Health care by the numbers doesn’t add up

Last week we considered the growing distance between health-care providers and their patients, driven by increasing demands by payers for providers to account for every minute of their time and to increase their “outputs.” Those outputs revolve around you, shivering in your hospital gown in a chilly exam room, awaiting your 10 minutes of time with your doc.

We have created a health care system that excels in research, diagnostics and treatment but increasingly lacks empathy and compassion. That is not the fault of providers, who continue to do their level best to aid and comfort their patients. But it is against increasing odds that they are able to do so.

There is a sense that the “care” in health care has been lost along the way, so what is behind the changes in health care that leave patients upset and unsatisfied? Mostly, it’s money. The stethoscope, once the doctor’s best friend, has been augmented with sophisticated diagnostic equipment at unsustainable cost. Amortizing those costs over the universe of patients means office visits must cost more and take less time.

Gone are the preliminaries (good to see you, how’s your aunt, nice bow tie); the provider must cut straight to the chase. Why are you here and what can we do about it? The “care” model has shifted from a deep and therapeutic relationship between provider and patient to a business model. How many patients can be seen in a day?

CodingIntel.com is a support platform for the universal system that translates health care into billable increments and shapes a provider’s practice. These CPT (Current Procedural Terminology) codes are excruciatingly detailed, covering everything from time spent with the patient, diagnostics, imaging, physical therapy, occupational therapy and more.

Providers live and die (financially) by the code. In the earlier days of coding, a public health nursing agency was sure to earn reimbursement for providing foot care for a diabetic. Whatever else was done during the visit (feed the cat, remove a trip hazard, get rid of spoiled food in the refrigerator) the nurse had only to submit diabetes and foot care and voila! Payment provided.

The code has grown in length and complexity and is so arcane that it has spawned new college courses and job opportunities for coders, who spend their days combing medical records, “transform[ing] health care diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes. ”

A website meant to attract students to medical coding as a profession explains the coder’s day reviewing documentation, combing through code books, researching physician notes, networking with peers in online forums and reviewing coding-related periodicals. It paints a happy picture of workers starting their day “settling into the office and grabbing a cup of coffee…” No mention of the other end of the day, when coders might well settle into the neighborhood pub and grab a different sort of libation, holding their weary heads in their hands.

How on earth do workers learn how to do this? Here is a sample of language from CodingIntel.com regarding “prolonged” services: “The AMA developed CPT code 99417 for 15 minutes of prolonged care, done on the same day as office / outpatient codes 99417, 99205 and 99215. Medicare has assigned a status indicator of invalid to code 99417, and developed an HCPCS code to replace it, G2212. If using either code, only report it with codes 99205 and 99215, use only clinician time, and use it only when time is used to select the code. ”

If codes are the bane of a provider’s existence, coders are the MVPs of the health-care team. Their success at worming out every last codable bit from a patient visit means a practice that survives financially. It is also a rich source of data for national health trends but is it possible that, in the effort to cram patient care into coding parlance, that data could be skewed?

Here’s more: “The reported time must be 15 minutes, not 7.5 minutes.” Certain “face-to-face prolonged care codes” may not be reported with codes 99202-99215. They may be reported for prolonged care services with psychotherapy codes 90837, 90847, with office consultation codes 99241-99245, with domiciliary care codes 99324-99337, with home visit codes 99341-99350, and with cognitive assessment code 99483. ”

The CPT code list for January 2022 contains over 1,000 entries, including “Tenofovir liq chrom ur quan,” “Unxpl cnst hrtbl do gn xprsn,” and “Mr elastography.” It appears that coders must learn a whole new language along with everything else.

Patients are advised to pay attention to their health-care bills because there could be coding errors. Like we would know, right? There is no code for resuscitation of overwhelmed coders. The code for patients lamenting the good old days of health care is WTH. (What The Heck?)

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

Jill Goldthwait

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