Physician: “Since we’re not reimbursed for education, maybe we shouldn’t provide it.”
Physician: “Since we’re not reimbursed for education, maybe we shouldn’t provide it.”
Yes, I actually heard a physician say patient and family education is not necessary, since it is not reimbursed by third party payers.
Devil’s advocate or honest opinion? Does it matter?
Interesting assumption, there.
Only the things that are reimbursed are valuable.
If it is not reimbursed, it is not necessary.
Well, that doesn’t make sense. Try running a hospital without any nurses. After all, nursing care falls under overhead. Nursing is not reimbursed separately.
Or maybe the physician meant patient education is valuable, but if we intentionally don’t provide it the third party payers will soon recognize they should be paying for it.
But is it ethical, or even possible, to not provide patient education?
Can you hand someone a prescription and not tell that person what it is for or how to take it?
Can you tell someone surgery is scheduled, and not tell that person what it is for or how to prepare?
Can you give someone an injection and not tell that person it is coming or why?
Can you send someone home with oxygen, or a cast, or a central line, and not tell that person what to do with it?
And then there’s the assumption that we’re not reimbursed for education.
Being a hospital nurse, all I know about reimbursement coding is that it exists. I never had to deal with it. But a quick search on the Internet leads me to believe there may be a little money for patient education.
It appears that the CPT codebook includes the usual codes for consultation, which could include teaching, and items like:
Codes for teaching self-management of a patient’s illness or disease, or delay disease comorbidity.
98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver or family) each 30 minutes, for one patient.
98961 same for a group of 2-4 patients
98962 same for a group of 5-8 patients
It appears that HCPCS codes include:
99411 or 99412 – Preventative Group Medicine Group Counseling
99078 – Physician Education in a Group Setting
G0375 – Smoke/Tobacco counseling 3 to 10 minutes
G0376 – Smoke/Tobacco counseling more than 10 minutes
And that’s just from a search of the Internet. It appears you have to pay for a comprehensive list of reimbursement codes.
So what do you know about this? What do you think about this? Is patient education paid for under the current system of reimbursement? If so, is it enough? If not, should we stop teaching? Do you agree with the physician I quoted? In what way? Are there other reasons to provide quality patient and family education? What about all the Joint Commission standards for a safe discharge, relating to preparing the patient for self-care? Are there other benefits besides money?
3 Responses to “Physician: “Since we’re not reimbursed for education, maybe we shouldn’t provide it.””
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What about the costs incurred to the health care system when patient education did not occur or did not occur well – readmission rates, etc. Patient education may not be reimbursed, per se, however – not doing it, incurs significant costs – both to the well-being of the patient as well as financially to the health care organization.
Fran: This reminds me of an old saying, “if you think education is expensive then what’s the cost of ignorance?” or something similar. In healthcare I thinks it’s called frequent and quick readmissions, right?
Chuck
Fran:
The key is having some standardization of the curriculum, like diabetes does. This lends credence to having patient education managers who can work with staff to develop inpatient and outpatient education that works in those settings.
Sandy