Wednesday, August 5, 2009

It's all in the numbers

I just read something written by a young woman who has lupus and blogs about how her life is complicated by this frustrating disease. She titled the post Everyone Wants to be a 10, But No One Wants to be a 710. (710 is the code providers use to hook "lupus" with the payment they receive for treating patients with the condition.)

I'm not a healthcare economist. And I really don't know what stories told by individual patients mean. I suspect that taken as a whole, individual stories help explain why Americans are spending 19% of our gross domestic product on healthcare. It seems sad that a young grad student would have such intimate knowledge of diagnostic coding--a key component of healthcare's error-prone, tit-for-tat bookkeeping system--when she faces so many other complex, inexplicable things.

I wish she didn't have to worry, as my college-age, cochlear-implant using daughter soon will, "Who will insure me when I get kicked off of my parents' health insurance plan?"

I don't like the way healthcare in the US is designed to treat "parts," not "people." I don't like that so many are denied access to basic care. And I don't like the fact that patchy, poorly coordinated care costs so much. So maybe there's something to be gained from sharing one more story.

It's a short story with a built-in fix, one that I first shared on Twitter. (Conveniently, it fit into one tweet, Twitter's 140 character micro-blogging constraint.)

Why I'm 4 e-docs: $40 copay 4 last real-time dx of "ovarian cyst." Never took my pants off.

Here's the rest of the story:

I saw my family doctor because I had right-sided pain that seemed an awful lot like the same pain I had on a previous occasion, when I was found to have endometriosis-induced ovarian cysts. (My OB/GYN had relocated, and I thought seeking care from, well, my family doctor might be a good idea.)

The family doctor listened to my symptoms, reviewed my history, and, as I recall, said the following,

"I'm not the girl for this."
"You're too complicated for me."
"See a specialist."
"I'm not insured to take care of people like you."

These statements are all valid points, reflecting sad realities of care that neither of us made but both of us face.

But they're points that could have been communicated without a face-to-face visit, saving my time and the doctor's. (Not only did I not take my pants off, I never even sat on the exam table. And the only touching that occurred was a handshake.)

I would have been happy to find out that the doctor had nothing to offer me via an e-mail exchange or a video chat, and I'd be happy to pay the going rate for e-consultation. Whether I had an ovarian cyst or a bad case of gas in December, 2008 will never be known. (The pain resolved before I could schedule a visit with a specialist.) And I don't mind not knowing.

But I do mind that the encounter was captured this way:

The diagnosis of "ovarian cyst" is certainly questionable. And where did 491.20, the CPT code for "obstructive chronic bronchitis without exacerbation" come from? Who had that?

1 comment:

Leslie said...


Thank you for alerting me to this post. You are right - there are/should be more important things to worry about than diagnostic codes. But I think you are also correct in that patients become reduced to these numbers, so how do we separate ourselves when that is all we know? I completely agree that there are major parts of our healthcare system that are completely warped. Being able to label me a 710 and lump me into a category may be easier for the doctor, but what it does to the patient is reduces them to something less than human, not worth knowing as a person.o I think we are all fighting to have our voices heard, but much in the medical bureaucracy seeks to stifle self-expression, individuality, creativity, etc. Thank you for writing this post!


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