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AMA "ungrateful patient" billing code

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June 17th, 2009, 11:11 AM
ShaunaB's Avatar Mega Super Mommy
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This will get you fuming! I received this in an email from a doula yahoo group.

AMA Resolution Would Seek to Label "Ungrateful" Patients

Redondo Beach, CA, June 11, 2009 - At the American Medical Association' s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label "non-compliant" patients.[1]

The resolution complains:

"The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction. "

"This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy," said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving
maternity care. For pregnant women seeking quality care and good outcomes, "non-compliance" is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. "My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die." She sought out another care provider and had a healthy and safe intervention- free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called "Evidence-Based Maternity Care: What It Is and What It Can Achieve[2]," shows that the state of maternity care in the U.S. is
worrisome, driven largely by a failure of care providers to heed
evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the "perinatal paradox" of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

. Billing codes that would categorize any disagreement and exercise
of autonomy on the part of the patient as "non-compliance" "abuse" or "hostility" could create a pathway for insurance companies to deny coverage to patients

. Use of these labels fails to recognize patients as competent
partners with physicians in their own care

. Tagging patients as "non-compliant" fails to recognize that there
is not a "one size fits all" approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion

. Labeling patients as "non-compliant" may, in fact, be punitive,
jeopardizing a patient's ability to seek out other care providers

The resolution also fails to address how it would implicate patients
navigating controversial issues in medical care, like vaginal birth after
cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC.[3] The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

"The reality is that the balance of power in the physician-patient
relationship is decidedly tipped towards physicians. The least patients
should have is the right to disagree with their doctors and not be labeled a 'naughty' patient," said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a
lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.
<http://www.ican- online.org/ resources/ white_papers/ index.html>
http://www.ican- online.org/ resources/ white_papers/ index.html

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery. <http://www.ican- online.org> www.ican-online. org
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June 17th, 2009, 12:06 PM
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Andrea, mom to 3 beautiful girls - Abigail (8) Annabelle (6) and Alexis (3)

Expecting baby #4 in April - It's a BOY!

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June 17th, 2009, 12:10 PM
ShaunaB's Avatar Mega Super Mommy
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Why this makes me so mad is the path this could lead to. Will doctors be paid more for having labeled a patient "non-compliant"? Will they then be more combative to their patients, thus making their patients more combative with them? Will your insurance premiums be raised if you are habitually labeled a "non-compliant" patient. Worse yet, could you be dropped from your insurance?!! And this doesn't just affect birth. What if you wanted to get a second opinion on any diagnosis and got labeled ungrateful or a trouble maker?

It's just another way to take away our voice, our autonomy. It furthers the thinking that docs should be listened to without question. And it continues to encourage uneducated thinking and decisions. So dangerous!!
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June 17th, 2009, 12:15 PM
DoulaMama's Avatar Platinum Supermommy
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it makes me mad, but I honestly don't think that many doctors would bill like this b/c if insurance won't cover it they're pretty freaking likely to get stiffed especially if the patient didn't like the care they recieved (or lack of).
Cheryl, mama to Noah Paul born 12/26/09, wife to wonderful hubby Rob
I am proudly a homebirthing, excluively breastfeeding from the tap, constantly babywearing, bed sharing, attached mama to a high needs baby. He is a part time diaper-free baby!

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June 17th, 2009, 01:58 PM
PixieQueen's Avatar Hi-Tech Hippie
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So it would punish patients for having two brain cells of their own to rub together? Wth? Didn't anyone read the article the other day about a high school student diagnosing herself in her biology class after being misdiagnosed for years? So would she be an "ungrateful" patient for finally figuring out what was wrong and being able to get proper treatment? Grr!

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June 17th, 2009, 02:31 PM
tygrss's Avatar Mega Super Mommy
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Wow. I need to look into this. I'm a physician and have heard of no such thing! I think that it's crazy and definitely isn't something that should be done.
Interestingly, we were taught in medical school to never use the term "non-compliant" because it's insulting to patients. Patients don't have to "comply" with a plan that physicians come up with. The patient and physician are suppose to come up with something together and then the patient tries to follow THAT.

I'm thoroughly disgusted. I guess I need to get more involved in the AMA because it seems like the "old guard" is going bizerk.

ETA: There are definitely people who probably need SOME kind of label though. I remember having a patient as an intern who had congestive heart failure. He'd come in and be treated, then not take his meds when discharged. A week later he'd come back in with the same thing! He was being admitted 4 times per month. On top of that, he'd walk around his room urinating on the floor or urinating in the basin and then would throw it at the nurses when they came in the room to check on him!! We finally got the ethics committe involved and determined that we no longer had to admit him at our hospital. Sad, but true. Of course, this is an extreme case. It is just to show that SOME people probably should have some label put on their chart. He was wasting everyone's time and money with this foolishness.

Last edited by tygrss; June 17th, 2009 at 02:35 PM.
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June 17th, 2009, 03:19 PM
mgm78's Avatar Zoe's mom Meredith
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Would I like to label patients? Sure, some of them deserve a label, but that is a fantasy, should never be a reality. this is a wretched idea.

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June 17th, 2009, 03:27 PM
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June 17th, 2009, 04:37 PM
ShaunaB's Avatar Mega Super Mommy
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I have no issue if a doc wants to label a patient in their chart. I'm sure many are sincere pains in the butt. My concern is creating a billing code for this. Anytime you link something that is interpretational to money you are bound to have rampant abuse.
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June 17th, 2009, 10:53 PM
liveandlove0725's Avatar Mega Super Mommy
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June 18th, 2009, 07:08 AM
Sk8ermaiden's Avatar Platinum Supermommy
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They didn't pass it this year, but want to vote again next year.

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June 18th, 2009, 07:50 AM
rachna's Avatar Platinum Supermommy
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WOW...so having a say in your treatment and knowing what you want/dont want is non-compliance? I know drs who would be horrified by this as well.
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June 18th, 2009, 11:16 AM
tygrss's Avatar Mega Super Mommy
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Originally Posted by ShaunaB View Post
I have no issue if a doc wants to label a patient in their chart. I'm sure many are sincere pains in the butt. My concern is creating a billing code for this. Anytime you link something that is interpretational to money you are bound to have rampant abuse.
Writing it in the chart could have the same effect though. Some insurance companies reserve the right to review their subscribers charts for billing/payment purposes, so if it were seen in there they could use it as a way to deny payment.

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June 19th, 2009, 09:35 PM
WhoaMomma!'s Avatar Danielle
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I know some people who work as lobbyists for the AMA and both of my parents are physicians. All of them agreed that insurance companies will refuse to pay for procedures if they decide it wasn't the "right" way to go. They seemed to think that adding a "noncompliant" code to the bill would indicate to the insurance company that they were forced to go with a secondary treatment option because the patient would not agree to the standard recommendation - in the hopes that they would then actually get paid for it. There's so much wrong with the way health insurance companies work (case in point, my mom loses money in her OB/GYN practice for every pap smear she does b\c the insurance companies pay less than the supplies cost) that I don't really blame the AMA for trying to protect its members. I just hope that more people will start to realize how badly the system needs an overhaul so things like this are not necessary.

My daughter is perfect, but her birth was not. If you or someone you love is struggling to cope with a traumatic childbirth experience, please visit http://www.solaceformothers.org/
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June 20th, 2009, 12:48 AM
ShaunaB's Avatar Mega Super Mommy
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Tygrss & Danielle, thanks for your insights. I guess thus is just another case in point of how broken our system is.
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