What's The Frequency — September 2, 2013 at 6:39 pm

Summer was brought to you by the letter G


I shall always remember the summer of 2013 as the summer of G Codes. It has a cold weather counterpart in the winter of 1999 which was, of course, the winter of our discontent, the winter of PPS. I don’t remember what season we were in when KX modifiers hit, but that was a particularly stressful time as well.

Okay, I’m an adult with decades working in the healthcare game. I get the need for periodic changes to the rules for reimbursement. It should be a minimum expectation. As a speech language pathologist, I realize it is part of the job. As a tax payer, I welcome any changes which try to control costs. As an aging American, I hope the changes mean Medicare will be there when I’m done caring for others and need some caring for myself.

And, it is there, with thoughts about the future, where I hit my boiling point. Each new rule, each federal attempt to control costs, each smarty pants MBA or JD adding to the litany of oversight for Medicare reimbursement only seems to add to the spending. How many more manpower hours do you think were needed to “roll out G Codes” to every OP, SNF, Mobile Xray, and other MedB service providers?

Let’s use me as an example. I spent 1 hour in training for G Codes. Over the course of the next week, I spent about 2 hours actually trying to apply what I learned to my real life clients and then entering the data into our documentation system. After the first month’s billing, I spent another 2 hours trying to fix errors which were discovered during transmission. Not bad, 5 hours to figure out a new system and work the bugs out of the software.

I hope everybody working in SNF’s, PT/OT/SLP, only shed 5 hours of the direct care time to this new system. Let’s make up some numbers and see how much was spent for the roll out. Come on, it’ll be fun.
There are 123,200 SLP’s in the US as of 2010 according to the Bureau of Labor and Statistics. Only a small percentage of SLP’s work under MedB. The Bureau says about 9800 work in SNF’s or Home Health. So, we’ll use that number. They also said our mean earnings are $33.50 per hour. If each of us only lost 5 hours to the G Code roll out then the cost would be

That only accounts for the hours spent learning and not the hours of lost revenue because no treatments were provided.
For the 19,560 OT’s working in SNF, their mean hourly rate is $36.73 according to Bureau of Labor and Statistics 2010 information. The cost of their education would be

The Bureau of Labor and Statistics data from 2010 also notes there are 22,000 PT’s earning $38.39 (mean) per hour. Their education using my 5 hours as a yardstick cost

So, my grand total guess-ta-ment is $9,468,319 to education PT, OT, SLP about G Codes.

We should remember that Gnomes with good intentions and pointed hats did not emerge from our med rooms with the materials to decipher and translate the Medicare rules into English. No fairies arrived on moon beams down the elevator shaft to rework the software with sprinkles of stardust to include the G Codes into the programs. And, wanders gangs of elves did not slip in through the solarium room windows and race to rehab to teach the new rules.

All that work needed to get done by people; IT, administrators, billing departments, medical coders and middle managers. I can not even guess how many manpower hours went into that level of work. But, I think we can all agree that more than 5 hours were needed by more than 1 person at every service provider billing under Med B. It is probably safe to assume the cost at that level was at least equal to the cost to educate front line staff.

For the sake of the rest of my rant, today, I’m going to make a rough round figure guess that education for G Codes cost service providers a minimum of $20 million for the roll out. This figure does not include the losses incurred when direct line staff could not treat because they were being educated.

Where are these losses going to recouped?
How will G Codes lead to national savings or even cost controls?
What has any of this got to do with clients who need care?
When was the last time anybody in the federal government asked a direct service provided what is wrong with the system and if they have any ideas on how to fix it?

I’m beginning to despair that Medicare will even exist in 20 years when I need it. Actually, the way the rules are changing, I might be delayed in retiring until well after my 70th birthday.

Why are we all just going along with foolishness that is masquerading as Medicare policy?

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