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Medical Economics readers comment on the impact of practicing as part of a medical home and the approaching mandate to use ICD-10 codes.

Single-payer system would simplify care

Kristofer Sandlund, MD, in “Primary care fixes come too late” (Talk Back, February 10, 2013), is right to suggest that whatever increase in fees that primary care physicians (PCPs) may be paid if they enlist in the medical home, it will be disproportionately small compared with the increase in administrative work expected of them.

Already the strain and drudgery that define administrative work have not only made these physicians inefficient but also have made it difficult for them and their office staffs to act in a cordial and professional manner. The drudgery and the strain in primary care are not isolated to any single source; they are an accumulation of many demands that come from many different sources. Insurers’ and pharmaceutical companies’ regulations are particularly noxious.

A single-payer system has the potential to simplify PCPs’ lives by minimizing the many different demands that result from so many different stakeholders, most of whom have a responsibility to their stockholders rather than to physicians’ patients.

Edward J. Volpintesta, MD

Bethel, Connecticut


ICD-10 codes are a debacle

Regarding your article, “ICD-10: Can physician groups stave off or delay implementation?” (February 10, 2013): Our electronic health record system already has some of the codes loaded. If you have access to them and want a good laugh, and to foresee the debacle coming down the pike, take a look. 

I was looking for a code for a patient with a burn and found burn from a burning sailing ship, burning fishing boat and the best…burn from burning water skis. Really? Has anyone ever seen a burning water ski?

Look in the allergy section and you’ll find, among other loony codes, allergy to squid ink and a separate allergy to octopus ink. Again, really? Who comes up with this stuff? I can imagine a group of MBA-types sitting around dreaming up this nonsense. I can hear one now saying, “I’ve got one: Pain in the leg due to porcupine quill.”

Yep, it’s that bad and will probably be the straw that will force physicians to become like veterinarians. Cash for care. That’s what’s coming, baby.

Joseph Karcavich, MD

Lockport, Illinois


Simplicity is key to efficiency

In response to your request for practice efficiency suggestions, the key to efficiency is to simplify every policy, procedure, directive, patient flow, phone call,  email, appointment, patient encounter, insurance claim, coding issue, office meeting, speech, and spend more time on encouragement, praise, and reward.

William Bart Pate, MD

Fort Worth, Texas

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