Getting Control of National Health Care Costs

"Opinion"

08/18/2012

Paul Munnis


One of the scare tactics being used by Republicans to oppose Medicare is to say that doctors could stop seeing Medicare patients if it doesn’t pay them enough to make it worth their while.

What they are referring to is the initiative that Obama is exercising to end fraud, waste, and corruption, by some doctors and suppliers who file illegal, phony, and criminal medical charges against Medicare. Studies have shown this fraud amounts to billions of dollars annually and Obama has taken a strong approach to assure that the fraud is policed and that false claims are denied.

Some medical doctor’s object to this and also some medical suppliers object too.

Another aspect of Medicare payments deals with uptown, celebrity doctors who charge way above the going rate in their region for a given medical procedure. These Medical doctors are called: Uptown Docs and their fees are more than a standard deviation higher than the median rate for the region for that procedure; thus they bill outrageous fees for Medicare services.

Medicare has established a fee schedule, the doctors must accept it if they wish to be paid by Medicare, and many are unhappy about having their fees capped to prevent fraud on patient billing.

Yes, some doctors may chose not to see a Medicare patient over an issue of fee payment. But, the physician or supplier will be the loser for most medical facilities and suppliers depend upon volume for profit and when they drop Medicare services to patients then they are destroying their business by cutting their volume. That is not a good business practice and they are forced to watch their patients go elsewhere for affordable care.

What Obama is doing is what he was elected to do. Restore regulation and oversight to American medicine. The reason for his charge is that Americans are paying the highest cost in the world for medical care and often getting sub-par outcomes.

That leads to a third objection by some doctors, hospitals, and suppliers. Obama is demanding quality outcomes and does not want to pay for shoddy work or forcing a patient to come back ten times for what could have been treated properly on the first visit. This patient “swizzling” must stop and it too serves to cap Medicare payments to marginal physicians and facilities.

The savings from his efforts is freeing up money to close the donut hole and is making pharmaceuticals more available for many senior citizens. He is not cutting Medicare but he is cleaning up waste and redirecting the money to improve services.

Much of what has happened has come from an initiative from Mayo Clinic to focus upon quality care of patients and to reward it by denying payment to those not focused on quality patient care. They have lobbied Congressman Tim Walz on the matter and he has carried it forward in the House and it has lead to reform legislation and an upgrade to the Obama Care legislation known as the ”Affordable Care Act.”

We applaud the work being done in terms of supervision, oversight, and accountability by Obama and our Representatives as we work to achieve a national healthcare plan for America that s high quality and affordable.

Democrats will work to continue the good work.