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Healthcare crushed by acronyms


Independent healthcare has some daunting foes: insurance industry and government-created acronyms. Acronyms represent the best and worst of healthcare today, and now is the time to make sure they don't get out of control.


We haven't progressed as far as the system in the above story-yet. But in that fictional world and in our real one, acronyms represent the best and worst in the healthcare industry.

In osteopathic or allopathic medical school, we learned acronyms so that we could more efficiently remember and communicate various disease states. Acronyms such as PE, for physical exam or pulmonary embolism, seemed benign enough. PSA (prostate-specific antigen) is a blood test for prostate disease, but media outlets use this acronym to refer to a public service announcement. Until recently, we all used written SOAP (subjective, objective, assessment, and plan) notes for hospital and office care notes.

Yes, all of these acronyms seemed harmless at the time, but that assessment has changed.

We doctors formed and joined groups such as the AMA and AOA (American Medical Association and American Osteopathic Association, respectively) to define our identities and feel strong. We further divided ourselves into specialty groups such as the AAFP, ACOFP, AAP, ACOP, ACS, and AAOS (the American Academy of Family Physicians, American College of Osteopathic Family Physicians, American Academy of Pediatrics, American College of Osteopathic Pediatricians, American College of Surgeons, and American Academy of Orthopaedic Surgeons, respectively). For many years, these acronyms, too, seemed protective and helpful.


The 1960s, with the government's invention of Medicare and Medicaid, marked early chapters in the acronyms saga. The CDC and NIH-Centers for Disease Control and Prevention (the full name by which it is known today) and National Institutes of Health, respectively-were successful. This from the same people who brought us the FDA and USDA (Food and Drug Administration and U.S. Department of Agriculture). The government also invented the agencies now known as HHS and CMS, as well as HCFA (Health and Human Services, Centers for Medicare and Medicaid Services, and Health Care Financing Administration), to devise new regulations for all participating healthcare entities to live or die by.

Private and public health insurance companies followed the government's acronyms and policies at every turn as they reset the standards. The RBRVS and RVUs (resource-based relative value scale and relative value units, respectively) came to save the day-or did they? The government's entry into medical care would be a point of no return for the acronym story.

The WHO (World Health Organization) devised the ICD (International Classification of Diseases), and the AMA devised CPT (Current Procedural Terminology) as a way for physicians and healthcare entities to communicate with insurance companies. Doing so turned out to be a highly profitable venture for the AMA, even more so than the physician membership, which was dwindling.


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