Conversations with an AI (Microsoft's copilot using Chat GPT-4)

I decided to ask the current AI to help me understand the answer to certain issues regarding current medical practice and the reimbursement, i.e. payment, models used.  It seemed to me that treating patients in a language other than English increased the complexity of the communication, documentation, and associated liability exposure to the doctor.  That seems obvious. Translations must occur at every level. Diagnosing, treating, documenting, and billing. No? Then why are these not allotted for in the payments? Why can other professionals charge for translations but not in medicine where this maybe crucial? Just as in a legal proceeding for example. 

Question asked the AI:

Why don't insurance companies compensate doctors who must translate or treat patients in a foreign language more than they do for native language office visits, AKA CPT 99203?

AI's answered with:

 Insurance companies are required to address language barriers and provide meaningful access to healthcare services for individuals with limited English proficiency (LEP). Here’s why:

1. Title VI of the Civil Rights Act: In 1964, Congress passed Title VI of the Civil Rights Act, which prohibits discrimination based on race, color, or national origin. This law ensures that federal funding is not used to support healthcare providers who discriminate. It specifically protects national origin minorities who do not speak English well. As a result, recipients of federal funding (including hospitals, doctor’s offices, nursing homes, and other healthcare organizations) must take reasonable steps to ensure LEP individuals have meaningful access to their programs and services¹.

2. Federal Regulations: The Department of Health and Human Services (HHS) issued regulations to implement Title VI. These regulations extend beyond intentional discrimination and prohibit practices that have the effect of discriminating against LEP individuals. Healthcare providers must not restrict access to services, treat LEP patients differently, or provide services in a way that differs from others¹.

3. Coverage Under ADA: Additionally, Title III of the Americans with Disabilities Act (ADA) requires doctors and healthcare providers to provide interpreters if patients need them to understand medical information. If a patient requires an interpreter, the provider is obligated to provide one².

4. Language Access Measures: Insurance companies should cover language assistance services, including translating forms and documents into foreign languages and providing oral interpreter services. Physicians should inform LEP patients of their right to have an interpreter without charge or to use their own interpreter (e.g., a family member)³.

In summary, insurance companies are legally obligated to ensure language access for LEP patients. However, disparities in compensation may still exist due to various factors, including reimbursement models, administrative costs, and cultural awareness. Advocacy efforts continue to address these issues and promote equitable compensation for language services in healthcare. 🌟

Discussion:

 I would seem, as I intuited, that the current laws and regulations exist to protect the patient and ensure access to medical care but none to address the additional burden on time and expense on the medical providers! How convenient.

Question asked of the AI:

Why is all this extra workload not reflected in the formula for payment of CPT code like 99203?

AI answered: 

The 99203 CPT code is an essential component of the Evaluation and Management (E/M) code set used in healthcare billing. Let’s dive into the details:

1. CPT 99203 Description:

   • This code represents an office or outpatient visit for a new patient with a straightforward medical problem.
   • It reflects a moderate level of service and requires:
     • A detailed history of the patient’s condition.
     • A comprehensive examination to assess their health.
     • Medical decision-making to determine the appropriate course of action¹².

2. Importance of Accurate Coding:

   • Proper coding is crucial for fair compensation for services provided by healthcare professionals.
   • Accurate coding helps maintain the financial health of medical practices.
   • For CPT code 99203, billing it correctly is vital to avoid issues like denied claims, revenue loss, and audits.
   • Overcoding (billing for a higher level of service than provided) can lead to inflated costs and insurance fraud.
   • Undercoding (billing for a lower level of service) results in revenue loss for the practice¹.

3. Reimbursement Rates:

   • The reimbursement rate for CPT 99203 varies:
     • Medicare (2024): $109.69 (previously $113.75 in 2021)².
     • Other payers may have different rates based on their fee schedules.
   • Modifier 25 may be applied when necessary³.

4. Why the Discrepancy?:

   • The formula for payment considers various factors, including time spent, complexity, and documentation.
   • However, it doesn’t directly account for the additional workload related to language barriers or translation.
   • Insurance companies focus on medical necessity, which is determined by the patient’s condition and the services provided.
   • While language services are essential, they are often considered part of the overall patient encounter rather than a separate factor in reimbursement.

In summary, accurate coding ensures proper reimbursement and helps demonstrate medical necessity. While the formula doesn’t explicitly address language-related workload, healthcare providers must prioritize accurate coding to maintain financial stability and provide quality care. 🌟

Discussion, My Summary

That last paragraph! I had my answer. I don't like the answer but there it is. Insurance companies focus on a concept that they invented called medical necessity.  Your insurance company only covers care, equipment, treatment, mediation, surgeries, or lab tests, if they are determined, by them, to be medically necessary.  This is an effective way of deciding whether to pay or not pay for something. But the regulations listed in the first answer clearly require that these non-considered costs and burden be placed on the medical providers. Sure, they will pay for the translator this will often require that the medical provider reschedule the patient until this is arranged.  And guess who is burdened with explaining all of this to ill patient.  And what about the translation for documentation. Why is the doctor not compensated for this special skill. Being multilingual suddenly becomes a tax of some kind it would seem. Extra skill and performance but no compensation. Hmm? Seems they found another way to get us to work for free. 

Fear of Drowning or How Johnny Weissmuller, 1924 Olympic Gold Medalist, Saved My Life

Fear of Drowning This is a link to the music created in association with this post. Check it out on Facebook
Watch Fear of --- on YouTube

   As a small child of 6 or 7, I nearly drowned. I saved myself and later I realized how this event molded my future life outlook. A life-changing experience a defining moment as it were. 

On a hot New York summer day, my family was afforded the rare pleasure of a day at a summertime resort outside New York City.  A friend of my father had let us in to use the resort on a day the facility was closed for renovations I believe it was.  The pool, however, was fully functional and we had it all to our selves. No people.  Not one!  Also no lifeguard!  

     When my brother and I got the news that we could go swim and cool off we raced to the pool towels in hand in our swimsuits.  Upon laying eyes on the shining blue Mecca of relief from the sweltering New York summer heat we raced toward it.  Subconsciously sensing that this was another sibling competition I was determined to win and be the one that leaped out into the water the furthest. I envisioned my leaping launch from the pool deck in my mind's eye.  I executed just so and tossing my towel aside all in one motion looking a running leaped feet first into the air my legs still churning under me as I traveled gloriously. Effortlessly and with the flexibility of a skinny youth,  I covered the remaining space in an instant.  I experienced the sensation that only a child feels.  Like you are weightless and can fly.

In doing so and in my childish recklessness I did not notice that this was the deep end and growing up in the big city New York I had not yet learned to swim!  Crowded wading pools in the inner city I had visited prior had not afforded me this opportunity.  

     I struggled to break the surface gasping for air! I had left far from my brother's position he was closer to the wall and in a similar situation. I realized he could not, as he had always done, help his little brother this time. My mind raced and was aware that I could choose. Chose panic and defeat!  But instead, I began to problem solve and despite the angry tearing sensation of my lungs begging for a breath of air I became alert but stayed calm.  It was eerie and it felt like I was suddenly me but not me.  An unknown part of me presented itself.  If I can’t go up to the surface I thought maybe down to the floor where I could push off! Closing my arms above me I counter-intuitively pushed myself under until I touched bottom.   If I was to drown then this would be as good a place as any.  It was a long way. I almost panicked again.  Maybe I couldn’t make it to the bottom.  Maybe I wouldn’t be able to push off the bottom hard enough to get to the surface ever again.  Was it a foolish choice? I reached the bottom and with lungs screaming for air I thrust upward.  So very far! When my face broke the surface I had lost all impulse and gasped only a bit of air and water together.  Now coughing and gagging on the water I knew I could not even scream help!  

     I had my eyes open underwater. Something I had never done before.  I saw the wall.  8-10 feet maybe.  3 body lengths.  I instinctively pulled and at the water and went under again to repeat the push of the water.  Surfaced pulled and paddled madly as I had seen  (1924 Olympic swimming gold medalist) Johnny Weissmuller do in the black and white Tarzan movies I had seen on TV that I so loved.  Swim. I was sort of swimming.  The pool wall got closer.  I could do this I thought. This, I know now, was only possible because I kept my body loose, relaxed, and worked with the water not fighting it.  I always marveled and how smooth and effortless Johnny Weissmuller looked in the water.  Surely Tarzan was master of all beasts of the jungle and adapted to his environment like nature and he were friends.  From swinging from the trees to running in the plains to swimming in the water, even his walk, he displayed strength and grace.  Somehow I drew on this. My body relaxed the water via the equal and opposite reaction to my action helped me make it to the side where I found my taller brother had achieved the same.  There was a short exchange and we did not stay in the pool long.  I never told my parents this story for fear of not being allowed in the pool ever again.  They did not know about this til 50 years later. In those days we were not encouraged to express our feelings etc.  Men were men and we fell, got up, gathered our shit and moved on! Even at the tender age of six or seven, I knew that much!

     Swimming later became my 1st love.  A place where I could experience the joy of body motion and the communion with natures most quintessential element, H2O, water.  Despite many fears and insecurities I have ever since experienced extreme clarity and calm in moments of high stress, trauma, or other calamities.  Without fail as things get crazier I get calmer.  Needless to say, this has served me well in many situations, not the least of was my medical training and practice. Panic is not an option. In med school, there is a saying that was passed on to me as I am sure it has  from gen to gen “in a crisis 1st take your pulse and THEN take the patients pulse!” LOL

The Worst Patients In The World

The Worst Patients In The World

The Devaluation of Physicians

The Devaluation of Physicians

The Business of Healthcare is Based on Exploitation of Doctors and Nurses!

The Business of Healthcare Is Based on Exploitation of Doctors and Nurses

This June 8, 2019, article in the opinion section of the New York Times written by a Bellevue Hospital physician, Dr. Danielle Ofri, author of What Patients Say, What Doctors Hear, hits the nail on the head! I and many doctors have discussed, if you consider cursing a discussion, these issues heatedly, repeatedly, despondently, angrily, etc in hospital hallways, doctors lounges, and operating rooms for many years now.  I am glad to see this article and and the work (video, blogs, lectures etc) of physcians like Dr Zubin Damania of zdoggmd.com addressing and disseminating this type information to the public.  Want to know more? Check these out! This is cutting edge stuff!

The state of healthcare as the medical professionals in the trenches experience it is note what you may have been lead to believe.  Shocker!  Not!  As with many industries the spin and infowar machinary is at full tilt in the healthcare debate and has been for some time now.  Speaking the facts about the challenges and the some of the unintended side effects of the direction and nature of the healthcare experience is difficult to distinguish from the propaganda we have all been fed. I believe it is time now, and the public may finally be ready to hear, what physcians and industry insiders have known for a long time.  I hope that this will help fuel what ZdoggMD.com calls healthcare 3.0, the next phase of the reshaping of healthcare. 

Bono Injured, May Not Play Guitar Again, CNN Reports

Original Music By Dr Abbes (Demos etc.)

Original music by Dr Abbes - Listen here, download free song!

What Will Fill the Void

What Fills a Void

Hooray, to every single human that ran to help, those with the courage to survive, those with the life force to endure or even just escape despite being challenged by destructive storm of man made evil! Here’s to you!

How do we measure the events of the 2013 Boston Marathon and the inevitable sense of void left by death and destruction? If we viewed this incident that maimed and killed innocent people, from the cold remoteness of a point in outer space, we can only conclude that response of the injured, the survivors, the spectators, the people of Boston, and the visitors in Boston, that the Boston of today is stronger and more proud and determined than ever.

When I heard today that Sweet Caroline by Neil Diamond was played at Yankee stadium in New York in honor of the rivals (yet brothers today) Boston Red Sox who routinely play this song at every baseball game in Boston (despite the fact that Neil Diamond was a New Yorker and a Yankee fan. Facts which seem wasted on Bostonians) I thought to myself, “now you really did it.” You, you creep or creeps, have attacked athletes and their fans. Be aware the word fan comes from fanatic. You attacked runners. One of the most obsessive type of athletes on the planet. And further you attacked marathon runners the most obsessed faction of the obsessed. The marathoner, the runner that runs 26 miles. To run this distance is not possible by physical ability alone. It requires breaking through pain and motivational barriers more than once just to finish the race. Not only do these runners do this, they dream of doing it, and repeating it, and doing it better! No small feat. And the wind that pushes and carries them thru this modern version of self flagellation and penance, are the fans. The running fan and runners are a family. They share the share and seek the nirvana of the trial of the self. They emerge from sort of dark night of the soul to elation. Caballo Blanco is no doubt looking down from the heavens in anger at what he saw.

Awakened is a sleeping Giant, runners, within a sleeping Giant, the USA. No doubt next years Boston Marathon will be the biggest in history. Mark my words! Even Zombies wont be able to stop the horde of runners and supporters that will descend on Boston to demonstrate that nothing will dissuade them from the running way of life and what it means to them as a free people. These are the bikers of the athletic world. And no where else do the words “born free” ever apply more. Free to run and do it their own way. Free to feel the pavement move under their feet in city forest, desert, across mountains, hills, and streams. Free to feel the the wind in their face! Beware anyone that would try to stop this human wave. They might just Forest Gump run and run, and keep running. Run until they have run over the weak minded worm of a human that did this horrific thing. They may just run over the pathetic shanty, or slimy cabin in the woods that housed the thing. The the thing that planned and brewed its psychotic manifesto, in its worthless demented world. Run until they’ve trampled and pulverized it back into the mud hole from which it crawled out of!

Marathoners straight from completing a feat that most are unable to achieve where among the first to jump into action. Offering the shirts off their backs to stem the bleeding of the lacerated. They were among the first to, despite the confusion of dismembered and injured humans bleeding and screaming in the hundreds, stepped forward to assist! Because that is the runner mindset. Keep moving forward!

And so let the groups begin organizing because now we are all runners today. And at the end of this battle, like the first marathoner in history who ran 26 miles to deliver news of the battle before collapsing, we too will say: “Nike!” (Victory!)

In the words of President Obama today referring to the bravery of the first responders and volunteers who ran toward to explosion almost immediately to assist the injured and save lives “So, if you wanna know who we are and how we behave? (You saw it yesterday) That was it!”

By the way, Boston, Thank You, for representing! That’s the way to fill the void!

Morning Donuts

Number 9...

Pick up stix