Technology versus Politics

Technology is marvelous. It tends to make things better, cheaper, more available. It tends to make people happy.

Politics, on the contrary, is the opposite of all the above.  The most exciting, promising technology turns divisive, corrupt, costly and deadly once politicians get their mitts on it.

We should never have let them monkey with our healthcare.  I’ve said so many times in the past (see links below), and I’ll keep saying so until we snap out of our stupor …or it comes crashing down around us (at which point I will say I Told You So).

So, let me offer just one, seemingly minor, even merely clerical reason, why your healthcare sucks.

It’s called ICD-10.

First of all, in my business of healthcare information/image technology, compliance with ICD-10 has been an enormous (i.e. expen$ive) undertaking. There are seven squillion, nine hundred and ninety three fillion codes (give or take) to correlate to software hooks and data. It has made the inherently complex business of making products for patient care even more complex.

The mass of codes and interrelations is certainly a hassle for the engineers making stuff to sell to doctors – presumably to make healthcare providers’ jobs easier (at increa$ed co$t, of cour$e).

But what does ICD-10 mean to doctors, patients and the tangle of insurance companies and taxpayers who ultimately pay for all this complexity?

Well, as of October 1, the wrong code can lead to not only a denied claim and/or months/years of costly hassle, but perhaps significant punishment (on basis of “Medicare Fraud” among other things too legally frightening to mention) for the doctor/institution as well.

Good, you say?

You want fewer mistakes in medicine.

Yes of course.  We all do.

Doctors must do better, certainly.  Prescription drugs, correctly taken, kill more people by far than do “illegal” drugs.  And hospital stays in general (with iatrogenic infections, drugs, mistakes, etc.) kill more Americans than everything but cancer and heart disease.

But what does “do better” mean?  And how do we help make that happen?

And how much arm-twisting, lawsuit-hurling, defrocking, fining and imprisoning force does it take to be helpful??

Let’s see how ICD-10 “helps.”

Let’s say a Farmer Andy comes to the Family Practice clinic with an infected wound that he’s not so sure he can explain. Stuff happens to farmers all the time, and he just can’t remember what this wound was from, initially. He’s always getting bangs and scrapes and cuts, after all.

(And let us be truthful. Andy is a terrible farmer. He’s mostly into quixotic politics)

So, what was the injury initiating this visit?

It’s legally critical we get this right!

Was it ICD-10 code W55.21, “Bitten by a cow,” or W61.33, “Pecked by a chicken?”

Was it when he became a V00.01 “Pedestrian on foot injured in a collision with roller skater?”
Come to think of it, he had been visiting his nephew in prison when that happened, which could add a Y92.147,“Courtyard of prison as the place of occurrence of the external cause.”

Does that qualify as a Z63.1, “Problems in relationship with in-laws?”

Anyway, the doctor knows it wasn’t Y92.253, “Hurt at the Opera,” since Farmer Andy hasn’t gone there since the last episode…(we mustn’t discuss it here.  That would be a violation of HIPAA rules which could lead to a revoked license and even prison).

Farmer Andy did mention (under his breath, seemingly ashamed) that it could have been an “Accident while knitting or crocheting,” which would be a Y93.D1.

The doctor hated to ask, but since he knew Andy and his family had been to Sea World, could Andy have been “Struck by Orca, initial encounter,” which would be a W56.22?

No, said Andy.  It certainly wouldn’t have been a Killer Whale, nor was it a strike.

There was perhaps that bite from a Sea Lion, Andy recalled.  Though it wasn’t the first time, or even the second time that had happened.

So that would be a W56.11XS “Sequela…Bitten by Sea Lion.”

Hmmm, the doctor thought. That would have a very specific look to it.  No; it must be something else.

The wound wouldn’t look like this if it were a V91.07 “Burn due to water-skis on fire,” certainly.  He’d seen plenty of those before.

And the doctor could tell just by looking at him that Farmer Andy hadn’t been “Sucked into jet engine,” or X52.

Or was he getting the codes wrong?

Damn!

Wait…X52 is actually “Prolonged stay in weightless environment.”

Was it V95.40? No…that one is the rather vague, “Unspecified spacecraft accident injuring occupant.”

How about Y37.54?  (Doctor types in code and waits…it’s a big database)

When the doctor worked in the hospital, there was an entire department of people whose only job is to “do coding.”  Here in the clinic, they’ve got a part-time/outside IT department, and sometimes their network bogs down, and…
Oh, here it comes…

Oh heck no!  Y37.54 is “Military operation involving nuclear radiation effects of nuclear weapon.”  SMH, he thought.  He should’ve remembered this one from last week’s incident.

Ah, there it is…V97.33 is the sucked-into-jet-engine code.

Dang it, he has to remember that.  The CMS (Centers for Medicare & Medicaid Services) “ICD-10 Ombudsman” was fairly lenient last time.

He can’t afford to make that mistake again!

OK, I have a question for you.  Does the preceding strike you as the best way to improve healthcare delivery?

No?

Now, codifying data is a great idea.  In the right hands and in the right way, when we’re ready (this is a key part), then having convenient, appropriate labels for all our data makes it easier to store, find, and use in a meaningful way.  And I’m even all in favor of people using ICD-10 exactly as it is…if they choose to.

Let me restate that.

If people trained in the care of patients, in their situation (hospital, clinic, private practice) find that using ICD-10 codes helps them treat patients, then great.  Excellent, even!

But that’s not how our $y$tem work$, is it?  It’s not up to the healthcare professional how things are billed and paid anymore.  It hasn’t been for many years now.  In the most practical $en$e, politicians are more involved in healthcare decisions than doctors are.  Doctors can bill for only what they can get paid for by people other than patients; and that is determined by politicians.  In this case, technology becomes more of a parasite than an aid.

As a true-free-market technology guy, that breaks my heart.

Just imagine you’re trying to sell something; a product you make, your old car, cookies at a bake sale…but bickering politicians, lawyers and lobbyists determined what you could charge for it.  Imagine they demand you buy some things, and don’t let you buy others…and that every political intervention not only directly affects your job…it substantially changes your job.

How would that work out in the real world?

And the way “meaningful use” and other “federal” requirements are being FORCED on healthcare providers is, at this state in our knowledge and technology, madness on top of even more madness (do I even need to mention Obamacare?).

To make matters worse, healthcare has been a union shop/monopoly for over a hundred years.  There can be no serious competition with what politicians and lobbyists call healthcare.

If the rest of our technology worked like this, we’d all be clacking away on Windows 3.1, at best.

There were smart people involved in the development of ICD codes.  Lots of them.  But their seemingly dedicated work was performed in disconnection from monetary, human and practical technology concerns.  It’s another good example, in fact, of such obsessive bureaucratic “paperwork” (albeit mostly without paper), that the recording and processing of all this data can and often does compromise patient care in ways analogous to the Observer Effect.

OK, so I have another question for you.

Should we let doctors, who go to school for many years and spend a lot of time in residency and continuous training, actually do the jobs they were trained to do, or should we continue to vote for ever-more intrusion into that profession by politicians, who don’t need any education or even interest in healthcare at all?

Well, please think on it.

It’s your money, your rights, your life and health at stake here, you know.

https://wedeclare.wordpress.com/2013/10/15/can-politicians-even-define-health-care/

https://wedeclare.wordpress.com/2009/07/28/health-insurance…or-healthcare…choose-one/

https://wedeclare.wordpress.com/2009/09/23/a-short-history-of-health-care-let-doctors-be-doctors/

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A Short History of Health Care: Let Doctors Be Doctors

I just ran across this on another website.  It’s a column I wrote for Indiana Policy Review a couple of years ago that seems more appropriate than ever now.

A Short History of Health Care: Let Doctors Be Doctors
By Andrew Horning

Healthcare is an odd business in that it has always been both expensive and unpleasant. Until the 1920s, the average doctor couldn’t even help with the average ailment. While medicine then included a range of arts like phrenology, acupuncture, homeopathy and allopathy it really was a coin-toss whether you’d be saved or killed by a doctor’s work.

Then the 20’s brought insulin, sulfa, other “miracle” drugs and sterile fields that meant, for the first time, that healthcare actually worked more often than not. From there, doctors, scientists and medical engineers really took off; rapid advancements increased life expectancies and decreased suffering. And because of increasing effectiveness and supply, healthcare was even becoming cheaper in real cost-benefit terms.

However, politicians had nothing at all to do with this, and that was apparently a problem. Teddy Roosevelt proposed a German-style, cradle-to-grave “socialized” healthcare system, but it was assailed as “the Prussian Menace” in those anti-German years before WWI, and Teddy’s scheme died. Even so, politicians wanting to seem compassionate started promoting socialized healthcare. The July 1919 issue of the Insurance Monitor made this prescient assertion: “The opportunities for fraud upset all statistical calculations. . . . Health and sickness are vague terms open to endless construction. Death is clearly defined, but to say what shall constitute such loss of health as will justify insurance compensation is no easy task.”

No matter. Between The Revenue Act of 1939’s health-related tax breaks, and 1943, when the War Labor Board excluded employer-paid health insurance from its wage freeze, American politicians charged into health care on their favorite horse, income tax.

In a nutshell, here’s what happened: Tax breaks for employer-paid health insurance meant that health insurance became a part of employment, and insurance became an integral part of healthcare. This inserted middlemen, which of course made everything more expensive. But who cared? The tax-subsidized, payroll-deducted cost was invisible enough that Americans started using insurance to pay for routine visits, dental checkups, eyeglasses and even plastic surgery. Group insurance offered large corporations better plans than small companies could muster, giving large corporations even greater advantages in hiring and competition than corporate laws already gave them. This also meant that the poor, or worse, the self employed, were even further distanced from the rich and incorporated in a very serious way. Obviously this created problems, but politicians never admit error, do they?

Four days before Tax Day, 1953, President Dwight Eisenhower established the U.S. Department of Health, Education and Welfare, giving government even more direct control over some of humanity’s most precious commodities. More political money and power meant more reasons for businesses to make campaign contributions and lobby. Of course, politicians at every level of government have used healthcare policy to reward their friends and punish their enemies. That’s their stock in trade.

Now tax money and policy is sifted and sorted through political appointees, immortal bureaucracies and defense-contract-style arrangements to feed a dwindling number of profit-starved insurance companies who then deny your claim. Doctors hire legions of workers to manage the regulatory, litigative, and insurance paperwork hassles; or leave private practice to become an employee within a clerically staffed healthcare corporation. So healthcare is still both expensive and unpleasant. But now it’s only because politicians, not doctors, are practicing medicine. Our healthcare injustices and vital statistics have decayed into an embarrassment at just the time when technology should make healthcare cheap, effective and available to all.

It is hard to imagine what politicians could have done to make our healthcare situation any worse. Yet, according to a July 2006 Harris Poll, Americans rate the issue of healthcare well-behind Iraq, the economy, immigration and even gas prices. Even more strangely, most people now think we must, to some degree and by some unspecified method, “socialize” healthcare just as Europe, Canada and other nations are now scrambling back toward free market reforms. What are we thinking?

Let politicians have their way with Iraq, the Colts and toll roads. Let them run lotteries and practice voodoo. But please, let doctors do healthcare at last; they’ve earned the right.

RELATED POSTS:
https://wedeclare.wordpress.com/2013/10/15/can-politicians-even-define-health-care/
https://wedeclare.wordpress.com/2009/07/28/health-insurance%E2%80%A6or-healthcare%E2%80%A6choose-one/