Wednesday, October 17, 2012


     Just what we need:  more paperwork.
     PQRS is a program that is supposed to make sure doctors are doing the right tests on patients.
     Doctors who don't fill out the paperwork and don't submit a bunch of new codes to Medicare, along with all the usual office visit and procedure codes, will have their pay rates cut in January.
     No one ever remembers what the acronym expands into, so I looked it up (again)--for this blogpost:  Physician Quality Reporting Initiative.  One hundred seventy nine parameters are being measured by the government.  Doctors can choose the ones that matter most to them, but then we have to prove we've followed the guidelines.
     Last year I entered all the paperwork for the bone density testing PQRS.  I was supposed to get a bonus, but it never showed up.  I found out later that for bone density reporting I was supposed to have entered codes for every month of the year, in those months.  Instead, I entered the right number of patients, with the correct codes to "report" how well I'm doing, but didn't report some in each month--therefore, I "failed."  I did bone density testing on every patient for whom the screening is recommended--except in the rare cases when patients declined--but I didn't take the government's test right
     This year I'm doing vascular disease reporting--like a lazy student, I figure out that it only requires three months of data.  Who knows why?  There might be explanations for the different reporting standards for bone density versus vascular disease versus the other one hundred seventy-seven "quality measures" the government has put into place, but they escape me.  The instructions for completing the forms and submitting information are more arcane than anything we do in regular old medicine.  I think regular old medicine has fallen by the wayside.  Writing about and reporting about regular old medicine seems to have taken the place of actually doing medicine.
     One of my doctor friends told me that he's dropped out of Medicare and Medicaid--and that Blue Cross dropped him.  He's charging cash for patient visits:  $200/hour (less than half of some of the lawyers I've had the past two years).  Today I envy him, because he doesn't have to learn all 68,000 new ICD-10 codes, or look at all the forms for entering PQRS data, or hold his breath for his Medicare "report card" to come out next year.
     "Does this patient have vascular disease?  Is this patient's blood pressure under 140/90?  Is this patient on aspirin?  Is this patient's LDL below 110?"  I fill in squares, send a bunch of new G-codes along with the claims for services I provided to the patient on the same day, and in this way let the government know how well I'm doing.  Then the government grades me based on the answers I provided, and my pay rate is attached to how well I'm doing.  It's a little like telling the IRS how much money you should be taxed, without having to show W-2 or 1099 forms to back up your figures.  Can't doctors just make up the answers?
     Do patients believe that if the government forces doctors to fill out reports on the quality of their medical services, we'll have better healthcare?

No comments:

Post a Comment