Getting sucked into a jet engine is more likely than a person being transgender. At least, that's the story medical billing codes tell.
Though population health management is a major buzzword in the health care industry, there are practical details that are standing in the way of integrating the needs of the LGBT communities in New Jersey.
“Nitty gritty” practical issues have been preventing a true expansion of health care, said New Jersey physician Howard Grossman.
Changing billing codes and questions on electronic medical records, creating gender-neutral bathrooms and rearranging inpatient bed assignments are just some examples.
“It gets down to practicality and cost of changes for hospitals,” he said.
Another physician disagrees, citing examples of recognized medical centers in the state.
The Human Rights Campaign, which advocates for the LGBT community nationally, recognized several New Jersey medical centers for excellence in treating the LGBT communities, including AtlantiCare Regional Medical Center in Atlantic City, Reproductive Medicine Associates of New Jersey in Basking Ridge, VA New Jersey Health Care System in East Orange, Morristown Medical Center, Overlook Medical Center in Summit, Newton Medical Center, Goryeb Children's Hospital in Morristown and Shore Medical Center in Somers Point.
Overall, education about what the specific care needs are for LGBT individuals is what is lacking, according to Summit Medical Group LGBTI Director Tom Ziering.
He has been practicing for 27 years and, when he has been invited to guest lectures at colleges, he is surprised by how surprised many students are by the information he imparts.
He now works with the largest physician group in the state and is trying to, slowly, improve inclusion for LGBT patients.
After small lectures to his colleagues, he passes out rainbow pins — “because I’m gay and we all like bling” — as well as suggests physicians place the Human Rights Campaign symbol on a window or near the entrance.
It’s so “patients know this is a safe haven,” Ziering said, adding that he sees many doctors continue wearing the rainbow pins.
The Human Rights Campaign symbol became nationally recognized when it was used as the symbol for supporting marriage equality, before the Supreme Court ruled on that issue last year.
“For those who don’t know what it means, they are oblivious (to its presence at a doctor’s office); for those who do, it’s comforting and a signal they can come in,” Ziering said.
Grossman, a West Orange native, specialized in HIV treatment and worked in New York City for years before deciding to open the Alphabettercare practice in New Jersey in 2013. He said there was, and still is, a need for more LGBT or affirming physicians in the state.
On average, Grossman said he sees at least 200 patients per day at each location.
Ziering said he easily gains about five to seven new patients each week.
Most general physicians and OB/GYN specialists don’t know what to do and focus more on above the waist treatment, Ziering said.
“Down there, they get confused.”
Grossman said simple questions about sexual activity or dealing with inpatient care are hindering proper care.
“How to bed patients is an issue for hospitals. I don’t know why the other (patient) will be looking at this person’s genitalia,” Grossman said.
And the regulatory bodies aren’t entirely supportive of LGBT care, especially for transgender patients.
The current, and newest, billing codes, which were implemented by the federal government’s deadline late last year, still discriminate against transgender needs.
The codes were first implemented in 2013, and many efforts to improve access to and coverage for care have since changed, but the ICD-10 codes lag behind.
“It’s frustrating for transgender care because the coding for reimbursement does not have for hormonal (treatment) coverage,” Ziering said. “It’s supposed to be the latest. It’s insulting (to patients) and physicians have to jump through hoops.”
The only option is an adolescent treatment code, which doctors have to use for patients of all ages.
“There is a code if someone gets sucked into a jet engine and there is a code if someone gets bitten by an alligator. But there is no code for hormonal therapy. The only option is dysphoria of gender in adolescence. It’s a judgment word. I doubt there are very many people getting sucked into jet engines, but there are many who are not comfortable in their own skin,” Ziering said.
On the other hand, insurance coverage has improved in recent years, especially for important treatments such as pre-exposure prophylaxis, or PrEP, which Ziering said is recognized as a cure for HIV. If it were not covered by insurance, it could cost as much as $1,000 for patients, Ziering said.
Both doctors said they hope the trend towards inclusion and awareness continues.
“Those of us who are out practicing attract the LGBTI population,” Ziering said.