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We Are All Accomplices In The Great American Coding Swindle

"Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008." "The AMA owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the association’s biggest single source of income" Aint that something? Okay, I would rank Elizabeth Rosenthal up there with Atul Gawande and Lisa Rosenbaum in the pantheon of standout healthcare writers active today.  They are all docs and have more skill in their writing pinky than I have in my entire body. They have a unique talent in stitching together narratives that speak to both docs and patients in their language--and do it within…

US Versus Foreign Trained Docs: Who Saves More Lives?

Yeah, I know the headline drew you in.  I sleuthed ya---but I have a reason. A study out in BMJ today, and its timing is uncanny given the immigration ban we are now experiencing. First, to declare my priors. I will take an IMG to work by my side any day of the week.  You need to be twice as smart, motivated, and industrious to make your way to American shores. The paper:   The researchers analyzed data on 1.2 million hospital admissions of Medicare patients aged 65 and over between 2011 and 2014 and for 44,227 internists. The average age of patients was 80, and the most common causes of death were sepsis, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. The difference in results was slight, but I post the tables if only to show, at least based on this sample set, at worst, IMGs are equal to, and best,…

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

ER Docs And Out Of Network Billing. Are We In The Same Boat?

This recent article in the NYT and the NEJM study precipitating it widened the (malevolent) coverage of the fees paid by patients and insurance companies to out of network physicians.  If you are not familiar with the issue, doctors working in hospitals--who may not participate in the plans the hospitals accept--separately bill the insurance companies for higher than average charges.  Since there is no upfront negotiated discount, typically found when docs belong to a plan, the insurance company may or may not pay the asking fee.  If they do not, the often sky-high balance becomes the patient's responsibility.  From the patient's point of view, the process makes no sense; if a hospital participates in their plan, so should the docs. Not so.  Hospitals do their thing.  Professional do theirs. The problem of balance billing and out of network providers does not reside in one or two states, and the practice touches…
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