Tuesday, November 18, 2008

Could ICD-10-CM reduce the primary care workforce?

On the heels of primary-care opposition to the switch to ICD-10-CM comes news of a survey that shows half of primary-care doctors would quit medicine today if they could. The major reason? Insurance-company and government red tape.

Well, the switch to ICD-10-CM is a big roll of federal-government red tape. Will this additional red tape from the federal government lower the threshold for many primary care physicians to leave medicine?

For starters, we'll let them tell you themselves.

The letter by the American College of Physicians on behalf of its Internist members states: The burden associated with implementing ICD-10-CM is likely to exacerbate the crisis in the primary care workforce.

The letter by the American Academy of Family Physicians (AAFP) was somewhat less pointed but no less clear: CMS must realistically consider whether pressures to rapidly adopt the ICD-10-CM code set outweigh the importance of supporting the already fragile backbone of patient care, primary care medicine.

The survey of primary-care physicians obtained responses from an impressive 12,000 doctors, 4000 of whom took the time to provide written comments. Here are some key findings of the survey:
  • 49% of physicians -- more than 150,000 doctors nationwide -- said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.
  • 94% said the time they devote to non-clinical paperwork in the last three years has increased, and 63% said that the same paperwork has caused them to spend less time per patient.
  • 82% of doctors said their practices would be "unsustainable" if proposed cuts to Medicare reimbursement were made.
  • 60% of doctors would not recommend medicine as a career to young people.
  • If they had the financial means, 45% of doctors would retire today.
  • Only 6% of physicians described the professional morale of their colleagues as “positive.” 42% of physicians said the professional morale of their colleagues is either “poor” or “very low”.
  • 78% of physicians said medicine is either “no longer rewarding” or “less rewarding”.
Instead of throwing these physicians a lifeline, the government is throwing them an anchor (ICD-10-CM). Many will very likely drown (leave practice) as a result.

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