The First Opportunity for Physicians to Take Back Control of Healthcare in 30 Years
Ever since 1969 when Richard M. Nixon signed the HMO Act, physicians’ and providers’ authority for care decisions and control over reimbursement has been steadily eroding, almost to the point of non-existence. The power of the insurance industry, which has taken over that mantle, notwithstanding, what has really allowed this to happen is the provider’s almost total lack of data with which to justify reimbursement levels or evaluate and prove effectiveness of care within specific disease categories or for specific conditions. ICD-10 and the use of EHR’s will give providers the ability to take back control of healthcare. The question is: Will they take it?
There has never been a lack of data on procedures or care administered. The lack of data has been largely on the side of the diagnosis coding. The overwhelming use of unspecified and vague diagnoses from superbills and EHR pick lists, that are designed to allow for quick generation of codes for billing and the doctors aversion to the time it takes to document, has left a database that shows low acuity level patients that do not justify the levels of care being administered. In addition, vague diagnostic information makes it virtually impossible to discern in any large scope what treatment protocols work effectively with what specific conditions.
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