mandate extensive revision of physicians’ paper and electronic systems. Transition to the new system is expected to cost solo physicians as much as $83,000 each, and group practices of up to 10 doctors as much as $250,000.58
The ICD-10 mandate will create significant burdens on the practice of medicine with no direct benefit to individual patient care. It is a huge weight to place on physicians when they face numerous other administrative hurdles, including implementing and achieving meaningful use of electronic health records (EHRs), meeting quality measures under Medicare’s PQRS and other programs, the impending creation of accountable care organizations in Medicare, and more. The timing of the transition could not be worse, as many physicians already are spending significant time and resources implementing EHRs in their practices.
ICD-10 is old technology developed during the 1980s and not designed to work in the current electronic world. A new version of the diagnostic and procedure codes, ICD-11, could come as early as 2015. It is being designed for use with electronic health records and the Internet, and should be more user-friendly than ICD-10.
Replace harmful restrictions with realistic incentives
TMA believes that the patient-physician relationship must be preserved regardless of patients’ health conditions, ethnicity, economic circumstances, demographics, or treatment compliance patterns. Unfortunately, many pay-for-performance strategies intended to contain health costs could undermine this relationship. These strategies have proliferated in both commercial and government health programs. The PPACA also relies on payment based solely on outcomes and mandates pay adjustments for all physicians, which may selectively penalize physicians who treat disadvantaged patients.
Pay-for-performance systems that do not risk-adjust properly for patients’ health status and that rely solely on claims data for evaluation of care will likely hurt the patient-physician relationship. This is particularly true if patient risk factors, chronic conditions, compliance, health disparities, and culturally competent care are not factored into the physician’s performance profile. For example, physicians’ ratings or payments are hurt if they are measured on how many of their patients obtain mammograms at appropriate times and the patient chooses not to follow the doctor’s advice to get the mammogram. Other examples of physicians’ quality rating measurements being directly impacted by
Increasing Cost of Medical Practice Cumulative Change Since 2000
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2007 Inflation (CPI) Sources: MGMA Cost Report, Multispecialty (not hospital/IDS owned) practice cost per FTE physician, Bureau of Labor Statistics 60 TEXAS MEDICINE October 2012
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