. I carbon-copied Diane Bristol, administrator for Midland Ob-Gyn Associates, PC. Diane is also the legislative liaison for the Michigan Medical Group Management Association and is a consultant to the Legislative Committee of the Michigan State Medical Society. She provided a significant perspective and I asked her if I could adapt her comments for my column. They are included below.
Ever wonder why doctors are looking a little more haggard and a whole lot more frustrated lately? There are many reasons. After 11-13 years of college and medical school, physicians are finding that the government is making it very difficult to continue to practice medicine unless they join large health systems. Gone is the time when a physician could just practice medicine in his or her own office. Now, a physician has to worry as much about the “business” of medicine as the treatment of patients.
Throughout history, physicians have wanted to provide the safest and best possible care for their patients. Today they end up spending more time becoming aware of costly government and insurance regulations than reading about new treatments and medications. They must constantly record every detail of the patient encounter to justify their codes and fees or face hefty fines, sanctions, or mandatory refunds to the insurer or government.
You can expect to get a new Health Information Portability and Accountability Act (HIPAA) privacy policy from your doctor next time you visit…the last one you received is now outdated. The government has devised a whole new set of HIPAA security rules that is forcing physicians to rewrite their policies. Instead of one page, the privacy policy is now a five page consent form. This is due to the new Electronic Health Record (EHR)/Electronic Medical Record (EMR) system that the government is “encouraging” physicians to buy. If you think your medical records are secure and “private” between you and your doctor, think again! Look how many government agencies are scrutinizing everything in everyone’s lives.
The government has also imposed certain requirements for the use of these EHR/EMR systems called “Meaningful Use.” There are now financial “incentives” if the physician can prove (by electronic reporting) that he/she is using the system in a series of “meaningful ways.” There are financial penalties if they don’t. More things to account for.
In addition to Meaningful Use, there is the Physician Quality Reporting Initiative (PQRI). This is another government requirement to report the information already reported in Meaningful Use. The insurance companies thought this was such a great idea they’ve now begun requiring that information through PQRI, too. And insurance companies are mandated by law to review certain Medicare records so physicians must now be sure those records are available for review and reflect all charting requirements.
Then, of course, there’s the Sustainable Growth Rate (SGR) to add to the alphabet soup. This is how Medicare determines what physicians should be paid. For the last several years, physicians have had to lobby Congress every December to get them to ward off massive cuts in Medicare reimbursements due to the SGR. Keep in mind that Medicare rates rarely are adequate enough to cover the cost of the medical care in the first place. Legislators on both sides of the aisle agree this is a terrible system for determining reimbursement and that it has many faults, but no one will fix it.
Do you remember hearing about “sequestration” on the news? That also affected your physician as Medicare rates were lowered by another 2 percent in the across-the-board cut.
The Occupational Safety and Health Administration (OSHA) felt left out and so they got into the act and required that employees be retrained on it’s safety regulations prior to Dec. 1, 2013 (in addition to the annual safety training) because the government has aligned itself with the United Nations Globally Harmonized System of Chemicals (GHS). Yes, even this affects your physician, as there are new Safety Data Sheets (SDS) for various chemicals used in the office. All must be on file and available for inspection in every office.
Now, too, doctors must become familiar with Accountable Care Organizations (ACOs), what they mean, and what physicians have to do about them so they don’t get left out of the whole reimbursement scheme…but that’s another story on its own, as is the Family Centered Medical Home (FCMH) or Patient-Centered Medical Home (PCMH) method of delivering care through a team.
The biggest folly physicians will face next year will be the new diagnosis coding system, ICD-10 (International Classification of Diseases, tenth edition). For the past several years, your diseases have been classified using a system of some 16,000 codes in ICD-9. Effective October 1, 2014, the coding system for physicians who expect reimbursement from any insurer will swell to more than 69,000 codes in ICD-10. Changing to this new code set is estimated to cost a 3-physician office $83,290, a 10-physician office $285,195, and a 100-physician office $2,728,780. Testimonies before Congress stated that the United States was the only country in the world not using ICD-10. That isn’t the case. No other country is using ICD-10 in physician offices, only in their hospitals, and they are only using a fraction of the codes being required by our government (e.g., Canada uses 17,000 codes and Australia 22,000 — but only in their hospitals). By the way, these other countries implemented their ICD-10 processes over several years, province by province and state by state, and at the expense of their governments, not their physicians or hospitals. To make matters worse, Workers’ Compensation plans are scheduled to remain on ICD-9, necessitating your physician’s computer to run both processes simultaneously.
And for more fun, under the new “Sunshine Act,” when a pharmaceutical representative brings a $10 lunch to a physician to discuss a drug, the rep has to notify the government of that lunch and its cost. The Sunshine Act is supposed to “shine the light” on what the drug reps are giving to physicians to entice them to listen to their information about new drugs on the market. They can no longer freely provide physicians with pens, pencils or note pads, as the government thinks this will cause physicians to prescribe one certain drug over another. All “gifts” are now recorded and are available online as a public record. Of course, doctors don’t need these pens, pencils and pads, but the fact that they are regulated adds a burden neither the doctor nor the rep should need to deal with.
Consider too that physicians still have to be vigilant for the ever-looming potential malpractice suit. Today however, many physicians fear the government more than a lawsuit!
Hopefully, this will give you a little insight as to why your doctor may be looking a little frazzled or considering retirement. And, this is all before the full impact of the Affordable Care Act (ACA, “Obamacare”) kicks in.
Ms. Bristol lays it out quite clearly. This column is already long and we could still add more pages of “alphabet soup”. The practice of medicine is now as much or more about the business of medicine as it is about caring for patients. The fear of fines, doing something wrong, or being sued can have a significant negative effect on the fun and concern of being a physician. Makes me wonder, were we all that bad before?
Dr. John L. Pfenninger’s column appears on Sundays. His office, Medical Procedures Center, is located in Midland. source
