Our Medical Cousins Complain Too
Written by Editor   
Thursday, April 24, 2014 05:47 AM

"My day is spent navigating around black holes of time suck," one medical doctor complains.  When asked "What frustrates you?"  "The list is endless; there are so many realms in which I'm frustrated," he replied.  Here are a few of the widespread complaints that our medical cousins are sharing:  unwarranted changes in insurance coverage; continuous maintenance of certification; and ICD-10.

Changes in coverage. For example, I had been prescribing a medication to a patient for years.  After 20 years the patient's insurance inexplicably denied coverage but is willing to cover the medication with the addition of an ingredient that the patient is allergic to.  "So my nurse and I spent 20 to 30 minutes of back-and-forth on the phone with the insurance company, followed by the requisite filling out of the evil and hated 'prior authorization' form in what is often a futile effort to get the insurance company to cover the medication they formerly covered.

If that fails to work, I will be forced to try to find the patient a new medication, and run the risk of subjecting that patient to unexpected adverse reactions."

Our medical cousins also complain when a treatment is no longer covered "for some unknown random reason, I have to hunt around for another drug in the same class (or sometimes, even worse, jump to another class) that will work as well, have the same lack of ill effects, and be covered. With each drug change, dosing titration will be required, starting with a low dose and gradually working up to the optimal dose. This can require several office visits just to fix something that wasn't broken in the first place and may well end up costing the insurance company more in extra office visits than if they had just continued to cover the drug the patient has been doing well on for years."

Continuous Maintenance of Certification (C-MOC). "Certification is supposed to be a voluntary process and, up until the 1990s, was valid for one's entire career, like the bar for lawyers. By the mid '90s, Maintenance of Certification (MOC) on a barely tolerable 10-year cycle was introduced. Now my board ... smelling the opportunity for more money from test fees, is expecting us to do MOC activities on a nearly continual basis.  They keep changing the rules, continually increasing MOC requirements, and, of course, the overall associated costs to doctors, with no robust data showing that MOC improves medical care or that an MOC doc is better than a non-MOC doc."

The certification boards "continue to push their agenda to expand MOC by evolving it from its once truly voluntary status to a de facto mandatory physician obligation by encouraging its linkage to three things: maintenance of medical licensure, Medicare and Medicaid reimbursements (and what Medicare does, private insurers tend to do a few years later), and hospital privileges."

"Without a license, you cannot practice ... . If your reimbursement is tied to MOC, and you are not MOC compliant, than you can work, but not get paid, and if your practice involves hospital work ... and you are denied hospital privileges due to your MOC status, then your practice will be significantly negatively impacted as a result."

While the certification board will deny all of this and "point out that it has no direct control over any of those three areas, the board, through its ceaseless public and private media campaigns, sets the national tone, or attempts to, on the issue of MOC, influencing the public, politicians, administrators, and policymakers, none of whom are likely to question the validity of" the certification board's agenda.

ICD-10. Says one M.D.  "They want a level of coding specificity that's mind-blowing.  When a patient has head pressure, green phlegm, and a fever, it's very likely to be sinusitis, right? For coding (and billing) purposes, I currently put 'sinusitis unspecified,' treat the patient, and move on."

"Well, not in ICD-10, where everything has to be specified to a fair-thee-well. Rather, I need to indicate (if I want to get paid) precisely which sinuses are involved, including whether it is left, right, or bilateral.  The problem is, in some cases I can't know this for sure unless and until I get imaging studies, and I may not have those results until hours later, or even the next day, long after my staff and I need to submit the billing for the visit and move on to the next patient."

"All of this will take more and more time to do correctly. Where is that time coming from, when the average time a doctor now spends with a patient is under 10 minutes?"

"The governmental bean-counters must think we have the luxury of 2-hour time slots per patient!" our medical cousin laments.  "I know that much of the rest of the world is already using ICD-10, but I can't for the life of me see how it will do anything helpful for patient care.  It will undoubtedly add to physician stress and suck more time out of my day; down a black hole I go!"

It seems that many of the complaints regarding insurance demands are similar, if the details of the complaints are different.

Source:  http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/45351