Word: doctorates
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Medical billing, for both hospitals and doctors, is accomplished via a system of codes, which is already so complicated that there are special schools for it, granting degrees not just in coding but in special branches of coding. Coding boils down to assigning specific numbers to every problem (diagnosis codes) and other numbers to every treatment (treatment codes). Though the lists, in my field of orthopedics anyway, are woefully inadequate to capture how we actually think about or treat patients, they are still ponderous and complex. From common cold to brain tumor, open heart surgery to handing over...
...diagnoses and treatments - to the billing side that pays for it all, makes billing faster and easier. Why give away that Ace bandage for free? This at least is efficient. But communication the other way, from billing to medical, will take place too. And this is more ominous. The doctor should tell the biller what he found and did. But that EMR program can easily be a very clever, covert way for the biller to tell the doctor what to say he found and did. We don't simply write whatever we want in an electronic chart: we must select...
When, for instance, does a urinary tract (bladder) infection become a pyelonephritis (infection involving kidneys and ureters)? There's no clear-cut answer. But when the computer reminds the doctor, every time he clicks on the "urinary tract infection" button, that the hospital gets many thousands more for the more serious condition, it's just as easy to click on the "pyelonephritis" button and make your administrators happy...
...doctor with a sore knee and for some reason he is examining your ears. It might be that you have a very thorough doctor who is ruling out a rare ear-knee syndrome. More likely, the EMR program he bought is reminding him that notes on the chart about just few more body parts will kick your visit up into a higher-paying code...
...potential to greatly increase insurance company denials of the tests and treatments that doctors order. In the old days, the tests we ordered were done first - though bills for them might not get paid. Now when findings aren't bad enough to "justify" expensive tests or treatments, (according to sources chosen by - you guessed it - insurance companies) the computer tells everyone, immediately, "you're going to eat this." Might this eliminate unnecessary testing and save money? Sure. But who determines what is necessary? Who should a patient trust to make her medical decisions? Can the government or an insurance company...