I’ve been an enthusiastic proponent of single payer health care – as long as that single payer is the patient. Especially in primary care, the patient is in the best position to determine the value of services received, and ensure that any money spent by them, or on their behalf, is proper compensation for a provider’s job well done.
In contrast to patients and doctors being accountable to each other, and patients being empowered to seek the best healthcare at the most competitive price, last week’s article in the American Medical Association’s American Medical News revealed the latest plan out of Washington fight our third-party payer system’s mathematically-driven demise:
Physicians would be given two months to return any money flagged as a Medicare overpayment from as far back as 10 years under a proposed federal rule.
When coupled with CMS’ recent criminalization of cloned documentation as grounds for denial of payment and recoupment of past payments, the proposed ten-year lookback period for payment recoupment becomes a potent weapon against the Medicare provider:
The proposal would require practices or auditors to report any overpayments that are discovered within 10 years of the date that the funds were received. The Centers for Medicare and Medicaid Services said the time frame is reasonable, allowing health professionals to close their financial books after the time period expires and not have ongoing liability. “We also believe that the length of the look-back period is long enough to sufficiently further our interest in ensuring that overpayments are timely returned to the Medicare Trust Funds,” the agency wrote.
While there are cases of Medicare fraud that deserve punishment, the current recovery audit (RAC audit) process is plagued with conflicts of interest, lacking in due process, and unfairly victimizes well-meaning physicians taking care of our society’s most vulnerable patients.
North Carolina’s former Academy of Family Physicians president Dr. Karen L. Smith is a good example of a physician trying to do everything right who was caught in a system where doctors are guilty until proven innocent, and systematically abused by an out-of-control bureaucracy:
How does extending the window of vulnerability for a practice to ten years – beyond when even the IRS cares about record retention – decrease health care costs, improve care quality, or increase access?
The answer, clearly, is that it doesn’t.
Further punishing providers serves only to reduce the accessibility of high-quality, affordable health care. Such a short-term solution is not even a “band-aid” – in reality, it’s more like trying to treat a headache by tightening a tourniquet around your neck.
While the mathematics of an aging population and exponentially-growing healthcare costs with growing disease prevalence demand drastic changes to Medicare and Medicaid, the fact is that we can improve access and decrease costs for all patients with a healthy dose of price transparency, patient accountability to improved health outcomes, and restoring the primacy of the doctor/patient relationship.
At Physician Care Direct, we encourage physicians to become accountable directly to their patients, and offer healthcare that is inherently affordable by avoiding the costs of coding, billing, and collections. Providing access to primary care – and outpatient healthcare in general – doesn’t need to be expensive. It’s just the way we pay for it makes it expensive.