Once upon a time, not so very long ago, it was thought that if only we could get all doctors to digitize their files, the American health-care system could be made infinitely more efficient.
Health technologists dreamed of millions of clunky, gray filing cabinets being carted out of medical offices (to be recycled, of course) and replaced with sleek new desktop terminals.
Electronic health records (EHR) promised so much! Easier appointment-making and follow-up, better coordinated care and more reliable recordkeeping, more time for doctors to spend with patients, more office space for potted palms and aquariums. And most important of all: a reduction in the serious, sometimes fatal, medical errors caused by illegible hand-written prescriptions.
The main thing holding it up was the non-digital doc. We don’t pretend it was a principled resistance; doctors who entered the profession during the epoch when people still wrote things down simply found it hard to change. And since they were accustomed to giving orders, not taking them, it was hard to get them to part with those filing cabinets.
However, the federal government’s campaign to coax and cajole doctors into the 21st century was largely successful. The U.S. Department of Health and Human Services reports that as of 2013, 78 percent of office-based physicians and 59 percent of hospitals have adopted some form of EHR, a doubling and quadrupling, respectively, of the figures from 2009.
The National Benevolency, presumably, is happy with such progress. But many doctors are not. Their grumbling can be heard in the office, read in the newspapers and seen online. Whatever medical complaint you bring to your physician these days, you will likely hear his or her complaint too, about the pain and discomfort of this digital panacea.
As Marc Siegel, an associate professor of medicine at NYU-Langone Medical Center, wrote this week: “The road to successful treatments and cures is cluttered with expanding red tape: courses to take, certifications to achieve, endless electronic recordkeeping that takes the place of patient contact, and now, a chokehold list of insurance billing codes that has been expanded from less than 15,000 disease/health issue entries to 68,000.”
A sampling of the absurdity: 100 different categories for diabetes (you thought there were only two types); and such common maladies as getting “sucked into a jet engine,” “problems in relationship with in-laws,” and V91.07XA: “Burn due to water skis on fire.”
Yes, there are separate billing protocols for each of those.
Nor is it just a headache for doctors. Patients will also feel the pain, Siegel says. The new system will result in longer wait times and require more ancillary staff, and in turn higher costs. Doctors will try to make up that cost by seeing more patients in even less time.
We can add to the complaint list ourselves: an unforeseen consequence of on-screen files is the privacy violation which sometimes occurs when computer screens are left open for the next patient to read.
As the one-year grace period for doctors to adjust to the new system comes to an end, incorrect filing of reimbursement requests to insurers could lead to denial of those requests, sticking the doctor or patient with more paperwork, or an unanticipated financial burden. The befuddling complexity of the reimbursement codes virtually guarantees such problems.
There’s no need for a powerful search engine to identify the culprits: 1) too many bureaucrats and not enough medical professionals drafted the billing codes; and 2) the expanded and aging patient pool, generated by Obamacare, which necessitates a bigger, more complex cataloging of diseases and disorders.
Fortunately, it is fixable. It will not require another exhausting national debate over how to overhaul health care (though that too may come).
It is not too late to revise the billing codes, to trim away a lot of the redundancy and absurdity that is raising the blood pressure of our doctors these days. The medical profession itself should be enlisted for their help in the task.
Of course, there may be a price to pay. It may mean in the end that if one gets sucked into a jet engine, or if his water skis catch fire, chas v’shalom, he may have to fill out a special billing form.