June 5, 2012

Antonym

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Last month I opined that the only real winners in the ICD-10 implementation project would include neither providers nor patients. That is, the government will get to flex its muscles, the payers will have more options for denials, researchers will have much better data, and so on, but providers really won’t gain much and patients will gain little, if anything.

Well, I must confess that during the last month … nothing has changed.

Oh yes, we probably have a yearlong delay of ICD-10, but that’s tantamount to delaying a case of the flu until next week. It’s still coming, it’s still problematic, it still will be expensive and it still won’t be good for providers and patients. Piling irony upon irony, the delay probably is a political concession to the American Medical Association (AMA), which went on record opposing the migration from ICD-9. And let’s be candid: physicians have lots of money to contribute to local, state and federal election campaigns.

Now we have the U.S. Supreme Court distraction, as the nation’s highest court is considering the “personal mandate” of the PPACA (Patient Protection and Affordable Care Act). The court may rule that the personal mandate is unconstitutional because it fines individuals who lack health insurance. But the mandate is the cornerstone of the entire PPACA (“Obamacare,” in common parlance) and if tossed, there will be much wailing and gnashing of teeth throughout the halls of the White House as “those In charge” decide how to offset the loss of anticipated revenue. Unfortunately, a lot of the PPACA changes already are in effect or about to go into effect – including many changes to Medicare, such as the Readmission Reduction program that launches on Oct. 1 – and it’s entirely possible that some of these things can’t be reversed.

The Democratic leadership is positioning itself to perform damage control if the Supreme Court doesn’t see eye to eye with the administration, and the Republican leadership (including the GOP candidate for president) is satisfied simply to criticize the administration and the Democratic leadership. Truly, nothing is changing for the better.

Note the following:

If costly changes have been made to Medicare, and those changes cannot be funded and cannot be reversed, then one day the PPACA’s greatest claim to fame may be that it shortened the time before the Medicare system goes belly up, defunct, out of money, busted. But if you listen to the pundits on both sides of the aisle, Medicare is doomed anyway, so the conversation should focus on how to replace it or how to make it someone else’s problem (rather than how to “save” it). In other words, perhaps it’s time to cut bait and run.

The PPACA is the administration’s cornerstone accomplishment of the last three years, and certainly the administration will point to the presently booming stock market, the apparent reduction in unemployment, the end of the Iraqi and Afghani conflicts and a few other random indicators of better times in its attempt to maintain status quo next January, but as you evaluate all those “improvements” always ask yourself one question:

Am I (yes, make it personal!) better off than I was two, six or 10 years ago?

I say “two, six or 10” because the current administration doesn’t deserve all the blame for the recession; the current administration merely accelerated an already speeding train. You see, neither the Democrats nor the Republicans can truly be blamed for our present situation: it’s faceless. But everyone in Washington, D.C. (and Austin, and Tallahassee, and Albany, and so on) is responsible for putting personal and political agendas ahead of what is best for those of us not on the public payroll.

It seems all we hear from the politicos are lip service and symbolic gestures:

Pitch: Let’s set a minimum tax for the “wealthy” (whoever that really is) so they pay their “fair share.”

Response: The Alternative Minimum Tax was supposed to do exactly that, and now it impacts the “middle class” far more than the “wealthy.” This idea failed before; there’s no reason to believe it will work now.

 


 

Pitch: Let’s reduce the size of the military to levels comparable to where they were during the 1930s.

Response: We have spent the last 70 years demonstrating that – while morally and ethically tenuous – the best way to avoid world war is to carry the biggest stick.

Pitch: Let’s push for alternative energy sources and applications like solar power and electric cars.

Response: Solyndra … oh, and the recent (2011) study published by the Low Carbon Vehicle Partnership, which noted that an electric car has a larger carbon footprint than a gas-burning car until it has traveled 80,000 miles because of the high pollution levels of the factories that make the batteries.

And finally…

Pitch: Let’s implement ICD-10 in healthcare so we’ll be on par with the rest of the world, and everyone directly or indirectly involved in health care will receive better care and be happier than they now are.

Response: [Insert your own…]

I suppose the point of these thoughts is simple:

We are immersed in politics for its own sake – and ICD-10 certainly is part of that – which is being served with a large side of finger pointing and blaming, all of which appears to have little to do with “what’s best."

Politics is the antonym of anything good.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.