Wednesday, December 31, 2014

On the Insanity of Medicare

According to a 2002 GAO study, Medicare customer service representatives were wrong 85% of the time when providing answers to billing questions (hardly surprising in that the regs are so confusing) that had been posed by physicians (in a 2004 follow-up, that number had risen to 96%). So, yeah, being that a doctor can literally go to jail for billing incorrectly, it is hardly surprising that so many doctors are now either restricting services to Medicare patients or refusing to accept new Medicare patients. Nice, huh?


Jerry Critter said...

From the 2002 GAO study,

"The results of the test, which were validated by the coding expert, showed that 32 percent of the answers were inaccurate, 53 percent were incomplete, and only 15 percent were complete and accurate."

So, wrong really 32% of the time. Of course 32% of the time is not acceptable either.

The fault however is with the training, not Medicare overall. Hopefully things have improved, but money must be allocated to properly train people, besides simplifying the regulations.

But then, when people want to prove that government does not work, underfunding programs is one way to do it.

BB-Idaho said...

It's not just Medicare. A relative in Kansas reports that their physician has tired of any and all insurance, guv or private and is opening an office where the patient pays a monthly fee,
about $35. I'm thinking that Doc
will have to babysit a flock of

Jerry Critter said...

Also from the 2002 GAO study,

"Although CMS does not have a policy preventing them from doing so, managers at the carrier call centers we visited reported that it is not their policy to provide information to callers on how to code a specific claim. Carriers reported that they are reluctant to provide specific codes because the CSRs lack the medical expertise to appropriately make coding judgments, and they do not have the physician’s clinical documentation at the time of the calls to understand the procedure or service in context."

However, the questions asked involved specific codes. Perhaps they were set up to get them wrong.

Will "take no prisoners" Hart said...

Come on, Jerry. If it wasn't there policy do give out information they should have said so instead of giving out the wrong answer. And I'm sorry but incomplete is wrong (at least it was when I was in school).......And apparently things didn't improve in that the 2004 report was even more damaging.

Jerry Critter said...

Certainly they should be clear if they cannot give out code advice. And that raises the question, where can providers go to get coding help? Hopefully,maybe now, they have a resourse available.

If not, this is a short coming which could be easily fixed by Congress...if they would do their job!

dmarks said...

"But then, when people want to prove that government does not work, underfunding programs is one way to do it."

No, those who prove government doesn't work are those who have money shoveled at them and STILL do a terrible job.

Look here: the money being spent on it is soaring.


Anyway, Will, this is one of the reasons we do not need Medicare significantly expanded, and we don't need absolute government control of healthcare (single payer). This sort of thing happens when you get rid of all accountability.

We need many small players.

Rational Nation USA said...

Lack of proper training, attitude of not caring or not taking ownership, and no individual accountability all lead to incompetence.

Jerry Critter said...

"We need many small players."

Just how do we get that? Are you proposing that we break up the big players? As long as they are around, they will dominate.

Will "take no prisoners" Hart said...

Jerry, my proposal (an individual mandate for health savings accounts and catastrophic insurance, subsidies for the poor, and case management for the indigent) severely lessens the power of all intermediaries (both the government AND those dreaded insurance companies) and has the patients for the most part dealing directly with providers. It's a plan that will keep costs down through competition (as opposed to rationing) and give to the consumer much more power.

Will "take no prisoners" Hart said...

And I instruct you again to look at the cost curve of things like Lasik eye surgery (the cost of which has risen lower than the rate of inflation) and compare it to virtually every other thing in medicine. It's like night and day.

dmarks said...

Jerry asked: "Just how do we get that? Are you proposing that we break up the big players? As long as they are around, they will dominate."

Certainly the WORST thing to do is to further concentrate matters, such as the horrible mistake of total government control of healthcare (i.e. single payer). That's the wrong direction.

As for real solutions instead of the fascist wet dream of single payer, look to Will's for one example. While I am uncomfortable with mandates, there have be tradeoffs, and his mandate is much better than Obama's massive middle class tax hike mandate scheme. Will's solution, more importantly, gives the people more power, and gives those who rule over the people less power. And it bites into the fat bottom line of the commercial insurance giants. That's good too.

Will "take no prisoners" Hart said...

Actually I'm not a big fan of mandates, either, and would much prefer that the government get out completely but like you say, 'taint gonna happen.

Jerry Critter said...

So, dmarks, when you say, "We need many small,players.", you are talking about individuals, not insurance companies. You want to restrict insurance companies to catastrophic coverage, and have individuals self-insure themselves (Will's plan)?