'Doubled doubt and disappointment in SGR and ICD-10 delays', and other letters

Regarding “SGR, ICD-10 extensions approved by Senate,” one-year sustainable growth-rate fixes can be funded annually, but the projection over the next three decades for a permanent fix is a budget buster. Neither Democrats nor Republicans are willing to take the blame for increasing the projected national debt by the hundreds of billions of dollars that the SGR repeal will require.

To compound the SGR disappointment, we face losing the significant investments we have made in ICD-10. These investments will not keep on the shelf for a year. My community hospital has spent thousands of man hours, and hundreds of thousands to millions of dollars preparing for Oct. 1.

Now, it looks as if we will have to do it all again next year, but after two aborted start dates, who knows? Why not go ahead with ICD-10 conversion this October but allow laggards to submit ICD-9 bills for six to 12 months? The CMS and the private plans would need to continue their conversions but be technically able to receive billing in either ICD-9 or ICD-10, which may not be possible. Maybe we should just wait another year and adopt ICD-11.

Dr. James Mhyre

We are a multispecialty physician group with 100-plus providers. We have worked very hard on this conversion and are proud of our people and results. The previous postponement from 2012 to 2013 was understandable. The task was large and many people were having trouble. However, this recent delay merely rewards those who are not serious.

Once again, high performers are held hostage by those that lack resolve. We embrace mediocrity instead of celebrating excellence. I am not sure whom we should be more disappointed in, those organizations that did not take this seriously, or the politicians in Washington who once again lacked the resolve to step up and follow through on their own mandates.

J. Christopher Thorn

I think that no matter when they mandate implementation of ICD-10, all payers should be required to provide end-to-end testing at least three to six months prior to the implementation date. Providers should not be left in the dark concerning when and/or if they will be reimbursed for services rendered. Since billing and coding policies and guidelines vary from payer to payer, it is completely unfair to require that providers just begin billing without knowing what the payers will ultimately require for ICD-10 claim submission.

Theresa Wilson

We appreciate the article “Rethinking spine care” and the important issues it raises regarding the healthcare system's need to reassess treatment of spinal problems in light of new information on the sharp increase in the frequency of spinal surgery, associated runaway costs, and the disappointment and mixed results that many patients experience.

The article notes that some hospitals have implemented programs requiring surgical candidates to undergo physical therapy and psychological counseling prior to their procedures. This conservative care approach should include all legitimate, evidence-based options. In respect to spinal pain, particularly low-back pain, chiropractic services have been proven to provide effective relief for many patients and at a lower cost to payers. One study (Liliedahl et al., 2010) looking at the records of 85,000 Blue Cross and Blue Shield beneficiaries in Tennessee over a two-year period, found that low-back pain care initiated with a chiropractic physician saved 40% on healthcare costs.

Another (Keeney et al., 2012) ob-served that 42.7% of back pain patients whose first provider was a surgeon eventually underwent surgery, compared with only 1.5% whose first provider was a chiropractic physician.

Back pain and the disability it causes is a problem in the U.S. and globally, and it only stands to worsen with the aging population. If more health systems partner with conservative care providers to screen and treat those patients whose conditions can be helped without surgery, we will see lower costs, better outcomes and more satisfied patients.

Anthony Hamm, D.C.

Regarding “Obama administration proposes sweeping new health plan rules," as a family physician, I am very encouraged by the implementation of the Patient Protection and Affordable Care Act. It is awesome what President Obama has been able to achieve so far for the good of all the American people. For many years, especially since medicine changed to being for-profit, patients and physicians have suffered at the whims of health insurance companies.

This revolutionary change in medicine will naturally take time to unfold. It amazes me how some still want to see medical care as a privilege for the few rather than as a right for all. I am very hopeful for the future of medical care in the U.S. because of the implementation of the Affordable Care Act.

Dr. Rosemary Eileen McHugh