Contrary to popular belief, the word "disinterested" does not mean
"uninterested." It means having no personal financial stake in the
resolution of an issue. But "disinterested" doesn't mean you can't get
passionate about something. And of all the issues that exercise your
(retired from active practice) Medicine Men, this is among the greatest:
The more medicine there is, and the better it gets, the harder it becomes
for people to access it. Not just because of cost or insurance (or lack
thereof), but because the federal government makes it so by straitening and
attacking the providers.
Straitening and attacking them to the point where more and more physicians
are opting out.
The year 2006, like most years, has been one of great advances in medical
diagnosis, therapy and futuristic medical technologies. However, these
advances may never reach those who need them most, the elderly, if many more
practicing physicians choose to opt out of Medicare.
In a few years, millions of covered patients may find themselves doctor-less
or, almost as bad, served by physicians and organizations overwhelmed by
patients.
In the past we have written endlessly (or so it sometimes seems) about
burdensome federal red tape, paperwork and controls: HIPAA, onerous Medicare
regulations, limitations on prescribing legal pain medications, and the
cutting of already inadequate reimbursement. Here we take our customary
swipe at the lawyer legislators who churn out these fetters, pausing only
long enough to note that, more and more, Congress is home to former
prosecutors - and the "guilty until proven innocent" mindset they so often
seem to carry.
Now, however, comes the congressional "enforcement" scheme that may lower
your life expectancy, hurt your health and drive your doctor into early
retirement or some other line of work.
Please pardon the pun, but the fed. may well end up breaking American
medicine on the RAC.
"RACs" are Recovery Audit Contractors, private entities paid by the
government to audit Medicare Claims, including Part A, Part B and home
health care and hospice services. Fair enough: auditing is a legitimate
government function. But "RAC's" are paid on a contingency fee (plus bonus)
system: The more "fraud" they find, the richer they get, and this applies to
both overpayments and underpayments. These include alleged unnecessary
treatment, improper coding and various technical secondary payer issues.
However, the AMA (no enemy of the government) has complained that RAC
methods are draconian and time-consuming and that, because of the monetary
incentives to find malfeasance, they're essentially bounty hunters. Many
providers also complain that RAC auditors don't understand complex and
endlessly changing Medicare rules and are not qualified to pass on medical
necessities since they're not physicians or specialists themselves.
Imagine somebody with no knowledge of automotive mechanics, and who hasn't
even seen your car, passing judgment on what repairs were necessary and what
they should have cost.
It gets worse.
The new Congress, controlled by Democrats, is expected to ratchet up
"enforcement." Among the anticipated changes: greater reliance on civil
monetary penalties over criminal action. Although this sounds like an
improvement, it is not. The standard of proof is less in civil actions,
-preponderance of evidence," not beyond a "reasonable doubt" and in this
case it's far more lucrative for the government to haul in the cash than
haul off the bodies. Also, such cases go before an administrative law judge,
where there is less due process for the physician or provider.
And, of course, should Senator Clinton find herself back in the White House
in 2009, this time as a salaried government employee, can another push for
full state medicine be far behind?
So what we have here is yet another imminent attack on the medical
profession's ability to provide adequate care.
But there's a saying in Washington, DC: "Nothing succeeds like the right
kind of failure." Ever since 1965, every time a federal medical program has
gone wrong or costs exploded, the federal answer has been, more laws, more
regulations, and more programs. Set up an impossibly complex, unworkable
system, then punish people for not being able to abide by it. A perfect
prescription for wrecking the system in order to take it over.
Or, as the Vietnam slogan went, "We had to destroy the village in order to
save it."
Editor's Note: Michael Arnold Glueck, M.D. wrote this week's commentary.
