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The NPI and One DDS’s Opinion

6 Responses

1. Griff Murphey DDS, on August 31, 2008 at 4:26 AM said:

   As a dentist, I already had a state license number, a DEA number, a State Narcotics control number, a social security number, a Tax I.D. number, and that wasn’t enough. Someone decided I have to have an N.P.I. number.

   But you know what, I still get asked for those other numbers and have to pay for three of them, annually. I just think it’s bureaucratic nonsense. It’s like, I’ve been in practice 34 years, and I have to justify myself on a daily basis. Its’ the “Who the heck are you”, sort of idiocy!

   Best.
   -Griff

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2. Darrell, on December 14, 2008 at 7:38 PM said:

   Trapping Scott Serota – CEO of BCBS
   By D. Kellus Pruitt; DDS

   I posted this on PennWell, as well as on Anne Zieger’s FierceHealthIT blog in response to her comment about BCBS.
   http://www.fiercehealthit.com/story/spotlight-bcbs-association-plans-healthcare-it-reforms/2008-12-08#comment-565

   The title of Anne Zieger’s lead, which describes an article on Healthcare IT News, is “SPOTLIGHT: BCBS Association plans healthcare IT reforms.”

   Should BCBS plans cause doctors and patients concern – Judge for your self?

   I read the article written by Dana Manos a couple of times. It is obvious that Scott Serota, president and CEO of BCBS of America, is scared. His insensitive arrogance reminds me a lot of another struggling CEO, Glen Tullman of Allscripts.
   http://community.pennwelldentalgroup.com/forum/topics/glen-tullman-ceo-of-allscripts

   Like Tullman, Scott Serota’s timing and sense of urgency betrays to attentive and active analysts like me that the government is not moving fast enough to suit Blues’ business plan to cut out a nice profit from patients’ healthcare dollars and call it “reform.” To understand their quiet crises better, here is some background information about semantics. The nature of the noun “reform” is different than the noun “transparency.” “Reform” can be used as a buzzword.

   Of course, one could argue that Serota is very transparent in his plans to use the immense size of BCBS to force change. One should not confuse transparency with common Bush-league intimidation. Surely by now everyone recognizes that BCBS cannot tolerate accountability to doctors and patients – and transparency is exactly what Obama brings. If you have not done so yet, visit Obama’s website Change.gov.
   http://change.gov/newsroom/blog/

   Now imagine how obsolete traditional silence will look when sleazy tactics from BCBS are openly discussed on future HHS Secretary Tom Daschle’s blog – by thousands of angry providers and patients. There is already a long backlog.

   Serota is running scared all right. BCBS’s business model matured in obscurity and is classically soft. It is just one more fat, slow-moving and unresponsive dinosaur on the verge of extinction. I’ll prove it. It may take a week or so. I got a head start working on the monster’s tender spots a while back in an article titled “The NPI and One DDS’s Opinion” that is posted on the Medical Executive-Post blog. It has proven to be very popular.
   https://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/#comment-2075

   Not unexpectedly, nobody from BCBSTX has yet found the courage to defend their employer. I think that means Scott Serota is also vulnerable. He is defenseless by association. Transparency to BCBS is like water to the Wicked Witch of the West.

   For the immediate future, not one person in the whole organization can be held accountable to providers, yet “Pay for Performance” – an substitute for our free-market system – is one of the five initiatives stressed by Scott Serota to attendees at the e-Health Initiative’s annual conference earlier this month – an enthusiastic collection of healthcare IT stakeholders and hobbyists.

   Here is my open challenge: Scott Serota, please come defend yourself right here on Anne Zieger’s website. I’m sure she won’t mind, and it would improve your reputation with doctors.

   Unless you haven’t heard, it stinks and will get exponentially worse very soon.

   Note: Dr. Pruitt blogs at PenWell, and others sites, where this post first appeared.

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3. Dr. Pruitt, on April 1, 2009 at 12:09 AM said:

   A HIPAA question answered

   So how many dentists in Texas have NPI numbers? 7,313, including specialists.

   This morning, a friend referred me to a handy Healthcare IT Transition Group Web site that provides a compilation of NPI adoption by providers nationally and state-by-state.
   http://www.npidentify.com/stats.htm#states

   I copied below the numbers for dentists in Texas, broken down by specialty. It appears that some dentists are counted twice because the total number of dentists with NPI numbers is close to 14,000. According to a pleasant person I spoke to at the dental licensing department, there are only 11,203 dentists in the state as of March 18, 2009. (She added that the number is growing every day).

   ———————————-
   Total number of dentists in Texas who have NPI numbers, broken down by specialty:

   122300000X Dental: Dentist 3,328
   1223D0001X Dental: Dentist: Dental Public Health 44
   1223E0200X Dental: Dentist: Endodontics 285
   1223G0001X Dental: Dentist: General Practice 7,313
   1223P0106X Dental: Dentist: Oral and Maxillofacial Pathology 69
   1223P0221X Dental: Dentist: Pediatric Dentistry 606
   1223P0300X Dental: Dentist: Periodontics 355
   1223P0700X Dental: Dentist: Prosthodontics 210
   1223S0112X Dental: Dentist: Oral and Maxillofacial Surgery 525
   1223X0008X Dental: Dentist: Oral and Maxillofacial Radiology 15
   1223X0400X Dental: Dentist: Orthodontics and Dentofacial Orthopedics 837

   I assume that the largest category for both the state and national level, “1223G0001X – General Practice,” probably represents the catch-all category, including the specialists.

   According to the HIT Transition data, there 7,313 Texas dentists who have NPI numbers, out of a total of 11,203 dentists in the state.

   This means that 34% of dentists in Texas do not have NPI numbers.

   Therefore, if an employer purchases a dental insurance plan as an employee benefit, and the plan requires an NPI number from dentists to process their employees’ claims, as does BCBSTX, then the insurance is worthless in one-third of the dentist offices in the state. Do you think BCBSTX salespeople inform their clients about this? I don’t.

   I consider this to be extremely important news that employers, insurance companies and consumers throughout the nation need to know immediately. I already informed Mr. Patrick Cannady in the ADA Department of Dental Informatics, so I expect them to be posting an article written by Arlene Furlong in the ADA News Online about this within a week. It would be oh so stupid not to.

   Nationally, the “General Practice” category lists 115,882 dentists who have NPI numbers. I have asked the ADA for an approximate number of the dentists in the nation, but sometimes it takes them a while to get back to me with information I request. I have heard an estimate of around 160,000. If so, this means that 28% of dentists nationally do not have NPI numbers. I’ll do my best to get the word out, especially to insurance executives who might otherwise consider playing NPI games of their own.

   Though one may hear differently from insurers, the NPI is a meaningless and cruel stakeholder gambit that will fail soon, starting in dentistry. As usual, calculated regulatory greed benefits big business as much as it harms consumers. Unfortunately, corporate greed in the insurance industry always harms the voiceless poor the most. For example, in Texas, for a dentist to treat CHIPS or Medicaid patients, he or she is required to have an NPI number. As of today, even a couple of people in Congress know that this means one-third of the dentists in Texas are out of reach from the pool of providers who can help the poor. For what?

   Even before dentists’ payments are delayed by foul-ups with the NPI number on NPPES crosswalks, the NPI limits access without offering any benefits to the patients. Doctors, read this carefully: When a provider voluntarily obtains an NPI number, the act is counter to the Hippocratic Oath. There is no way around that fact.

   In your heart you know that we owe our patients 100% loyalty. Mandate or not, there is no room between a doctor and a patient for a ten-digit number.

   D. Kellus Pruitt DDS

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4. Darrell, on July 28, 2009 at 3:09 AM said:

   Healthanddental’s conflict of interest

   Dear Editor, Healthanddental, whoever you are:

   It’s been over three days, and nobody from your blog has come forward to acknowledge two straightforward questions that I posted in response to your article, “Do I Need a NPI Number?”

   http://healthanddental.livejournal.com/1282.html

   1. How does the NPI number improve dental care?

   2. What happens if I don’t sign up for one?

   Why the delay, Mr. Editor? You are sincere when you request comments, aren’t you? And how come both you and the author of your article hold yourselves anonymous? Here’s what I think: Like you, the author doesn’t want to be trapped between an advertiser and honesty – exactly where you find yourself today. So what are you going to do to get out of this mess? Do you think it will just go away?

   I’ve witnessed your type of fear of accountability before. I think anonymity is a natural, protective reaction to garden-variety conflict of interest that occurs when advertisers control a blog’s content – even while the editor pitifully seeks respect from colleagues, friends and family. I suggest that since the marketing vice president at Affordable Health Plan, whose name I also don’t know, pulled you into this disaster, you invite her (?) to help you develop well-considered answers to my two questions. They are indeed trickier than they might appear to those who are uninformed – such as naïve dentists you accepted money to deceive. Then listen for sounds of evasion just before the exasperated officer reminds you how much she pays your blog each month.

   Whoever you are, I know very little about you. But I do know this: Your bargaining position blows. Even if you choose silence over standing up for your honor, I’ll come up with creative ways to have subversive fun with your Website – indefinitely. The only road to repentance for your ethical sin is to tell us the truth about the NPI number even if it means losing an account or two. You know what I am talking about, Editor. (And just so you know that you are dealing with a special bastard, if you don’t play my way, I hope to help sink your business. I don’t like you).

   Healthanddental, you have your nation-wide attention now. Is there anything you’d like to say to me? (No phone calls, please).

   On behalf of interested dentists and physicians who are already following our conversation on PennWell and Medical Executive-Post, I bid you welcome to our neighborhood.

   And please pay attention: It is in your interest to provide a real name. I prefer not to have conversations with anonymous editors because I have found that such encounters always end badly, if entertaining. By our next meeting, if you need a default name, I’ll assign one. How’s “Chuck” sound to you?

   D. Kellus Pruitt; DDS

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5. D. Kellus Pruitt DDS, on December 8, 2011 at 1:10 PM said:

   The NPI Deception

   Remember my annoying conspiracy theory about the NPI number? Well, I told you so. “Using Medicare data to rate doctors gets approval” by Ricardo Alonso-Zaldivar was posted yesterday on SFGate.com.

   http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/12/05/MNOT1M8IG3.DTL

   “Picking a specialist for a delicate medical procedure like a heart bypass could get a lot easier in the not-too-distant future.

   The government said Monday that Medicare will finally allow its extensive claims database to be used by employers, insurance companies and consumer groups to produce report cards on doctors – and improve current ratings of hospitals.”

   Doc, if the US Department of Health and Human Services, insurers and other ambitious dentalcare stakeholders were to ask your permission to both determine your value to society by data-mining dental claims you’ve submitted and to then share your “report-card” with potential patients via the internet on an HHS-sponsored site – would you knowingly grant them permission? How about unknowingly?

   The “NPI Times” was a cheerful but short-lived monthly pamphlet published by BCBSTX with healthcare dollars and mailed to thousands of Texas dentists between 2006 and 2008. It was intended to persuade slow-moving dentists like me to quickly sign up for National Provider Identifier numbers – a goal shared by the Texas Dental Association Board of Directors for reasons they might never reveal to membership. Even though BCBSTX is a non-profit organization, the four-page brochure resembles expensive, professional-quality newsletters that some dentists use to attract patients. However, there was nothing attractive about the tone of NPI Times.

   The headline on the front page of the December 2007 edition announces: “All providers — including non-contracted providers — must share and use their NPI!” Providing balance to the tyranny of the lead article, with the sincerity of a happy face sticker, is a cheerful “Best Wishes for a Healthy New Year!”

   On page 3, there appears an article admonishing dentists to “Make sure tomorrow’s claims get paid. Share your NPI with BCBSTX today!” Then, at the bottom of the article in bold italics: “Claims submitted to BCBSTX without an NPI as of January 7, 2008, will be rejected.”

   Those who have been following me for a while, may recall that I alone – against resistance from the TDA – made such a huge public fuss about BCBSTX’s capricious NPI requirement that BCBSTX officials ultimately chose to abandon enforcement. I remember it as my first tangible win, occurring a year into the adventure.

   Like other ADA members, you might have signed up for an NPI number after reading staff writer Arlene Furlong’s encouraging articles in the ADA News. While BCBSTX threatens to withhold payment of claims, the only reason Furlong ever gave for adopting the NPI was to replace all those other identification numbers required in order to be paid by insurers. Since nobody has ever suggested that the NPI improves patient care, renegade ADA officials who promoted it were acting outside the mission statement of the professional organization, deceiving dues-paying members and violating the tenets of the Hippocratic Oath… And for what?

   Just like physicians, by signing up for NPI numbers, dentists unwittingly give healthcare stakeholders control of their reputations, and thus their career paths. What’s more, the “voluntary” NPI number that ADA officials still refuse to discuss with the dentists they tricked, is PERMANENT. If you back out now, you can be certain that your “non-compliance” will look bad on your report card, forever. It’s far better not to have a report card at all if you haven’t yet volunteered.

   Like I warned 5 years ago, when a dentist accepts an NPI number, he or she allows insurers to determine their value rather than the free market. Are you OK with that?

   D. Kellus Pruitt DDS

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6. D. Kellus Pruitt DDS, on January 6, 2013 at 1:59 PM said:

   The NPI snuck up on us, Doc

   I would like to point out that other than on Dental Speakers Linkedin Group, nobody in dentistry is interested in exerting thought on the National Provider Identifier – even though 96% of dentists have one and very few even realize it’s a HIPAA requirement.

   The almost complete success of the ADA Department of Dental Informatics’ ambitious efforts to sign up every dentist in the nation is a testament to the blind trust once enjoyed by ADA leadership. When dentists obediently applied starting years ago, they were not told they consented to 3rd party quality control measurement and reporting – now a part of ARRA Stage 3 Meaningful Use requirements, which have also not been discussed with membership. I first learned about the ADA’s secrets from a courageous employee in the Informatics Department around 2006. Since then, I have been observing with increasing fascination how long ADA officials can stoically ignore the shameful consequences of the worst blunder in the history of the dental profession.

   As anyone can see, if intentionally clueless dental leaders whom dentists personally trusted had been capable of telling their friends the truth, the vast majority of dentists in the nation would have never volunteered for the PERMANENT identifier. So instead, self-serving ADA employees in the Department of Dental Informatics used ADA publications to trick those whose dues funded the expansion of their department. The ADA News did its part by telling members that their modern 10-digit identifiers would replace all other identifiers (which it didn’t), and that most importantly, “The NPI is free!”

   I’m hardly a legal scholar, but I suspect it was fear of criminal prosecution for depriving dentists of one or more Civil Rights which prevented HHS Secretary Michael Leavitt from simply assigning us NPI numbers – which will inevitably harm the reputations of the majority of the nation’s dentists simply because logically, only a small minority of dentists can receive an A on their internet report cards.

   For young dentists fresh out of school who are tempted to work faster than you should for low fees offered by managed care organizations – especially Medicaid – it is important for you to always do your best work and to try to instill good brushing habits. Like my friend in the ADA Informatics Department, dental benefits executives have also been long aware of coming opportunities for 3rd party control of dentistry allowed by the amended HIPAA Rule. Their algorithms have been grading dentists’ work based on data mined from claims for decades in anticipation of the day when HHS grants them the power to leverage steeper discounts from dentists with bad grades on their internet report cards. They might even call it “Pay-for-performance.”

   It’s only fair that I warn young dentists that your future, publicized value to your community is already being determined from claims you submit. It’s unjust, but the longevity of the restorations you place in mouths of poor children with cariogenic diets and poor oral hygiene habits will inevitably be compared to the lifespans of restorations performed by dentists who are paid enough to invest the time that successful handwork requires, and still make a profit.

   D. Kellus Pruitt DDS

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