Update: A twitterer tells me this was just considered by the AMA and defeated – I’m looking for details. Because if they tried this once, they’ll try it again.
Further update: Found it. Details are appended.
The American Medical Association (AMA) is currently considering Resolution 710 (A-09), titled:
Identifying Abusive, Hostile or Non-Compliant Patients
The Resolution has been referred to Reference Committee G, chaired by J. Leonard Lichtenfeld. Unecesarean says that voting is scheduled for Tuesday, June 16, 2009 from 7:00 a.m. to 8:45 a.m – a few hours away.
I reproduce the resolution in its entirety here, for every sentence is about as abominable as the next:
Whereas, Many patients are becoming more abusive and hostile toward physicians for many reasons not limited to the economy, increasing co-pays and deductibles, unreasonable expectations and demands, a lack of instantaneous cure, arrogance and/or the belief that they “own” their physicians; and
Whereas, There are decreasing numbers of physicians both in primary care and specialties especially in terms of access; and
Whereas, Increasing noncompliance with treatment can reflect negatively on physicians during black box audits by insurance companies and oversight governmental agencies; and
Whereas, Abusive, hostile, and noncompliant patients result in increasing office resources adding to office overhead and added stress on all of the office personnel, which can lead to potential ill health; and
Whereas, The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction; and
Whereas, Any complaint to any oversight investigative regulatory body leads to uncompensated expenditure of time, resources, and monies to defend physicians or the “guilty until proven innocent” principal; and
Whereas, Physicians need to own the data to simplify patient collection and identification to defend themselves as well as alert outside investigating agencies to the potential nature of the patient’s records; therefore be it
RESOLVED: That our American Medical Association ask its CPT Editorial Panel to investigate for data collection and report back at Annual 2010 meeting: 1) developing a modifier for the E&M codes to identify non-compliant patients and/or 2) develop an add-on code to E&M codes to identify non-compliant patients. (Directive to Take Action)
Yes, you heard right. The AMA wishes to develop coding to label ungrateful and non-compliant people. The AMA is pissed off with people who they think hold “the belief that they own their physicians”, which, as it turns out reading the rest of the resolution, is actually a problem with people who hold the belief that they own their own bodies.
Physicians writing this resolution aren’t concerned for the health of people who come to them for recommendations; they are concerned that people who are not sufficiently grateful may not completely follow orders, thereby making the physicians fear looking bad.
Physicians writing this resolution are pissed off because people who can’t afford their ridiculously overpriced healthcare and who can’t get insurance get upset in the face of the choice between bankruptcy and untreated illness or death.
The expectation of accessible, affordable healthcare is “unreasonable” in the eyes of these physicians.
The expectation that physicians are consultants, not military sergeants, is “non-compliant”.
The expectation that physicians treat patients like humans is “ungrateful”. Physicians have a right to have their barked orders followed unquestioningly, because this leads to a more satisfying workplace experience for them.
And if you don’t fit the bill perfectly, if you persistently ask difficult questions, if you decline treatments you believe are unnecessary or harmful, if your illness undermines your ability to adhere to medical treatment – you get coded “Abusive, Hostile, or Non-Compliant”.
And in the USA, if you get coded “Abusive, Hostile, or Non-compliant”, you can guess what is going to happen next. No insurance.
Who could this affect? If you’re currently saying “piffle, that will only apply to methed-up assholes who physically threaten the staff”, think again. (And also, spare a thought for the fact that people with substance abuse issues need medical treatment also.) This is a country that sent law enforcement officers into a woman’s home, bound her legs together, and forcibly operated on her in the name of fetal rights.
If this resolution makes it down to coding level, every single time you decline a doctor’s ‘orders’, you could be threatened with the punishment of having your insurance revoked.
- Every time a woman declines a due Pap smear with a doctor who she doesn’t feel comfortable with but who is the only one she can access right now to get a script for her eczema;
- Every time a woman chooses an abortion when any doctor told her she ‘shouldn’t';
- Every time a person with severe CFS who can barely function declines a rigorous gym programme;
- Every time a pregnant woman declines a caesarean section for twin or breech presentation or “hey the baby’s looking a little big dontcha think?”, or chooses a vaginal birth after C section;
- Every time a pregnant woman decides that she’d rather not be induced at 40-41 weeks for no medical indication at all;
- Every time a fat person decides not to go on that 800-calorie diet;
- Every time a person with depression decides to try without the medication without her doctor’s ‘permission’;
- Every time a person decides not to fill that antibiotic script for their daughter’s middle ear infection, because she seems to be getting better already by herself;
- Every time a woman decides that her vomiting baby is keeping breastmilk down better than Pedialyte, when the doctor said to feed only Pedialyte;
- Every time someone walks out of the office of an abusive, creepy, rapist, or just ignorant doctor;
- Every time a person who is misdiagnosed as ‘psychosomatic’ and told that they should have psychotherapy for their illness, and doesn’t;
- Every time an ignorant doctor says something utterly ridiculous and you decide to quietly ignore it, and they find out;
- Every time you miss a scheduled appointment or don’t get around to getting those bloods taken or don’t bother with the expensive, inconvenient followup visit because you’re just fine now;
- Every. Time. You. Freely. Choose. Not. To. Give. Your. Informed. Consent;
Every time. Every single person here probably falls into this “non-compliant” category in some way or another. All of you USAns. Which means that every single time you see a doctor and they decide not to head-pat you as a good little girl, you could risk having your insurance taken away.
If there’s any way USAns can lobby against this effectively, please offer your suggestions in comments. Because I’m frightened for you.
[The original Resolution, then titled 3-09A, as it passed through the Michigan State Medical Society. It was introduced by Alan M. Mindlin, an ophthalmologist.]
Update 16 June 2009 P.M.:
The AMA Reference Committee’s recommendations can be found in this PDF, Report of Reference Committee G
RESOLUTION 710 – IDENTIFYING ABUSIVE, HOSTILE OR NON-COMPLIANT PATIENTS
RECOMMENDATION: Mr. Speaker, your Reference Committee recommends that Resolutions 710 not be adopted.
Resolution 710 asks that our AMA ask its CPT Editorial Panel to investigate for data collection and report back at Annual 2010 meeting:
1) developing a modifier for the E&M codes to identify non-compliant patients and/or
2) develop an add-on code to E&M codes to identify non-compliant patients.
Your Reference Committee heard limited supportive testimony on Resolution 710. The author stated that the intent of this resolution is to identify non-compliant patients, especially as there is an increasing focus on physician performance and releasing of physician data. Testimony was empathetic to the difficulty in working with non-compliant patients, but expressed concerns in labeling patients and acknowledged a desire to be sensitive to the possible mental health issues of non-compliant patients.
Testimony provided by the CPT Editorial Board stated that the appropriate forum for addressing CPT issues is through the CPT Editorial Panel process, not the House of Delegates. In addition, while there are no codes that exist to identify someone as specifically non-compliant, there are existing modifiers to identify patients who do not comply. For example, Modifier 2P (Performance Measure Exclusion Modifier Due to Patient Reasons) is available to report non-compliant patients. The list of reasons for Modifier 2P include (1) “patient declined”, (2) “economic, social, or religious reasons”, and (3) “other patient reasons”. This modifier is intended to be used with performance measure Category II codes. CPT Category II Performance Measurement codes are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care. These codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Given that there exists an appropriate avenue to code for non-compliant patients and that this issue should be directly addressed through the CPT Editorial Panel, your Reference Committee recommends that Resolution 710 not be adopted.
I am not particularly reassured by this. Are you?