Emergency Care under Obamacare

Dr. Jitesh Chawla speaks from personal experience as a physician who as frequently worked in emergency rooms/  

   "Packed waiting rooms and we will have to see 50 patients or more in a shift," answered one emergency room physician.  This was in response to my question of how the Affordable Care Act will affect the volume of patients that a provider in the ER will see.  Many experts speculate that the expansion of Medicare under “Obamacare” will allow more people in the country to access the healthcare system.  These same experts believe that the people who receive this access will flood emergency departments around the nation in record numbers for conditions that are not emergent, causing physicians to be overworked.  In this article we will examine claims from the experts and also specific examples in the bill that pertain to our subject matter.  Hopefully we will shed some light on the subject as we move forward.

     So why the panic over the expansion of Medicaid? Many commentators cite numbers in a recent CDC report ¹ that show that recipients of Medicaid visit emergency rooms twice as much as the uninsured.  The program is being expanded for people between 19 and 65 years of age that meet the required criteria and this will allow millions of new people the opportunity be covered.  With this, many believe that these new recipients will run to the ER anytime there is a problem that could be treated by a primary care physician. The question comes down to human nature and people can speculate but no one can accurately predict the future.

      What are the commentators saying? Well there seems to be many differing opinions, most based on political leanings.  The fact remains that the Affordable Care Act has been upheld and it is a reality.  Whether you agree with the bill or not, it will affect you and your practice.  According to a paper done in 2010 by John Goodman, CEO of the National Center for Policy Analysis, the rise in emergency room volume is inevitable.  Goodman concludes that the expansion of Medicaid under “Obamacare” will insure an additional 32-34 million people. Using past projections of emergency room visits, Goodman calculates the increase of patients. "Consequently, we project that insuring between 32 million and 34 million additional people will generate between 848,000 and 901,000 additional emergency room visits every year," Goodman stated in his article.

     What does this mean for emergency room physicians? It means that in an average 12 hour shift, physicians may see 30-35 patients at a busy hospital and many consider this a busy night.  Some fear that with the projected rising number of patients, doctors will be spread too thin and the quality of care will decrease as physician fatigue increases.  As it is with many issues in the United States, a problem presents itself and businesses and society responds.  Many states have opened Osteopathic medical schools, with a desire to train new physicians to practice in rural or underserved areas.  The thought process is that if more physicians are trained with an emphasis on these areas, they will meet the demand that the increased numbers cause.  Many allopathic medical schools are now offering rural health programs.  The University of Alabama offers a rural physicians program in which a qualified student can train to practice in an area where healthcare is not usually abundant.  This can be in rural farming communities or lower income neighborhoods.  The hope is that by training the physicians to serve in these areas, more patients will seek help at these clinics than flock to the emergency room.

    It may be inevitable that emergency rooms will have an increased number of patients under the expansion of Medicaid.  All signs seem to be pointing in this direction.  However, maybe the attempts at filling the physician shortage in certain areas will funnel the patient load away from ER's around the country.  We will continue to examine how the Affordable Care Act will affect certain aspects of our healthcare system.

 Stay tuned from more health information from Jitesh Chawla, MD.
Reference:

1. http://www.cdc.gov/nchs/data/hus/hus10.pdf

What medical providers need to know about switch to ICD-10

Jitesh Chawla, MD. would be the first one to say this is a major "trial period" for fellow medical colleagues due to the ever increasing requirements from the governement.

Most providers of small practices don’t have the time or resource to fully understand how ICD-10 will impact them. In this article, I will explore this very important topic and provide suggestions for providers of how to prepare for ICD-10 compliance.

The intention behind ICD-10 is to provide a tool that would provide a more detailed, accurate code to match the actual diagnosis. As disease diagnosis has become more specific, ICD-9 codes appear to be obsolete and often don't describe the condition accurately.

The law states for all organizations covered under the 5010 electronic transactions version instead of the older 4010/4010A versions. If you are not familiar with this terminology, please check with your billing manger or practice management software vendor.

ICD-10 is divided into 2 areas: clinical modification (CM) and inpatient procedure coding system (PCS). Inpatient procedure codes are not affected. Outpatient codes are still represented under the current system. ICD-10 is more specific on anatomical location, specificity of diagnosis, etc. To put this into perspective, take for example, if a patient was had a furuncle (boil) on the face and went to the dermatologist. The same patient then returned a few weeks later and had a carbuncle. In ICD-9, the same code would be used which is 680.0. In ICD-10 (specificity of the condition) would be recorded. The furuncle would be L02.92 and carbuncle would be L02.93. Furthermore, ICD-10 would enable you to record which encounter (initial versus subsequent).

The basic structure of the ICD-10 code is:

Characters 1-3: the category, 4-6: cause of problem, body part affected, severity of illness, 7: Place for extension of the code

Some EMR systems have a connection with live database and so a switch to ICD-10 will not affect the users when picking a diagnosis for their note. However, with EMRs that don’t have this link to the live database, the issue is how to migrate the codes into the system. A strategy would be to use transition tables which provide the ICD-10 equivalent to the ICD-9 code since there is no way to convert the codes. ICD 10 Code Translator . Just plug in the ICD-9 code and it will convert it to the equivalent ICD-10 code. This provides enough relevant background for most people about ICD-10 and the issues surrounding it. Please be sure to examine the table below that compares ICD-9 and ICD-10 codes. For providers, health care staff