How to save $500,000,000 in Medicare [Dr. Jay]

Dr. Jay writes:

I believe I've come up with a way to save a crap-load (a medical term meaning "a lot") of money in the health care system.

I have been pondering one of the great mysteries of medical practice. I spent four years of college, four years of medical school and three years of post-praduate training in order to understand medical terminology and diseases. But once in practice, armed with all of that knowledge and training, I must learn a new and even more esoteric code that serves as a substitute for all of medical accomplishments. This code does not directly correspond to accepted medical practice. It is not even internally consistent. But learn it I must or perish from the inability to be paid.

I speak of course about the CPT and the ICD codes.

In medicine every medical condition is reduced to a numerical code. That is because 40 years ago computer systems were primitive and limited in memory. They could typically use numbers as shorthand -- and not long numbers at that. So two great classes of codes were established of procedures and diseases (CPT and ICD respectively). These were things you could do and the conditions you were doing it for. English could not be used because the computers were insufficiently advanced. So every medical interaction that required a payment from an insurance company required numerical identifiers, plus all of the other correct data elements (insurance policy number, employer, address, etc.)

And since physicians are fairly smart, they learned the codes and got paid, so the modifiers were invented. You could not just use codes to represent what had happened, you had to modify them in a variety of circumstances. And then the codes were changed, and then again, now annually.

So a huge industry of coders developed, working for doctors, insurance companies, government agencies, billing companies, educators and all manner of other parties. Costs escalated constantly for books, classes, correspondence, employees, records, follow-ups and delays; all of which serve to simply gum up the system.

For example: can anyone explain why it is reasonable to have a different code for the same examination in an office, the hospital, the nursing home and the emergency room? Wouldn't it be easier to simply use the examination and say it was in the office, the hospital, and so on? Easier, faster, no complicated interpretation, much less likely to make a mistake and delay payment. We would reduce the costs of all medical care by a conservative 15% to perhaps as much as 30%. And it would serve to make the system more efficient and faster.

Yes, it's a radical idea: we use English instead of numerical codes.

Why must there be an additional code if two procedures are done on the same day? Why not just list the two procedures? And why use a different additional code for an examination and a procedure on the same day?

Put a single medical dictionary into practice and then simply use that very precise medical terminology. It is what [gasp] doctors are taught in the first lace and upon which the whole medical system is based. There is a big difference between pancreatitis, esophagitis and tonsillitis; there is no need for three completely different codes. Imagine how many people would be free to more productive work than pushing paper.

Of course, there is one practical problem with this suggestion. If we used English instead of the CPT and ICD coding system, the delays in payments to patients would be reduced. Indeed, that is the reason for the whole thing in the first place; to reduce the outflow of money to patients and doctors. But the costs incurred by the rapid payment of claims would be more than offset by the reduced costs of less man hours, postage, coding books, training and communications requirements. How much money is being saved by Medicare and the insurance companies by delaying justified payments to patients and Doctors? Could it really be 15% to 35% of the costs? And if it is, isn't that a flagrant example of almost criminal inefficiency?

I do believe I have outlined a fairly simple way to save the entire health care system a lot of money. In fact, it saves money for all concerned: government, regulators, insurance companies, providers and patients.

When do we start?

Because this idea is so simple and so elegant, it is certain that we will have to wait until after we have excised Democrats from control of the Senate and the White House.

Remember, Jay: the modern Left that now controls the Democrat Party wants the system to collapse. It's called the Cloward-Piven Strategy and it has been documented copiously throughout the Inter-tubes.

So, to answer your question, we can start in 2012 provided we can eradicate these locusts at the ballot box.