Viewpoint

Too many qualifiers, part II

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

For those of you who are paying attention, you’ll remember that in last month’s editorial I couldn’t decide what to write about because there was so much going on — so I wrote about everything that was bothering me.

I’m going to do a similar thing this month, because so much continues to bother me. Sign of old age? Probably. Sign of common sense? Most definitely. And here’s why: I want you to be aware of this stuff too — it’s crucial for your future.

Thank you, Kevin and Sue

Kevin Corcoran’s fine article this month (Click Here) points out the surprising percentage of practices that get evaluation and management (E&M) coding wrong. Would you believe 42%? And he isn’t just looking at the Office of the Inspector General (OIG) stats, but 25 years of Corcoran Consulting Group audits. Surprisingly the overall error rate for ophthalmology was much lower as compared to other providers’, and nearly half the error rate of optometry. One of the biggest red flags? Around 35% of diagnostic test claims don’t pass muster.

And then there is Suzanne Corcoran’s blood-boiler: MACRA and MIPS are upon us, on Click Here. (If you’re wondering, yes, she is the better half of one Kevin Corcoran.) It’s been temporarily modified so you can avoid penalties without a tremendous amount of effort in 2017. But it still takes some effort.

Ignorance isn’t bliss

And while I mentioned MACRA last month, I’m pointing it out here again for one crucial reason. As of this summer, one survey found that only half of docs had even heard of MACRA, and now that the rules are in place and finalized, it also found that a mere 17% of the 600 doctors surveyed said the measures “accurately capture quality of care for my specialty.”¹ Wow. Maybe these are all the guys and gals who sold their souls to hospitals so they needn’t worry about these things anymore. But if you are reading this now, I’m pretty sure you are in my camp. Keep in mind, you can totally ignore this and be blissfully unaware of any consequences—till major penalties show up in your reimbursements, starting in 2019.

But it doesn’t stop there. Stay tuned for a future report about a band of physicians who are trying to “disenroll” from Medicare, fed up to the heavens with all the aforementioned issues. They have good counsel saying what they are doing is perfectly legal, but there are others with equally good lawyers saying what they are doing could land them in serious doodoo. We’ll report both sides.

A last thought: those of you who are paying attention might want to ask those who aren’t, why not. Ignorance has never served a noble cause. OM

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