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How much red tape can you endure?


Over the past few weeks, the government red tape has piled up and there's only one thing left to ask. How much more will physicians put up with?

The amount of government red tape physicians and staff must manage to get paid and remain in compliance is mind numbing.

Just after the 300-plus page rule outlining Medicare's 2013 fee schedule was released from the Centers for Medicare and Medicaid Services (CMS), it was followed by a 208-page encore outlining the International Classification of Diseases, 10th Revision (ICD-10), which takes the number of diagnoses and procedure codes from 17,000 to 155,000.

Physicians are being wrapped, bound, and immobilized by government-sanctioned red tape. And it's coming after our lawmakers passed another 30-page Federal Register law to "simplify" regulations.

Doctors are frustrated, and it's been underscored in a recent survey by Medical Economics. In fact, 23% of physician respondents said that Medicare/Medicaid is the "one source that posed the most significant challenge to the success of their practice." In a separate question, 14% of doctors responding to the survey said that government regulations remained the most pressing issue for medical practices. And it only ranked second to concerns about reimbursements. Conversely, a recent survey from the Massachusetts Medical Society shows a similar sentiment among patients. Those survey results state that 13% of patients believe the government is "most responsible for difficulty in accessing healthcare."

On average, according to the American Academy of Family Physicians (AAFP), Medicare and Medicaid make up about 25% of the patient population for most office-based practices. And although physicians have warned that the level of bureaucratic excess is undermining the delivery of healthcare, it is also needlessly inflating its cost.

Last year the American Medical Association conducted a survey of 2,000 of its members to find out more about which regulations were particularly onerous. Unfunded federal mandates poked a nerve; so did the elimination of Medicare payment for physician consultations and incompatible and inconsistent quality initiatives.

And although the government is actively promoting any reduction it makes to the bureaucratic burden to doctors, most say it couldn't happen fast enough. A study conducted by Health Affairs last year shows that medical practice staff spend 20.6 hours per physician per week on administrative duties. And that, the study says, racks up some $27 billion a year in administrative costs. Medicare's mandates for drug plan authorizations, translators for hearing-impaired patients, documentation and certification, are all compounding the burden for doctors.

In 2012, the only thing that isn't adding up is reimbursement revenue.

Although the 2013 Medicare fee schedule calls for some relief (a 5% boost for internists and a 7% hike for family physicians), uncertainty whether Congress will fix its nine-page sustainable growth rate formula tempers the optimism. If lawmakers don't act, it will reduce Medicare payments by 27%.

So, how far have we not come?

"To date, there has never been a return on investment for physicians for the implementation of any HIPAA administrative simplification requirements," wrote Donald Berwick, MD, of the AAFP last year to Kathleen Sebelius of the U.S. Department of Health and Human Services. "The human and technological investments needed to participate in quality incentives are competing for physician time and resources needed to move to an enormous new set of diagnosis codes in ICD-10. The struggle to keep up leaves little time to get engaged in the practice redesign and payment and delivery reforms envisioned in the ACA and detracts from patient care just as the ACA is promising access to millions of uninsured Americans."

Something tells me the sentiment rings as true today as it did last year.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health