Monday, April 14, 2014

Is it really a good thing???

By: Richard Stroud, MBA FACMPE
Practice Manager at UAB Eye Care

As you read this, a few weeks will have passed since H.R. 4302 passed the Senate and was sent to President Obama for signature. While there were sighs of relief from some, there were also some teeth-gnashing by others. As an administrator, I can see the benefits for some, and I understand the frustration of others.

When you review this legislation, you will realize that while the bill addresses several items, there are two things that really make you wonder. First, the “doc fix” has been addressed in the usual manner – TEMPORARILY postponing the impending Medicare Cuts to the fee schedule for another year. Second, the implementation has been postponed until at least October 2105.

The “doc fix” is almost becoming comical. This is not a new issue, as there have been discussions for over ten years about the “flawed” Medicare fee formula. At the base of this flaw is the Sustainable Growth Rate (SGR), which was implemented in 1997 as a part of the Balanced Budget Act. The intent was to force Medicare expenditures to be “budget neutral”, or to limit the spending per Medicare beneficiary so that it does not exceed GDP growth. While this is a noble goal, the issue is really not about GDP growth, but rather, the growth of Medicare beneficiaries. And, as many will tell you, it is a good political tool for candidates to use for election (or re-election). The interesting thing about the discussions is there appears to be a universal recognition that the formula is flawed. A “fix” has been proposed several times, but then is caught up in the addendums and never happens. So, to prevent Medicare beneficiaries from potentially losing access, Congress will step in to “save Medicare”. Good political fuel for the campaign. Congress has stepped in 17 times so far, and will probably continue to do so in the future.

The postponement of ICD-10 is also interesting due to the rhetoric that has been bantered about for the past few months. Make no mistake, the implementation of ICD-10 is a major shift in healthcare, it’s not just about coding. To implement such a change, there have been millions of dollars spent to accommodate this initiative. Software companies have had to invest in substantial programming to meet the October 2014 deadline as well, redesigning their databases to accommodate the additional space required and to be able to transmit data to the payors – which takes months to develop. Physician practices (both private and public) have spent an incredible amount of time and resources to be trained on the new system, knowing that this was a long learning process that could not be implemented overnight. In February, Marilyn Tavenner, CMS Administrator, announced there would be no more delays in the implementation of ICD-10. With barely seven months to go until implementation, the pressure was on for the health care system to be ready. This was very concerning for many (AMA, MGMA, and others), as this new process was lacking in confirmation testing or “end to end testing”. Many anticipated a potentially tremendous financial issue for health care providers if the system did not work. With the recent debacle with registration for the health exchanges, the worry was probably valid.

So, what happens now? Maybe it is time for everyone to take a step back and look at the “big picture” and then be realistic. While Medicare has been a welcome benefit for many Americans, it has also contributed to a wasteful healthcare system. Millions of dollars have been spent to be “in compliance” which could have been used for actual patient care. Physicians have worked hard (going to medical school, residency and maybe fellowship) to become a healthcare provider, a career that guarantees long hours, unreasonable expectations from patients, and other frustrations. I do not think anyone begrudges a physician that makes a good living considering the work that is involved. After all, there are attorneys and other professionals that are just as prosperous. But, the political impact on healthcare may also be the demise of healthcare in the U.S. At what point will physicians decide they have had enough, and tell Medicare “no thanks”? At what point will physicians do something about it, instead of waiting for “reasonable people to make reasonable decisions”? After all, we are talking about the federal government!

The business of healthcare is probably very confusing to the public. It is also very confusing and frustrating for providers. When thinking about healthcare, sometimes the “care” is lost in the chaos of the business. Providing compassionate, effective, efficient care should not be such a burden – but it is. Much of this burden has been created by the government –which while having good intentions, knows very little or nothing about the reality of healthcare. Healthcare has evolved into a “right” for all Americans. But, there is a price for this “right”, which tends to be overlooked. Just like any other service provided by society, there is a cost, which must be paid, at a fair market rate. And those that make the rules should be accountable for the chaos and waste they create.

So, you have read my opinion. What’s yours?

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