Home / Pressroom / Mac's Columns

Mac's Columns

COLUMN: No wonder your doctor is frustrated

By: Rep. Mac Thornberry

Washington, May 1, 2014
One of my family members was recently in the hospital (and is doing great).  Spending some time around those doctors, nurses, technicians, and volunteers reminded me what a special calling medicine and health care is.  The doctors, nurses, and other health care professionals were amazing, not only in their professional skill, but also in their caring.  We all tend to take that for granted until we or someone we love needs them.

But if you talk to someone involved in health care, you soon find out that the government is making it as difficult as possible to help heal people.  Since the first of the year, I have met with a variety of health care providers, touring hospitals, meeting with groups of doctors, and sitting down with administrators.  To say they are frustrated would be an understatement.  And for good reason.

The most obvious cause is the mess created by Obamacare.  Health insurance is in turmoil.  Many individuals have had their coverage canceled or have seen huge increases in premiums.  Many others have seen insurance policies with which they were perfectly happy changed because of new mandates in the law.  It is very difficult for any health care provider to find out who has coverage and exactly what their coverage is.

In addition, to pay for the new entitlements in Obamacare, Medicare was cut by several hundred billion dollars.  Medicare was already in financial trouble, so this added pressure on Medicare means that new cuts and restrictions are issued regularly.  It is very hard on doctors and their staff to keep up with these constant changes and to figure out how they can afford to continue to treat Medicare patients.  Unfortunately, this pressure to reduce Medicare spending will grow.

Another cause of frustration is that this constant pressure to cut costs in Medicare means endless audits and investigations that doctors and other providers must endure.  Some of them last years.  More than one doctor has blurted out in anger and desperation that they are treated like criminals by the federal government.  And every staff hour spent dealing with federal audits and regulations adds to the cost of health care we all receive.

As bad as it is now, worse is coming.  Many people agree that electronic medical records has promise to reduce costs and improve outcomes in patients.  But, like most things the federal government tries to mandate, this requirement can add costs and hassles to doctors and patients alike.

One example of the new frustrations faced by our doctors that most of us do not know about is the new International Classification of Diseases (ICD-10) billing codes.  Every few years the World Health Organization revises the categories of diseases to help keep track of trends.  In the U.S., the government and health insurance companies use those categories to get paid as well.

Now there are about 13,000 codes health care providers use to identify medical conditions and receive payment.  Under the new ICD-10, that will jump to about 68,000.  All health care providers and health insurers will have to use the new codes.  Congress recently voted to delay by one year the mandatory shift to ICD-10.

Of course, it costs a lot of money to convert to the new computer systems and to train people on the new system.  Estimates range from $56,639 to $226,105 for a small practice to convert to over $8 million for a large practice.  And that does not take into account the increased time and effort it will take to find the right code.  The index itself is more than 400 pages long.

But, I am afraid that the real cost will be in added frustration that drives good people out of medicine.  A recent Washington Post story about the new codes noted that

There are different numbers for getting struck or bitten by a turkey (W61.42 or W61.43).  There are codes for injuries caused by squirrels (W53.21) and getting hit by a motor vehicle while riding an animal (V80.919), spending too much time in a deep-freeze refrigerator (W93.2) and a large toe that has gone unexpectedly missing (Z89.419).


While it all sounds extremely silly, the danger is that an overworked employee would submit the code for getting struck by a turkey rather than the code for being bitten by a turkey, opening the potential for another fraud investigation.  The more complex the system, the easier it is for all of us to make a mistake, and the easier it is for the government to prosecute.  No wonder doctors feel like criminals and are frustrated at all the government does to make it hard for them to help people.