March of the Medical Interlopers Threatening Patient Care

Interlopers are government personnel who impose regulations that take me away from my work in order to check boxes, collect meaningless data, or fill out forms that address “nothing” about “something.”  Interlopers are vendors, insurers or bureaucrats who have something to gain in dollars and power at the expense of the health of America’s patients.

I am a physician and my job was to manage the health and medical care of my patients. That was the basis of my very extensive training and the focus of my life until the invasion of the interlopers. The schizoid attempt by the interlopers to confound me and other physician professionals is driving the health industry into an expensive civil war.

According to the Physicians Foundation there are already 2,167 quality metrics demanding a physicians’ time and attention. The individual private practice is overwhelmed by the increasingly irrelevant paper work while larger groups find it easier to purchase staff to assist.

Further, productivity has decreased by an estimated 30 percent with the implementation of the electronic medical record. The utility of the EMR should be the opportunity to provide patient data at the point of service. That has not been accomplished because the 2 major EMR vendors (Epic and Cerner) don’t integrate with each other or doctors’ offices. Every EMR is a silo of data: data collected so that doctors or hospitals might collect a bonus from the payer (government or insurer). This data is administrative, not clinical, data nor is it an accurate representation of a physician’s work. It is, however, readily available to hackers.

Ms. Faulkner, the multibillionaire CEO of Epic also sits on the government panel that recommends IT standards. Typical of an interloper, Epic has found a way to create a need for itself while supervising his or her own work.

ICD is an administrative coding system attempting to translate a patient’s clinical condition into a code. ICD 10 is the 10th iteration of this code set and increases the codes available to 87,000 from the 14,000 codes in the ICD 9 code set. While this is the coding set used by the World Health Association as a means of documenting diagnosis, in the U.S., these codes are used as a means of validating payment. In either case, the data is useless as a means of legitimately documenting a patient visit or ongoing care. Our patients’ medical history doesn’t fit into a box created by a bureaucrat.

Physicians throughout the country have attempted to explain to our legislators what this latest interloper will do to our ability to manage our patients’ health and well-being. In an attempt to explain to Congress why this billion-dollar opportunity for third party vendors will only suck more energy out of the exam room and force many in private practice out of business we have met a wall of pushback.

The American Medical Association estimates that small practices could spend between $56,639 and $226,205 to implement the coding system: money that is just not available to most small businesses particularly when the return on investment is negative.

When a patient seeks help in an Emergency Room, the American Hospital Association (AHA) reports that for every hour of patient care there is a full hour of questionably productive paperwork. And yet, the AHA has endorsed the evolution of yet more regulation in its support of the implementation of the ICD-10 code set. Why would hospitals oppose the doctors who work with them?

As private practitioners face bankruptcy, the hospitals are there to buy us out. It would seem to be the easy answer but there is an inherent conflict of interest when a doctor works for the hospital. As reported by Scott Gottlieb in Forbes, this can predictably decrease physician productivity as salaried employees and increase health care costs.

To quote Gottlieb, “The doctors will get squeezed but the real misfortunate will befall patients. We will increasingly be getting our medical care out of busy, hospital-run clinics. Our doctors will be salaried employees, more beholden to the rules that hospitals erect to manage their activities than the medical practices that they once owned.”

The interlopers can come from anywhere even from within the health care industry. They are endorsed by Congress and financed by big business. Physicians will need to engage our patients as our partners in order to fight this war. It is time for patients to demand as much from us, their trusted physician, or suffer the inevitable long lines in emergency rooms, even longer wait times and increasing costs only to fill the back pockets of the interlopers.