Dhruv Khullar on overdiagnosis

David Ryon dyspneadoc at AOL.COM
Mon Nov 19 18:55:03 UTC 2018


To answer Dr. Bell, 
Current E/M coding for office visits offers some incentive for listing more than one diagnosis, as this makes the case more complex. 
It is anticipated that CMS will be simplifying the documentation and billing process, which will actually de-incentivize extra effort on a given case.
So, if there is presently a problem in incentivizing over-diagnosis, this should change soon.

Sent from my iPhone

> On Nov 14, 2018, at 1:11 PM, Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
> 
> Thanks Helen,
> 
> Important post.
> 
> Is money a driver for any of these diagnoses?
> 
> Which brings up the argument as to how big an issue money is in the diagnostic process. 
> 
> Many years ago there used to be concerns in the medical community about certain surgical procedures being done so frequently by some.
> 
> Is there literature that discusses the influence of money on diagnosis and has SIDM ever considered it in their positions and writings?
> 
> Rob Bell M.D.
> 
> 
> 
> On Wednesday, November 14, 2018, 9:04:11 AM MST, Helen Haskell <haskell.helen at GMAIL.COM> wrote:
> 
> 
> https://www.nytimes.com/2018/11/06/well/live/a-profusion-of-diagnoses-thats-good-and-bad.html
> 
> "A central problem is that medicalized diagnoses often come with medicalized treatments: Our penchant for pills outstrips even our desire for diagnosis. Since the 1990s, the number of office visits for sleep problems has doubled, and diagnoses of insomnia have increased sevenfold. But prescriptions for sleep medications have increased more than 30 times.
> 
> This is perhaps most concerning for children. About 12 percent of children in America now carry a diagnosis of A.D.H.D, and there was a 40-fold increase in childhood bipolar disorder diagnoses between 1994 and 2003. Five times as many children are now prescribed psychostimulant and antipsychotic medications as were in the 1980s. Today, a quarter of children and teenagers take prescription drugs regularly, and seven percent of older adolescents and young adults report abusing opioids — most of whom were initially prescribed them by a doctor."
> 
> Also Lown:
> https://lowninstitute.org/news/blog/when-diagnosis-becomes-dangerous-a-taxonomy-of-medicalization/
> 
> "More newly recognized diagnoses is not inherently a good or bad thing. But we need to look deeper at this pattern – who is creating these diagnoses, who they are affecting, and how they are treated – to better understand how some diagnoses can be helpful and others harmful."
> 
> 
> 
> 
> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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