Complexity Is a Waste of Time (and therefore money)


The new ICD-10 is out–and over a 1000 pages long. This is the book we doctors are forced to follow when billing for our services. It is a list of diagnoses and conditions we must adhere to when trying to justify our importance to patients and more critically to their insurers so that we can be paid. It weighs in at several pounds but its value is inversely proportional to its size: it does nothing to improve patient care, and less than nothing to keep down costs–in fact because it takes an inordinate amount of time to use this garbage doctors have less time to actually take care of patients and are incentivized to extract as much reimbursement from better coding from this time-consuming process as they can–which inevitably leads to higher medical costs. Duh.

Just one more example of how unecessarily complex our health care system is–could we please just take care of patients?

Let me give you an example. When I admit a patient to the hospital with pneumonia I am not allowed to simply write a diagnosis of pneumonia, the liklihood of how and where it was acquired denoting an assessment of the risk and severity of it, and also of the indicated treatment. To be paid the best level (which matters very much to my employer if not to me) I have to write what kind of pneumonia it is, for instance, due to gram positive or gram negative bacteria. I have to write this even though I don’t know, and will never know, what kind of bacteria it is. This is because we don’t sample lungs for bacteria – it’s dangerous- too dangerous to risk. So we guess. No matter what hoity-toity medical center you go to – we always guess at the cause of pneumonia. In fact the pneumonia may not be bacterial at all – it may be viral- and which is even less easy to identify than bacterial. But still we are forced to adhere to this guessing game of what specific kind it is to be paid. Stupid, just stupid because it doesn’t serve the patient, it doesn’t serve the doctor. It just serves the insurance company. Bravo American health care.

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