ICD-10 Is Coming

The ICD-9 five digit diagnosis coding system is scheduled to be replaced October 1, 2014 by the seven digit ICD-10 version.  This conversion involves massive expense for the physician’s office.  John Goodman, in his insightful book Priceless: Curing the Healthcare Crisis, estimates that a small office will incur a minimum of $83,000 in expenses to properly comply with ICD-10 demands.  With the purchase of new software and hiring of coders, the expenses will definitely increase.  The impact will be felt directly by the physicians trying to practice medicine.  And this comes at a time when running a PCP office may be little more than a break-even effort.

The ICD-10 system demands information to an extreme level of detail.  According to Goodman, “There will be ninety-six different codes for bites— including three different codes for getting bitten by a squirrel (i.e. initial encounter, subsequent encounter and sequel).”  The busy physician must start by learning what questions to include in his history-taking before that information can be available for coding!  This system is totally counterproductive for improving quality of care and reducing cost. 

Medical Economics reports that nearly 40 national physician groups are calling on CMS to block implementation, but there is little hope for meaningful relief. An influential physician responds, “There is considerable concern among private MDs about implementation of the ICD-10, and all consider it stupid.  Most will not be able to comply simply due to economics and time issues, and they will ignore the Feds’ efforts. ICD-10 is doomed to fail no matter what the Fed wants, and ultimately the Feds will have to scrap it.”  That is one point of view, but, the Feds actually have the power to enforce anything they decide to enforce.  They can simply refuse to pay for any services not “properly documented”, or worse yet, they can play the “insurance fraud” card. At this point, we really just do not know this is going to work out.

This change is of great concern to PDA. We will track how the proposed program unfolds, and you will get the facts.

It Was A Very Good Year

The New Year is here!  And with this calendar milestone there is a fresh excitement.  Looking back on 2012, it was terrific!  We now have a Narrow Network, PDA membership has doubled, etc.  Let us review some additional important victories we accomplished together. The main event of 2012 has been a never-failing contribution of time, effort, and insight that is freely given by Daniel S. Karin M.D.  In addition to spending time in the operating room, he has pulled his roller wheel computer case from Dallas to Houston to College Station, Frisco, East Dallas, Oak Cliff, etc.  He is a Benefits Consultant licensed in all areas of health benefits, and he is also in Property & Casualty.  He is Medical Director, Blog Master, sales guy and friend of all independent practitioners.  He provides an example for independent physicians who want to be a contributing part of PDA.

Tim Paquette, VP of Finance and Administration for the Miers Group which manages PDA, identified and secured a premier workers compensation agreement for PDA.  This is a special, exclusive deal that puts our practitioners into a very attractive reimbursement realm for municipalities, school districts and governmental workers.  This will be a difference-maker for 2013.  He also achieved an improved Aetna contract, added Coventry and tightened up numerous mature PDA contracts.

Medicare Advantage was both serviced and sold in 2012.  Agency Sales Executive Harry Miers III & his Medicare product marketing group earned sales certification, secured bi-lingual support and tied the product to a number of PDA’s PCPs.  It was a successful effort and will be even better next year.

James Martin, PDA Operations Manager, worked with Michelle Dawn, a prize intern, to broaden and deepen the credentialing skills of the office and to add another problem solver to the team.  Michelle has been hired after completion of her internship and is now heading the credentialing and physician office service slot.  Her contribution enables James to concentrate on multi-market physician enlistment.  That is what we independents need…additional active, involved members.   

Related big news in 2012 was the addition of many physicians and allied health professionals by James Mathis, Market Manager. He has diligently worked to build out the “Lakeview” market for PDA and the Flagship Network.  James can do it all.  Enlist, fix a software issue, and explain winning programs to everyone who needs help understanding.

Lana S. Ralston, ANP joined the team in 2012. She has a large presence in primary care and brings insight for 2013 regarding the enlistment of nurse practitioners, physician assistants, and other allied health practitioners.  Lana’s experience organizing a national NP/PA entity underscores her future PDA role in long term care and chronic disease.

David F. Varnell, Director of “The Company Store”, is a new resource.  This West Point trained former army officer is our representative for a carefully vetted portfolio of services and equipment that contribute to quality care for PDA patients.  David has years of DFW physician relationships to compliment his sound technical knowledge.

A number of PDA practitioners have earned positions of importance during 2012.  Tom N. Jones, D.O. has been elected Chief of Staff for Doctors Hospital at White Rock Lake.  He is an important PDA board member.  Dwight A. Lee, M.D., Chairman of PDA, has set a star high above.  He has been appointed a “Regent Physician” by Tenet Healthcare Corporation.  A past Chief of Staff and founder of numerous hospital-physician strategies, his recognition is highly justified.  Hard workers like Dwight attract other winners to the PDA board like Mark Heaver D.O., Rufus Greene, M.D. and Ron Bristow, M.D.   They bond with the PDA membership to build out the vibrant IPA that is our organization.  Dr. Lee has re-built and reinforced the PDA Board of Directors.  Along with leadership from Buddy Miers, the core PDA leaders are pursuing a shared vision. We are building a future that makes the independent physicians more money, without hassle and extra work.