The medical insurance system just got much, much worse

July 22, 2015
Volume 12    |   Issue 87

It's time for me to go on a rant. I don't usually do it, but I can't take it anymore. So please forgive me. My heart is breaking. Our federal government is ruining the practice of medicine to the point that unless you have an acute medical problem, there's little to no chance of getting the treatment you need.

All that your doctor will have the time to do is to just give you drugs for your symptoms. The latest intrusion of the government into medical practice comes with the new ICD-10 insurance codes. What? You don't know what ICD-10 codes are? Well, you might as well. Because they might be more of a determining factor regarding how your doctor can help you than your lab tests.

Years ago, when the federal government started regulating medicine through Medicare, it felt the need to establish a coded list of all the possible diagnoses that your doctor could arrive at. Hence, the ICD (International Classification of Diseases) coding system. In order for either you or your doctor to receive reimbursement from Medicare or other insurance, the doctor must use the correct code for the diagnosis of your condition. In other words, if your problem is gout and the doctor does not enter in the correct code for gout, then you and your doctor might not be reimbursed. Now, so far, this probably sounds pretty reasonable. But let the Feds get a hold of something reasonable and within a given amount of time, they are likely to turn it into a monster. And that's what ICD-10 has done. ICD-10 is the tenth installment of what used to be a reasonable idea.

The new coding system has gotten so specific as to be completely ridiculous. No longer is it adequate for your doctor to make a diagnosis of high blood pressure. Now there are an unbelievable amount of categories of high blood pressure. Or how about that gout. In order for the doctor to properly code for gout, he has to select from over 750 categories of gout! Folks, this is just insane. Gout of the right foot. Gout of the left foot. Gout for two weeks. Gout for two years. Gout caused by eating too much meat. It goes on and on. They even have a code for when a patient gets bitten by an Orca whale! Modern medicine is finally following Alice into Wonderland. So how is all this craziness going to affect you?

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I already mentioned one way — you or your doctor won't get any reimbursement for the service. And if your condition is unique and is not listed in the ICD-10, there is no chance that there will be any reimbursement at all. Now that all by itself is a big problem for doctors and patients alike, but it can get much worse than that. If the doctor uses the incorrect code for your service, both you and the doctor can be accused of fraud. When that happens, both of you are subject to fines and even jail time. But as offensive as these issues are the worst is the effect on patient care.

The time is now here when doctors spend more time on paperwork and coding than they spend on taking care of patients. Why? Because if they don't, they won't get paid. I can't tell you how many times in the past two years, patients have commented to me that when they see their doctor, during almost the entire 15-minute visit, his face is glued to a computer screen. The time is coming when it will be more important for doctors to get the diagnosis code right than getting the actual diagnosis right. And in order to implement all this coding and paperwork doctors now need to have entire staffs dedicated to nothing more than pushing paper. This translates out to more overhead expense, higher costs to you, and less time with you.

The problem was recently well summed up in an article called “The Craziness of ICD-10” that appeared in the online medical news journal MedPage. The author, an internist of many years, said, “This [ICD-10] is yet another example of the system getting ungainly and impractical around us, as government regulators and insurance companies demand we do stuff that doesn't help us take care of patients, and in fact steals our valuable time and mental energy from what could be real efforts to transform and improve the healthcare system in this country.” I could not have said it any better.

So what can we/you do about this situation? Absolutely nothing. This is the way the system is rigged and nothing is going to stop that train. But here's the good news. Many doctors and patients are operating outside of this system. They know that it isn't possible to deal with chronic or serious diseases in the increasingly small amount of time that insurance-driven medicine gives them. And they refuse to bow down to the insurance system regulations. So they choose to do what they need to do and spend the time they need to spend regardless of insurance codes. In the old days, we had a simple name for this. It's called fee-for-service. The idea is simple. The patient pays a fee, the doctor provides a service. The number one priority is not insurance, it's getting well.

Does this mean that you should cancel your insurance right now. No. That's not the point. The system, as bad as it is for chronic disease, is great for emergencies and acute problems. And these can get incredibly expensive. So keep your insurance for these special times. But if you ever have to battle any kind of chronic condition from heart disease to cancer to arthritis, please don't get stuck in that I'll-only-see-doctors-who-accept-my-insurance mode. For reasons beyond their control, insurance doctors just don't have the time to do the job right. All they will have time for is a quick assessment of symptoms followed by a prescription for the symptoms. And thanks to the new ICD-10, it just got worse.

To your health, naturally,


The Craziness of ICD-10 by Fred N. Pelzman, MD. MedPage Today. July 2, 2015.

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