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medpundit |
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Friday, August 23, 2002I’m not so sure about that. I believe that each individual physician has a duty to provide care to someone in clear need regardless of race, politics, or ability to pay; but no one is obligated to provide free or discounted care to those who don’t need it. That’s the problem with our system today. Somewhere along the line, we’ve devolved from a system in which charity care was reserved for those who were deserving of charity, to a system in which everyone is considered deserving of charity, regardless of their ability to pay. How else to explain this letter in response to the “luxury care” article from two Palm Beach matrons? We cannot believe that this kind of medical practice is legal. As Medicare patients, we are entitled to access to our physicians with nothing more than a 20 percent copayment. That last sentence says it all. Even our wealthiest citizens feel themselves entitled to discounted healthcare, and it’s all Medicare’s fault. Medicare was designed to help the impoverished elderly, but it has expanded into an entitlement program non pareil and into a regulating body whose power over doctors and hospitals is nothing short of tyrannical. Consider the history of “balance billing.” In the beginning of Medicare, doctors were allowed to bill patients for whatever part of their usual and customary fee was not covered by Medicare fees. That reasonable measure fell long ago to the sword of Medicare regulations: Medicare in particular has been hostile to balance billing. At one time, balance billing of Medicare beneficiaries was the norm, and physicians could bill patients for the portion of fees Medicare did not cover. To counteract this practice, Medicare has gradually introduced penalties for physicians who do not accept the Medicare reimbursement as full payment, and today most physicians are not allowed to bill patients for the balance. Medicare has pursued this policy for a number of reasons. First, Medicare wants to keep health care costs for its beneficiaries under control. In addition, Medicare has strived to create what it believes to be an adequate payment system, a perception that would be undermined if balance billing were allowed. In many states, commercial insurers and Medicaid programs have followed Medicare's lead. For example, in Massachusetts, the state-regulated Blue Cross program successfully lobbied for a ban on balance billing. The legislature also imposed balance-billing bans for Medicaid. Many commercial insurers include a prohibition of balance billing in their terms of participation for individual physicians. Thus, providers are often not able to obtain their usual and customary fees by charging patients the balance for a service once the insurer has paid its share. Medicare sets the sub-standard of reimbursement by which all the other third party payers live. Now, not only do Medicare beneficiaries think of health care as an entitlement for which they owe nothing, but the insured feel that way, too. The only people in this country who have to pay for their healthcare now are those who are unfortunate enough not to have insurance, yet not unfortunate enough to qualify for Medicaid. They are the least able to afford it, and are in truth more deserving of discounted fees than the insurance companies and government. That’s the crux of our problem. Our professional relationship and duty is with the patient, but our financial relationship is with these large corporations and government bureaucracies, who don’t care a fig for the patient or their health. The patient, in turn, doesn’t care a fig for the cost. It’s time we recognize that not everyone is equally deserving of medical charity and return the financial responsibility of paying the doctor where it belongs - with the patient. I’ll leave you with a few other select comments from the letters inspired by the article: The current system of primary care is the creation not of doctors and patients, but of those who pay for care — in general, insurance intermediaries acting on behalf of employers or governments. -a group of doctors who are practicing luxury care Certainly, most people believe that food and shelter are more important than medical care, yet there is no expectation that builders have an obligation to provide for the equitable distribution of housing or that supermarket chains have an obligation to provide for the equitable distribution of food. - a Boston physician Finally, could you comment on the 13th Amendment to the U.S. Constitution and its applicability to persons holding the M.D. degree? - a Virginia physician Medicare Part Deux: Not only is Medicare a tyrant when it comes to setting physician fees, they also are a very punitive organization, accusing doctors of fraud if they disagree with a chosen billing code for a patient visit (also known as an “evaluation and management, or “E/M” code). A reader e-mailed an article from the Annals of Emergency Medicine which proves what physicians have long known - Medicare’s coding system for billing services is needlessly confusing and complex. Even coding experts can’t agree on proper codes for visits: To determine the reliability of the federal government's E/M coding system, Raymond E. Jackson, MD, and his team of investigators from William Beaumont Hospital System in Royal Oak, Mich., sent emergency department medical records to several coding specialists to determine their level of agreement in assigning codes. Two sets of charts were sent to multiple specialists at four different coding agencies (inter-agency) and a third set was sent to several coding specialists within the same coding agency (intra-agency). The records were blinded so coders were unaware of what codes others had assigned. ...The study shows poor agreement among coding specialists on which codes they assigned to emergency department medical records. In 6 percent of the medical records, the study found no agreement at all among the four different coding agencies, and in only 15 percent of the cases did coding agencies have complete agreement. (emphasis mine) Remember that the next time you read about a hospital or physician being accused of “fraud”. posted by Sydney on 8/23/2002 06:23:00 AM 0 comments 0 Comments: |
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