Medicare, Medicare, Medicare. I know, we’ve had this hate-hate relationship with them for so many years. So many chiropractors are afraid of it and hate the reimbursement. I get it.
But…
You need to understand that Medicare drives this whole train. Everyone else follows Medicare. They created the documentation guidelines. They guide the CPT and ICD10 codes. So, instead of fighting them (and losing), how ‘bout we understand their perspective a bit more.
Medicare wants TWO things from us.
The first thing is PAIN. In 2009, the American Pain Foundation identified the following pertinent facts related to the impact of pain:
· 76.5 million Americans suffering from pain.
· Pain affects more Americans than diabetes, heart disease and cancer combined. It is the number one reason people seek medical care.
· Uncontrolled pain is a leading cause of disability and diminishes quality of life for patient, survivors, and their loved ones. It interferes with all aspects of daily activity, including sleep, work, social and sexual relations.
· Under-treated pain drives up costs – estimated at $100 billion annually in healthcare expenses, lost income, and lost productivity – extending length of hospital stays, as well as increasing emergency room trips and unplanned clinic visits.
· Medically underserved populations endure a disproportionate pain burden in all health care settings. Disparities exist among racial and ethnic minorities in pain perception, assessment, and treatment for all types of pain, whether chronic or acute.
Stewart et al. (2003) identified almost thirteen percent of the total workforce experienced a loss in productive time during a two-week period due to a common pain condition: 5.4% for headache; 3.2% for back pain; 2.0% for arthritis pain; 2.0% for other musculoskeletal pain.
What does Medicare want from us with regard to documenting PAIN? They simply want us to document a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present. There are a number of standardized tools that Medicare gives as examples, but the easiest and fastest is the Verbal Numeric Rating Scale. This is the familiar 0-10 scale, with 10 being the worst pain imaginable. Add to that the % of time the patient notices that condition, and you’ve got Pain Assessment locked up.
Be BulletProof.