Dr. Rosen:      The latest word is that the International Classification of Diseases, 9^th revision, which was supposed to be retired in Oct 2014, had a one year reprieve to Oct 1, 2015. Has anyone heard anything differently?

Dr. Ruth:        I understand that insurance companies were unable to make the changes by Oct 2014 and thus the delay. We’re getting ready to convert in October.

Dr. Edwards:  We’re still discussing whether we want to proceed. We’ve gotten so many offers for training with ICD 10. We haven’t bought any of them yet. We thought we’d hang low.

Dr. Michelle:   We’ve not gone to any of the training courses. They seem rather expensive.

Dr. Milton:      There are always those who will make money on any program shoved down our throats.

Dr. Patricia:   Our Practice Fusion Electronic Medical Records is all geared up to substitute the new codes in October. Their training videos are free to users. They also state that they would help us walk through any problems we might have.

Dr. Edwards:  We also have Practice Fusion which is now the largest and most popular EMR for Medical Offices. It’s on par with EPIC for hospitals which Kaiser Permanente spent billions on installing. It works very well to interconnect their 20 medical office buildings and three hospitals in Sacramento.  What is the down side of using ICD 10?

Dr. Rosen:      Remember we had a physician in Sacramento go to jail for 22 months for using the wrong ICD 9 code 20 years ago. But ICD 9 has 16,000 codes. The new ICD 10 has about 68,000 codes. Then there are the Current Procedural Terminology or CPT codes which are also extremely important.  In fact one has to have the correct diagnosis that justifies the procedure. The data reflects that 59% of doctors disagree with the Centers of Medicare and Medicaid Services (CMS) as to what are the correct codes. Hence, in any dispute, CMS could put up to 59% of physicians in jail with our present code structure.

Dr. Edwards:  I think you have just convinced me that I must eliminate Medicare and Medicaid by October 1, 2015. There are already a dozen different codes for the various cardiac diseases. I see what you mean. With four times as many codes, it may be difficult to make the correct diagnosis in heart disease without a cardiac cath.

Dr. Milton:      You’re giving me major trepidations on the ICD 10. I never even considered eliminating Medicare and Medicaid. I understand there are huge risks involved in resigning from Medicare. We had our practice evaluated for a Concierge practice and the numbers didn’t add up. And if you jump through all the hoops of resigning from Medicare, you can’t let covered patients pay you. What to do? Become an employee again?

Dr. Dave:        The law doesn’t allow the corporate practice of medicine. The corporation can influence your medical decisions. Hospitals are getting around that by forming Medical Foundations which is only one step removed. One such foundation bought up a large number of medical practices and paid a salary of $180,000 according to some people that should know. The doctors were given a two year contract. They had plush surroundings. Hallways twice as wide as most medical office buildings. Rest rooms twice as large. But expenses caught up with them. When the two year renewals were given, the salaries dropped to $140,000. The local paper last week featured a journeyman plumber who made $120,000 a year. He had On-the-job journeyman training, no college. Physicians generally have 8 to 12 years beyond college of post-graduate and post-doctoral educations and training. How did this de-professionalization occur?

Dr. Rosen:      That’s a huge topic for another day. But at this time we all have to make a decision as to what we’re going to do by October 1, 2015. I have made mine. I placed a sign in my office on January 1, 2015, wishing them a Happy New Year and stating that this office would close on June 1, 2015 and we would do no insurance billing after July 1, 2015. That will give me three months to complete all my insurance billing and collections. I’ll put my charges on my Bulletin Board by next month. Those that wish to continue in my practice can do so by paying at time of service with cash, credit card or check. Each patient account will close at the completion of the visit with a super bill in their hand for tax ID purposes. I think this may be the first step in reassuming medicine as a profession. I may not be able to charge $50 for a 1-15 minute phone consultation and $75 for an email consultation like my attorney does. But I will charge $10 for a phone call and $25 for an email all through my Practice Fusion EMR which can record them in HIPAA compliance and charge the patient’s credit card, should they wish this service.

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