dozens of other medical societies have written to CMS “about the imminent storm that is about to occur due to simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden, as well as mass confusion, for physicians.”
It’s because of the vast number of complex commercial insurance and federal and state regulations that affect physicians and their patients that TMA developed the Calendar of Doom.
The cost to operate a physician’s office continues to climb unabated. Unfunded mandates threaten the viability of practices and patients’ access to care. The average cost to staff and run a practice now exceeds $500,000 per physician, and that’s before the physician gets paid a dime. These excessive administrative expenses add to the escalating cost of medical care that are borne by patients, employers, and taxpayers.
Excessive regulations also hurt local economies, which receive nearly $1 million in wages and benefits for each physician in practice.55
Oct. 1, 2013. The punishment for noncompliance is severe: no payment for any medical services provided.
The number of diagnostic codes that physicians would be required to use under ICD-10 would grow from 13,500 to 69,000. The number of codes for inpatient procedures also would soar from 4,000 to 71,000.57
For example, the new system has 480
codes for a fractured knee cap — up from a grand total of two in ICD-9. Switching to ICD-10 will
2011: A case study
The phrase “the secretary shall” sent strong regulatory shivers down the spines of American physicians last year — and most of it stemmed from laws other than the PPACA. Consider this murderers’ row of regulatory carrots and sticks displayed in TMA’s “Calendar of Doom,” an Internet-based tool to help physicians remember and plan for the compliance deadlines:
June 30, 2011: Write 10 electronic prescriptions or face a 1-percent Medicare penalty in 2012.
Physician
offices employ support staff and often work with nonphysician providers, increasing the total number of employees in the industry to well above the count of physicians alone. In 2009, Texas office-based physicians supported 249,010 jobs. On average, each office-based physician supported 5.8 jobs, including his or her own.56
Texas should not burden practices with additional regulatory costs that provide no benefit to patients or their health care.
Put ICD-10 on permanent hold
The ICD-10 requirement is an excellent example of a costly regulation that will disrupt practice operations. ICD-10 is a 20-year-old boondoggle of a system that will help only health care researchers. Before Secretary Sebelius delayed the new coding language for an additional year, the federal government announced that all physicians, hospitals, providers, and insurance companies must shift from ICD-9 to ICD-10 no later than
Sept. 6, 2011: New Medicare audits begin for anesthesiologists, covering claims back to October 2007.
Dec. 31, 2011: Reporting deadline to claim 1-percent electronic prescribing bonus.
Dec. 31, 2011: Reporting deadline to claim 1-percent Physician Quality Reporting System (PQRS) bonus.
Jan. 1, 2012: Convert all billing to new HIPAA 5010 format or receive no payment from Medicare, Medicaid, or commercial insurance for any health care services provided.
June 30, 2012: Write 10 electronic prescriptions or face a 1.5-percent Medicare penalty in 2013.
Oct. 1, 2012: Last chance to achieve 90 days of meaningful use for first-year participants in Medicare’s electronic health record incentive program.
Dec. 31, 2012: Reporting deadline to claim 1-percent electronic prescribing bonus.
Dec. 31, 2012: Reporting deadline to claim 0.5-percent PQRS bonus.
Oct. 1, 2013: Make massive shift to ICD-10 coding system or receive no payment from Medicare, Medicaid, or commercial insurance for any health care services
provided. (Later shifted to Oct. 1, 2014.) October 2012 TEXAS MEDICINE 59
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