Never underestimate the brilliance of our federal bureaucracy.
The Department of Health and Human Services has announced that it must delay implementation of new reimbursement codes for Medicare. Those new regulations would have increased the total number of reimbursement codes from the current 18,000 to more than 140,000 separate codes. The delay will undoubtedly come as a relief for physicians who will have additional time to try to understand the bureaucratic complexity of rules that, for example, apply 36 different codes for treating a snake bite, depending on the type of snake, its geographical region, and whether the incident was accidental, intentional self-harm, assault, or undetermined. The new codes also thoroughly differentiate between nine different types of hang-gliding injuries, four different types of alligator attacks, and the important difference between injuries sustained by walking into a wall and those resulting from walking into a lamppost.
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And Democrats wonder why Americans still resist having the government control our health care?
Less than a month before the Supreme Court hears arguments on the constitutionality of Obamacare, the American people have already reached their judgment. According to the latest USA Today poll, fully 75 percent of Americans believe the new health-care law’s individual mandate is unconstitutional. And if the Court doesn’t throw Obamacare out, Americans want Congress to do so: Half of voters want the law repealed, compared to 44 percent who want it retained. Moreover, those who want it repealed feel much more intensely about it. Fully 32 percent “strongly support” repeal, compared to just 18 percent who “strongly oppose” it. This is consistent with other polls — for example, the latest Rasmussen poll has 53 percent of likely voters supporting repeal, with just 38 percent opposed — and virtually unchanged since the law passed.
Despite constant predictions by the media and the laws supporters, Obamacare is not becoming more popular.
The public seems to understand that government intervention does not generally make things less expensive. And there are good reasons for the public’s skepticism. For example, the Congressional Budget Office reported in December that at least six programs that were supposed to save money under Obamacare not only don’t, but some actually are increasing costs. And Jonathan Gruber, one of the architects of both Obamacare and its precursor Romneycare, now says that premiums are likely to rise under the new health-care law. In fact, Gruber warns that, even after receiving government subsidies, some individuals will end up paying more than they would have without the reform. Gee, thanks, Mr. President.
And the public understands that imposing new taxes, mandates, and regulations will do nothing to create jobs in a struggling economy. In fact, a poll released last month by the Chamber of Commerce showed that for 74 percent of small businesses they’re “causing an impediment to job creation.”
At the same time, the controversy over the administration’s contraception mandate has brought home to voters just how coercive the health-care law really is.
Most of all, Americans understand that, from the beginning, the debate over health-care reform has been about control. The Obama administration believes that decisions about health care are simply too important and too complex for the average American and his doctor to make for themselves. Only the experts in Washington can get those decisions right. After all, only Washington can understand the difference between a burn from a hot toaster (Code No. X15.1) and a burn from an electronic-game keyboard (Code No. Y93.C1).
Unfortunately for the Obama administration, the American people just don’t believe them.
We are wise enough to appoint the proper temporary politicians who summarily empower themselves to deem the correct light bulb, toilet, shower head, car, bicycle, and doctor.
I'm sorry, but I think you might be wrong. The American people are quite capable, each and every one. Every person on this planet is capable. I don't think you really believe what you said, you're just frustrated -- happens to me all the time. :-)
I know I am frustrated, I'm just not sure I'm wrong..;-)
I see a topic every American adult and many American children can understand, spending more than you have and accumulating debt, yet there is no National outcry for our government to stop.
There has been a nibbling away at our Constitution for decades (I believe even more aggressively under Obama with Tsars, HealthCare, Federalizing the Auto Industry, recess appointments, selective enforcement of laws, lawsuits against the States, and so on......), yet Americans can ignore this latest assault on the First Amendment that has been directed towards the Catholic Church. Few Americans, let alone Catholics, press this issue. Of all the people who need be fighting this, the least affected may actually be the Church as we will continue to practice. It is the remaining First Amendment "rights" that fall with the Religion clause: Assembly, Speech, Press and Redress that impact all. When the protections go, the Amendment goes; when an amendment goes, another will follow and then the document is useless.
"And the public understands that imposing new taxes, mandates, and regulations will do nothing to create jobs in a struggling economy. "
Wrong!
Imposing new taxes, mandates, and regulations creates numerous jobs in a struggling economy for hordes of bureaucrats and otherwise superfluous, unemployable people to administer them.
To get reimbursed a doctor needs to code each patient encounter based on two factors, a diagnosis code and a workload code. Doctors will be audited on their coding practices, if the medical documentation doesn’t match the diagnosis code they are in trouble. If they over code 1 of 1000 patient encounters, they can go to jail and/or be heavily fined. Even if for every overcode they have undercoded 10 times as many patient visits! The government of course will not reimburse for any undercodes.
18,000 codes is more then physicians can handle and they require administrative support to do this for them, that costs major $. Especially in high volume low reimbursement primary care settings. Due to the draconian penalties for over coding, they are paying their admin help to ensure every encounter is rounded off to the lowest cost code. In other words the doctors are billing less than they should.
Now the government is going to expand this chaos to 140,000 codes??
Anyone with a brain will never enter medical school leaving the good citizens with brainless or brain dead providing our care.
Oh yes we are on the fast track to 3rd world status.
I spend a lot of time going to meetings (and paying my staff to go to meetings) to make sure we're coding properly. I don't want to get on the wrong side of the bureaucracy, for sure. The problem is, a lot of these codes are nebulous and you can code for something in good faith, only to have the bureaucrat reviewing you deny this. Enough of those episodes, and they put you on the Group W bench.
Remember the old NRA bumper sticker--'When guns are outlawed, only outlaws will have guns'? The medical corollary is 'As medicine becomes more bureaucratic, only bureaucrats will become doctors'. A chilling thought.
I have a few patients who ask me, 'Hey, whaddya think about this Obamacare comin' down the pike?' I put on a straight face and say, 'Well, I'm glad to see the Government is gonna have experts sort it all out.' Most of them shiver, but at least 10% of them don't catch the intended irony.
The sad part is that the best and the brightest are starting to avoid medicine. Say you're a brilliant college student with a knack for the biological sciences. You could go to med school, then have at least 4 years of residency afterwards, and start out in a career in your thirties with at least 6 figures of debt, and have government (or insurance company) bureaucrats second guessing much of your work. (Fields which have extra long training periods, like cardiovascular surgery, have for years been having problems filling their training slots, so you'll be seeing a shortage of those specialists pretty soon.) That brilliant student instead might go into a biotech field and have a normal life with a nice salary and stock options and none of the petty bureaucratic BS that practicing physicians have to deal with.
The single most damning statistic, though, is the number of physician's children going in to medicine. Thirty or forty years ago, lots of them did; now, it's by far the exception, and very few of them want to put up with what they see their physician parent having to endure.
This article is complete BS. The CPT reimbursement codes, which are the same for ALL insurance companies as well as medicare, are devised by the American Medical Association. That is a fact. The code system is onerous, but it is just as bad for any insurance company. Medicare just reimburses less for the same code.
This article is complete BS. The CPT reimbursement codes, which are the same for ALL insurance companies as well as medicare, are devised by the American Medical Association. That is a fact. The code system is onerous, but it is just as bad for any insurance company. Medicare just reimburses less for the same code.
The AMA has an exclusive contract to distribute the CPT codes and makes tens of millions of dollars selling them each year. In other words, the government controls the AMA through dollars. These codes are idiotic, and designed mostly to deny payment for services and find out how to control health care by monitoring who gets what and how much.
Thanks, Mr. Tanner, I agree regulations are sickening sometimes. I have a question that I need to pose and so I might as well pose it here. There was an article in the WSJ Opinion page, same day as this NRO article, by Holman Jenkins called "Conservatives and the Individual Mandate." Now, I have been avidly opposed to the individual mandate for quite some time, so I was curious to read Mr. Jenkins's article. I needed my brother's help, but we slugged through it. After reading, it seems to us (brother did most of the cognitive work -- since my SAT scores clearly indicate that I have nonesuch) that there may be a "free rider" problem associated with the zero amount cost level of a completely market-based health insurance scenario. Could this be one of those Milty Friedman exceptions to the rule? People, go to Uncommon Knowlege and watch Peter Robinson's interviews with Mr. Milton Friedman. If a zero cost level is available, there may be a reverse incentive for people to depend on hospitals/others to pay their emergency bills. Am I acting like one of those cloud people in "Gulliver's Travels"? What do you guys think?
The billing codes to which you refer are copyrighted by the AMA. Every time a physician uses one (via forms or software), the AMA earns royalties. During the PPACA debate, Democrats quietly threatened to abolish this monopoly, which is the primary source of revenue for the AMA, thus putting substantial pressure on the AMA to endorse Obamacare. The AMA sold out its members to retain this lucrative revenue stream and backed health care overhaul. Now the administration is back to seek more concessions from doctors and the codes are again being used as leverage to gain the support of the AMA. Look for the AMA to back the next round of regulations, which will hurt both us (doctors) and patients.
Don't private insurance companies have a similar reimbursement scheme? Yes, they do. And worse yet, I bet they are not standard from one insurance company to the next. Think of the thousands of insurance companies with their onerous coding systems, inefficient and non-uniform reimbursement rules, tens of thousands of employees being paid just to get through the bureaucratic mess of the private insurance industries billing practices.
What's worse, private or public? I be if your measured overhead rates, the government option is much easier and cheaper to administer.
