Gyroscopic Investing

http://www.slate.com/articles/news_and_ ... rices.html

Five years ago this week, Barack Obama signed the Affordable Care Act into law, and we’ve been debating it ever since. Like many Americans, I oppose Obamacare, and I think we ought to repeal it and replace it. Over the past few months, however, I’ve come to the conclusion that the fight over Obamacare is a distraction from a much deeper problem, which is that America’s hospitals are robbing us blind.

Justifications for ICD10:

"It's more modern"!!

We want to replace words with numerical codes

We want to give administrators more power over physicians

Everybody else is doing it

Easier to computerize on those crappy EHR systems we made you buy

Physicians, screw you, you're doing it our way

And did we mention that this is going to determine how much you're paid

We think this will help research even though we don't care a bean for researchers in general

Here's what you can look forward to with the switch to ICD10:

ICD10 will "convert Medicare from a passive payer to an active purchaser of health care"....say WHAT??

We think ICD10 will magically result in better care, lower costs, and will make "consumers" (i.e. patients) feel like they're in charge.  How, we don't know...that's your job.

We're hinting that this will help cut down on lawsuits even though there's neither a shred of evidence nor even a logical reason why this might be the case

We know that this will make your life harder and increase expenses.  In fact our own data show a 10-20% decrease in productivity and 10-25% increase in rework.  Suck it up.

We couldn't think of anything positive to say so we're promising that your reimbursements will go up.  This of course is an obvious fib since the pot of money that insurance companies have to distribute isn't going to increase just because we thought up ICD10.  They'll just find other ways to deny claims.

WiseOne wrote: A quick tutorial on the relationship of hospitals to doctors:

Reimbursements for procedures are divided into two parts:  the technical fee (2/3) and the professional fee (about 1/3).  For inpatient procedures for Medicare patients, the technical fee is subsumed into the DRG (diagnosis related group) fees, which means that the hospital gets a flat fee from Medicare that covers everything regardless of what actually happens in house.  For most private insurers, hospitals charge a la cart.  These are the astronomical fees referred to in the Slate article - so the article messes up by suggesting that Medicare pays these fees.

Doctors get the professional fee - or at least, whatever portion of the professional fee that the insurer decides to pay, minus whatever gets paid to billing (usually outsourced) in order to collect the fee.  The fee ends up being maybe a tenth of the original amount, which is not a problem since the original amount was inflated 10x since that's all part of the game.  Doctors also get "E&M" reimbursements ("evaluation and management") which is typically peanuts, like $30 for a followup visit.

Doctors are typically not paid by the hospital, so not a penny of the hospital's fees goes to doctors except in certain unusual situations.  Example:  our hospital pays a portion of one person's salary to compensate our division for staffing the hospital's Medicaid clinic, for which we are not paid directly.  Naturally, they picked the person with the lowest salary to define the compensation.

Hospitals do, however, pay companies to create these silly online courses that I have to wade through on a monthly (or so) basis.  Here's some notes I jotted down while taking the ICD10 online course a while ago - I was indeed being sarcastic since I sent this to a friend who had yet to experience the pleasure of taking the course:

Justifications for ICD10:

"It's more modern"!!

We want to replace words with numerical codes

We want to give administrators more power over physicians

Everybody else is doing it

Easier to computerize on those crappy EHR systems we made you buy

Physicians, screw you, you're doing it our way

And did we mention that this is going to determine how much you're paid

We think this will help research even though we don't care a bean for researchers in general

Here's what you can look forward to with the switch to ICD10:

ICD10 will "convert Medicare from a passive payer to an active purchaser of health care"....say WHAT??

We think ICD10 will magically result in better care, lower costs, and will make "consumers" (i.e. patients) feel like they're in charge.  How, we don't know...that's your job.

We're hinting that this will help cut down on lawsuits even though there's neither a shred of evidence nor even a logical reason why this might be the case

We know that this will make your life harder and increase expenses.  In fact our own data show a 10-20% decrease in productivity and 10-25% increase in rework.  Suck it up.

We couldn't think of anything positive to say so we're promising that your reimbursements will go up.  This of course is an obvious fib since the pot of money that insurance companies have to distribute isn't going to increase just because we thought up ICD10.  They'll just find other ways to deny claims.

WiseOne wrote: We think ICD10 will magically result in better care, lower costs, and will make "consumers" (i.e. patients) feel like they're in charge.  How, we don't know...that's your