Medicare Bills Rise As Records Turn Electronic 294
theodp writes "As part of the economic stimulus program, the Obama administration put into effect a Bush-era incentive program that provides tens of billions of dollars for physicians and hospitals that make the switch to electronic records, using systems like Athenahealth [note: video advertisement] (which made U.S. CTO Todd Park a wealthy man). The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis. There are also fears that features which can be used to automatically generate detailed patient histories and clone examination findings for multiple patients make it too easy to give the appearance that more thorough exams were conducted than perhaps were. Critics say the abuses are widespread. 'It's like doping and bicycling,' said Dr. Donald W. Simborg. 'Everybody knows it's going on.'"
Sounds like... (Score:2, Informative)
Mission Accomplished!
Medicare fraud is not new (Score:5, Interesting)
Medicare fraud is not new. It existed way before electronic records.
Florida's governor, Rick Scott's company committed medicare fraud way before electronic records were introduced.
Electronic records should make it easier to detect medicare fraud, as statistical analysis is much easier with computerized systems.
Re: (Score:3)
The problem here isn't exactly fraud, it's that the 'optimization' of billing codes allows them to go right up to the line but not over. It's the closest thing to fraud there is without actually being illegal.
Re:Medicare fraud is not new (Score:5, Informative)
Because the whole system is idiotic. It's not like doctors and hospitals have prices for (non-emergency) procedures, tell you what those prices are in advance, tell you what the procedures they will be performing on before in advance, and get agreement on price before doing anything. They don't even do so much as give you an estimate.
No, instead, assuming an insured patient, they do an exam and get a flat fee from you. Then depending on what they did during the exam, they bill for everything they did (according to the standard set of codes) at some totally fictitious rate that maybe one sucker in a million pays. The insurance company or Medicare then looks at what they did (according to the codes), ignores completely the amount they charged, and pays them whatever they, the insurance company or Medicare, feels like paying. So basically, a doctor who doesn't code the most expensive codes he can based on what he did is leaving money on the table for no reason.
Re: (Score:3)
It's not like doctors and hospitals have prices for (non-emergency) procedures, tell you what those prices are in advance, tell you what the procedures they will be performing on before in advance, and get agreement on price before doing anything.
They are starting too. [latimes.com] Ironically, it seems like Obamacare is indirectly the cause of this change.
Re: (Score:2)
Just saw Pokidok [pokitdok.com] on Boing Boing.
It's kind of a crowd-sourced price-list of cash prices for treatments.
Re:Medicare fraud is not new (Score:5, Insightful)
I have no problem at all with free healthcare providing a safety net for those who can least afford it. Indeed, I find the escalating costs of the US's private health insurance system quite scary and it is not sustainable at all. However, if you're going to have a publicly backed health system then have it within a public sector organisation with a proper mandate. Mixing public sector planning with public sector printed cash and the private sector simply results in private companies and those who make public sector buying decisions getting drunk on printed cash at taxpayer's expense. The whole fraudulent system is based around how big everyone feels they can make the numbers on their invoices because they know the government can always print more, and everyone knows that is the case with Medicare.
Re:Medicare fraud is not new (Score:5, Informative)
Then depending on what they did during the exam, they bill for everything they did (according to the standard set of codes) at some totally fictitious rate that maybe one sucker in a million pays.
Furthermore, insurers typically calculate their reimbursement for procedure #123 based on a percentage of the average "retail" price of procedure #123 across all physicians in the local area. For instance, say the average price for a strep throat exam in your suburb is $100. An insurance company might say that they'll reimburse at 40% of the local rate for a billing code, so any given doctor will get paid $40.00 for that exam whether their invoice price is $20 or $200. Is your doctor a med school near-dropout or the guy who invented the exam procedure used worldwide? Doesn't matter. $40.
Because of that, doctors almost universally raise their rates regularly, not to increase the amount they'll get paid for each invoice but to bring the local average rate up. In case you're wondering, that 40% in the example is particularly generous. Most insurance companies reimburse at significantly lower multiples. Medicaid has notoriously horrible reimbursement rates, to the point that my wife (a podiatrist) would literally get paid less for many common procedures than she spent for consumable supplies. Every patient she treated like that took money out of her pocket - it's hard to make money when you get paid $15 to do a procedure that costs you $20 to perform (assuming your time is free) - but she saw them anyway because she feels morally compelled to help sick people regardless of their circumstances.
Re:Medicare fraud is not new (Score:4, Insightful)
Yup, 40% definitely seems high based on the ton of medical bills I've seen paid.
I love it when people say that if you pay cash the doctor will give you a big discount since it saves them a lot of hassle. The big discount turns out to be "OMG 40% off retail!!!" That means that you're paying 60% of retail, or likely double what any insurance company would pay.
If I were in charge of health care reforms the first reform I'd enact is that EVERYBODY pays the same thing for the same service. Doctors would register their prices by ICD9 or whatever in some central database, which would be publicly viewable. Oh, and doctors wouldn't be able to collect a penny without having an estimate signed off before any work was done - just like how virtually every other industry works. Oh, and while you're at it if the customer isn't handed a copy of the chart on the way out the door, then the work is free.
Re:Medicare fraud is not new (Score:4, Insightful)
No doubt. But I live in the wonderful USA, where medical billing is like people haggling over a Honda Civic and the dealer is asking for $400k, and the fleet buyer is looking to spend $19.95 but pays $10k, and the dealer tells some poor bum who walks in off the street that because they're in so much need that they can have the car for only $80k.
Re: (Score:3)
Re: (Score:2)
More and more things move this direction. Compliance with different filing requirements for any small (incorporated) business are a mess, so a business with gross revenues of $100k needs to spend $2-10k in managing all the filings. The question becomes twofold: does this filing serve a useful purpose, or is it excessive regulation. I am starting to think the latter; if you are doing electronic filings, use them to simplify the process.
Re:Medicare fraud is not new (Score:5, Insightful)
Also, the 'issue' at hand is about $3.33/citizen. That means its a tornado in a teacup like th 12 milion dollar muffins.
300BN fighter jet programs are $1000/citizen, and considering our absurd power, are much more worth PRIORITIES in what may be a 'issue' of waste.
This is silly (Score:5, Interesting)
I gotta ask (since I'm far too lazy to read the article): Is this a lame attack on the existing administration?
Is this a lame attack on the current admin.... (Score:2)
Re: (Score:3)
That said, it's tough to say. But I think it's been pointed out that electronic bill
Re: (Score:2)
Re: (Score:2)
I think the Times used to worship President Obama but now they think he's far too conservative. They'd really like someone along the lines of Nancy Pelosi or Cynthia McKinney.
Re: (Score:2, Insightful)
You lose credibility when you call the largest television news network, owned by the largest media company, non-mainstream.
Re: (Score:3)
You lost all credibility when you can't tell the difference between a business news channel and the mainstream media outlets. Mainstream by default would not be limited to business news. Fox news would be mainstream, fox business channel would not be. It is a niche channel trying to focus on a portion of news like ESPN news is a niche market focusing on sports.
Re: (Score:2)
Interesting... I cannot tell whether you are making a joke or not.
In case you are not, you might want to stop drinking the kool-aid.
Re: (Score:2)
it's already been established that moving to electronic records helps track Medicare fraud. Yes, the system has a lot of gaps, but electronic tracking reduces them. If that wasn't true companies wouldn't use electronic purchasing systems to track expenditures, and the spreadsheet would just be an interesting foot note in computer history...
True, but as organizations such as anonymous and other hacker groups frequently show us they also help make fraud easier. It's very much a double edged sword.
I gotta ask (since I'm far too lazy to read the article): Is this a lame attack on the existing administration?
I didn't get that impression. They mention the Obama and Bush administrations together since both were pushing electronic records. I think if it were a political attack, you wouldn't see dubya's name on it.
Re:This is silly (Score:5, Insightful)
OK, a lot of this came about due to HIPPA, the Health Information Portability and Privacy Act. At the time HIPPA went into effect, private insurance paperwork ('administration costs') for medical costs were running 30-35% of every healthcare dollar spent, while with Medicare, the paperwork costs were only about 3%. It wasn't too bad of an idea, considering we're dealing with the Feds here, and rather visionary at the time. This of course was while the Feds were still directly administering Medicare/Medicaid, before they privatised it out on 'cost-plus' contracts. The intent at the time was to reduce paperwork/administration costs to something comparable to what Medicare was doing, i.e., dirt cheap, to reduce healthcare costs. At the time, it was a good idea.
Standardising medical records and insurance forms along Medicare lines meant the girl in the billing office only needed to really understand one form and how to fill it out, where before, each healthcare insurance company could use their own proprietary form, and change said form at will to delay payment of claims. Hey, this kinda shit happened a lot in the 80's, peaked in the 90's, and basically added the gasoline to the fire that caused HIPPA to happen. Back then, they didn't use your Social Security number as identification, but as an account number for your Medicare and/or Social Security/SSI/disability check and to make sure your Social Security account was properly funded for you. In fact, back then, they even printed on the bottom of your Social Security card 'NOT TO BE USED FOR IDENTIFICATION'. (BTW, that came off your SS card some time ago.) It was cool because they weren't using your SSN for anything else, your credit report and such wasn't indexed by it, and the only way to get somebody's SSN was to steal their wallet and look at their card. Then the laws changed.
Now, your SSN is used for identification. It's tied to your credit report, your SS/Medicare account (which has a seperate account number now), yadda yadda yadda. Kids are issued SSNs at birth, where before, when I was a kid ('Get off my lawn!!!'), you filed for your SSN when you landed your first job or enlisted in the military. You file for your kids, the Social Security Administration would look at you and tell you they had laws in this country against child labor.
Anyways, the intent was to cut healthcare costs by cutting paperwork & administration costs. Then Medicare got privatised. And where they once had 3% admin costs, they were soon up to the 'standard' 30-35% costs of 'regular medical insurance'. The medical insurance companies had standards dammit, and they weren't gonna let Medicare exceed them. Especially not when there was a few billion bucks to be made. What needs to happen is, healthcare should be a government funded monopoly, paid for from your taxes. It's in the government's interest to do this. Access to healthcare means a healthier citizenry, with less time lost from work due to illness. It also means lower healthcare costs overall because little problems get caught before they become big expensive life-threatening/altering problems. See the Chinese 'barefoot doctor' program for further information, and let's marry that concept to a Canadian/UK/Scandanavian model single-pay system.
Re: (Score:2)
it's already been established that moving to electronic records helps track Medicare fraud. Yes, the system has a lot of gaps, but electronic tracking reduces them. If that wasn't true companies wouldn't use electronic purchasing systems to track expenditures, and the spreadsheet would just be an interesting foot note in computer history... I gotta ask (since I'm far too lazy to read the article): Is this a lame attack on the existing administration?
Making billing and payment systems electronic reduces processing costs. That's the primary driver of the multi-industry-wide push to do all that electronically. It's really expensive to have humans transcribe things and add up columns of numbers.
Re:This is silly (Score:4, Informative)
Making billing and payment systems electronic reduces processing costs.
Wow. I don't know where to begin. This is a lot more variable than you'd think.
I think the following statement is much more accurate.
Making billing and payment systems electronic has the potential to reduce processing costs.
Keep in mind that the adoption of E-mail did not eliminate mail fraud or reduce the labor involved in processing mail.
I'd argue I spend more time processing my mail than I did in the 80's. It might have reduced the costs of sending an individual letter using a stamp. Your actual results may vary. Do did you buy Microsoft Exchange server, Outlook? Oh wait...it's not a purchase...its a temporary license. Did you have to renew the license? At what cost? Did you send 90 letters out last year? 200 letters? How about when measured as "cost per correspondence" that year? When you renewed software licenses under the new version, could you continue to use your orginally purchased hardware? ...or did you have to upgrade your hardware as well? Was your labor cost free? If you used a "free" provider, such as Yahoo, how much time did you spend fiddling around, following animated Yahoo links. Does your time have value?
Medical billing system goals and project architectures vary. There's a lot more to this than coding medical procedures or reducing the human clerical involvement in working with Medicaid. I analyze and track the success of various medical IT projects and there are too many failures sold as successes and the costs shifted around, but ultimately paid by citizens, self-insured customers, quality of care, quality of non-medical service. Definitions of "success" vary from person to person and many are not based on objective, measurable criteria.
Keep in the mind the labor for regulatory compliance, developing and managing electronic systems runs $35-$230/hr. Accounting clerk and medical-coding labor runs $16-$40/hr and "maintenance" involves periodic training. The labor cost ranges can actually be wider depending on the economy of that region. Think New York City vs. Podunkville, WV. Keep in mind that there are often unplanned and improperly budgeted costs such as security and maintenance. The medical coding and accounting clerk labor typically is not eliminated, but retrained to use the new system and often given a raise to retain them after the training, because they are in more demand. The transaction labor time is often increased in the new system and the transaction errors harder to detect and diagnose because of the increased specialization and fragmentation of knowledge about the system.
Some of the billing labor requires maintaining industry certifications. As standards become more internationalized, there's potential for labor savings by exporting the jobs and broader sharing of expertise. Sometimes these savings are offset by increased coordination and communication costs (not long-distance fees, we're talking subtle mis-communication with big impacts resolution of business outcomes) caused by the shift from localized clerical work to exported clerical work.
I've seen many implementations where total operating costs, per unit of the same function, dramatically increased AND it created new costs, hidden by being created in other departments, such as, Legal, Customer Service and Communications.
(Did lawsuits increase? Was there more confusion about work-products? Was resolution of the confusion easier or harder? Did we have to "educate" our customer on our system with PR campaigns? What did that cost? Was it effective?)
If we ignore all the issues that come with new implementation projects and switch our focus to the new power of having more (and better?) data to sift...that's easier to analyze, there are two sides to that coin.
1. Automated algorithms make it easier to detect some types of fraud. (in email analogy, spam)
Re: (Score:2)
No, it isn't an attack. Doctors and hospitals find that with medical records, upping the codes for service in their favor is made easier. Hence, the government and insurance companies pay more.
It isn't clear how to go about fixing this. There's no way the government could have enough monitors to make sure doctors and hospitals are honest. Maybe they could use statistics. That has its own problems, what is the baseline. And baselines would change across the country. Spot checks might work if backed up by pro
Proper coding != fraud (Score:5, Interesting)
It's not clear to me that medicare providers changing their coding is the same as fraud. If a doctor was coding for a 10 minute E&M (evaluation and management) but was actually spending 20 minutes with the patient, then it's totally reasonable for them to change their coding. If EMRs are making it more obvious that the practice users are mis-coding, then this is at worst an unintended side-effect of the EMRs.
(Full disclosure, I work for a company that builds EMR systems.)
Re:Proper coding != fraud (Score:5, Informative)
The issue is changing from an E&M to an intensive care E&M. Same procedure, higher payout. Same goes for taking a common tests that are bundled and breaking them into smaller component tests. A few wears ago I met with an Ausie founder of a startup that was talking about how revolutionary their software was that would optimize billing codes to ensure maximum revenue per procedure by basically scanning a billing batch and re-coding it using more lucrative codes for the same procedures. I waked on doing any development for them.
Re: (Score:2)
I think that the electronic records are probably making it easier for physicians to bill more accurately, not necessarily more "lucratively". Electronic recordkeeping doesn't turn otherwise honest people into fraudsters overnight. So I don't see the increase in billing as tied to an increase in fraud.
Now, the Australian company you declined to work for, they seem like the kinds of scum who hospital administrators might hire to commit wholesale fraud. That obviously would give rise to increased billing ra
Re:Proper coding != fraud (Score:5, Interesting)
Now, the Australian company you declined to work for, they seem like the kinds of scum who hospital administrators might hire to commit wholesale fraud. That obviously would give rise to increased billing rates. If there's still a sliver of justice in the world, they'll go to jail for falsifying records.
Both the company providing the service and people enriched by using that service need to be held accountable.
Re: (Score:2)
I think that the electronic records are probably making it easier for physicians to bill more accurately, not necessarily more "lucratively"
Except this story is precisely about it being more lucrative, even if more "accurate." Doctors and hospitals are getting more now than they used to, for the same services they were always providing. Thats the very definition of "more lucrative."
What the electronic billing is allowing, as other have mentioned, is for the doctors and hospitals to automate getting the most they can for the services provided depending on who is doing the paying.
This is equivalent to an online store offering different price
Re: (Score:3)
The issue is that electronic records ups the ante for both sides. Medicare can better understand what is going on and optimize their reimbursement rates. The hospital can better understand what is going on and game medicare. And so on...
I suspect the goal of doctors is to take the least time possible filling out codes on a form. I know most doctor's I've seen have a checklist of codes that are common in their practice that they just mark off. They could care less if they're "accurate" as long as they'r
Re: (Score:2)
optimize billing codes to ensure maximum revenue per procedure by basically scanning a billing batch and re-coding it using more lucrative codes for the same procedures.
Sounds to me like the coding system need to be revamped to remove the duplications if possible.
Re: (Score:2)
Sounds to me like the coding system need to be revamped to remove the duplications if possible.
Re: (Score:3)
optimize billing codes to ensure maximum revenue per procedure by basically scanning a billing batch and re-coding it using more lucrative codes for the same procedures.
Sounds to me like the coding system need to be revamped to remove the duplications if possible.
Problem is, there's usually 2-5 different ways to code in any given procedure, and the codes can change at any time. That's how insurance companies delay payment to make their bottom lines look better to their shareholders, they'll kick the form back to the doctor's office/medical billing office with a note saying 'You coded this wrong. Recode and resubmit please' and push payment to a later date. Of course, it's a house of cards that should have come down ages ago, but computerised systems allow them to
Re: (Score:2)
Would you walk if it was for tax reporting software to maximize deductible expenses and limit tax liability?
This stuff exists. The rule is generally pretty clear on the line between fraud and "optimizing."
Re:Proper coding != fraud (Score:5, Informative)
Somebody at Medicare should be looking at the billing records and saying, "It can't be right for every procedure to be billed at the highest possible code when they're a regular full-service hospital. These people are cheating us and I have a red phone on my desk to the Department of Justice Prosecutor's office."
If there are two legal, legitimate ways to code for a given procedure, why would a clinic not bill for the more expensive of the two? Medicare - not the hospitals - sets the reimbursement rates and defines the codes. If they didn't intend for the higher code to be billable, they should have written the definition so that it wasn't.
There are also lots of coding seminars that teach doctors things like "if you ask question X during the history and physical part of their exam, you can bill code #123-2 instead of your normal #123-1. You're already doing 95% of the work to qualify for #123-2, which pays double of #123-1, so why not do the extra 5% and double your income?". Again, Medicare and the insurance companies are settings those standards. Sucks to be them if health care providers decide to play by the rules that have been dictated to them.
Let's put it in tax terms. Suppose that if you give $10,000 to charity, you get a $5,000 tax break. Your accountant notices that you've already given $9,500 to charity and advises you to donate $500 more before the end of the year. You do so, and that $500 turns into a $5,000 benefit for you. Are you cheating? You didn't make the rules. You're playing entirely within the codes that Congress has set. It would ring a little hollow for Congress to complain that you're defrauding the IRS of $5,000 by going along with the procedures that they put in place.
Re: (Score:3)
If there are two legal, legitimate ways to code for a given procedure, why would a clinic not bill for the more expensive of the two? Medicare - not the hospitals - sets the reimbursement rates and defines the codes. If they didn't intend for the higher code to be billable, they should have written the definition so that it wasn't.
If a care provider is doing additional services with the only objective being getting paid more and not treating the patient, it is fraud - even if it just five percent extra.
The
Re: (Score:3)
Honestly, I think the only real fix for many of the woes we suffer is for a judge to occasionally issue the following verdict: "I find that the defendant corporation acted completely within the law. I find that the CEO of the defendant operated completely within the law and is legally shielded from any personal liability. I find that the CEO is also a scumbag. Bailiff, please shoot the CEO now, thanks." It wouldn't need to happen often - just often enough to make "taking advantage of your legal rights"
Re: (Score:3)
It would seem like a benefit of the system that you can actually get paid for the work you did, rather than being narrowly restricted to a handful of codes and having to 'pick the closest', where you go from say a 25% error on paper to 10% electronically that's good.
Obviously there will be fraud - even in a fully nationalized healthcare system doctors still try and find ways to get more money for the same work. It's management and oversights job to prevent it, and the more tools they have to find it, the b
Re: (Score:2)
The problem is that the 'underbilling' is still costing patients four times what healthcare costs anywhere in the civilized world.
Re:Proper coding != fraud (Score:5, Insightful)
Different problem (a real problem but a different problem).
The big issue here is how the billing codes are set up for physician encounters. You determine the code (and hence the charge) with a laundry list of things - how many issues you covered in your interview, how many parts of the body you examined, how much extra detail you went into (family history, smoking history and the like).
Then you get brownie points for medical complexity.
So, you add all of this up and you get your E&M code (Evaluation and Management). Now, in the olden days you had to manually keep track of how many 'points' you were wracking up. Amazingly enough, computers can add! So the program keeps track of all the little points and thus can maximize the code. Extra bonus points for the program 'helpfully' pointing out a few things you might have missed (did you ask about smoking? Vaccines?) - you can then go back and do them (or at least say that you did) and up code.
The other problem is cut and paste - you can take the Past Medical History of the patient and copy it from one encounter to another. Now, that seems perfectly reasonable - you WANT to know this stuff, it's important and that's why you take the time to write it down. However, you don't need to go through a 45 minute interview with the patient ever time you see them - but that's what the billing codes assumed you did. Now Medicare has decided if you copied the old data that's "fraud".
Basically, you have a clumsy, prehistoric system for coding physician encounters that has been computerized without much thought as to what happens after the fact.
One of my favorite aphorisms in this arena is "Computerizing chaos yields computerized chaos."
There's a problem on both ends (Score:5, Insightful)
The real fraud... (Score:5, Insightful)
...is how much health care costs in the first place.
Re:The real fraud... (Score:5, Insightful)
The Real Fraud is how much health care costs in the first place.
The main reason for that is simple. Insurance and Litigation
1) You Need Insurance to get healthcare, because healthcare costs too much.
2) Your Doctor Needs Insurance because you might sue him for malpractice, the state he's in requires it, or both, Raising the cost of healthcare.
3) The pharmaceuticals your Doctor prescribes you needs Insurance because you might sue them for complications. Raising the cost of healthcare.
4) Your Hospital needs insurance because you might sue them for hiring the doctor that you sued for malpractice, or because he prescribed you something that didn't work, or the state they are located in requires it or a combination of all of the above. raising the cost of healthcare.
5) The ambulance chasing lawyer on TV needs more money to buy TV commercials to help you, so he sues the insurance companies of your doctor, the pharmaceutical company, and your hospital for malpractice, so you get the 5-25% of the total compensation that you deserve and he pockets the 75%-95% to pay for his paper costs and time, which of course, Raises the cost of Insurance, which in turn raises the cost of healthcare.
1) Repeat step 1
Until we get a president and congress that will pass healthcare reform that will truly end this cycle for good, expect your health costs to skyrocket.
Re:The real fraud... (Score:4, Interesting)
Not what my doctor says, though it is a plausible contributor to one of the problems he identifies. He's been paying malpractice insurance premiums for forty years and has been an expert witness in malpractice cases, so he knows what he's talking about.
He sees the problem as fueled by unnecessary procedures and caramelization (wow, that's a great autocorrect failure. I wrote cartel-ization). Unnecessary procedures might be caused by fear of litigation(*), or by a desire to milk the system.
Drug companies like to say that their prices are necessary to recoup research costs, but that doesn't explain doubling the price of a drug after it's already on the market. He's seen that happen.
Health insurance companies have lavish offices in expensive parts of downtown. They didn't get that money by being lean, scrappy competitors.
What he wants to see happen is single payer! That doesn't have to mean government, by the way. A nonprofit mutual insurance company is an option.
(*) If skipping a test might lead to a lawsuit, then skipping the test might lead to a patient getting hurt, in which case it's a necessary test.
Re: (Score:3)
A nonprofit mutual insurance company is an option.
Wow, you guys really don't have that? (I would have expected that)
As a European I have my country (which runs the hospitals and keeps cost down), and if I want even more healthcare insurance, dental, glasses, contacts, different styles of pseudo-scientific treatments not proven scientifically valid, we have self-owning non-profit organizations offering decent insurance plans.
Anyways, I don't think that's enough. My government recently experimented with private hospitals, off-loading patients on waiting l
Re: (Score:2)
Re: (Score:3)
No, wrong. And frankly, evil.
1) You need insurance because healthcare is legitimately expensive, and only the top 10% or so can afford to self-insure. Insurance in the US is more expensive than it ought to be because our system is a mess, with dozens of insurers and thousands of plans.
2) Your doctor needs insurance because he might make a mistake that literally costs you a limb, or worse. My friend lost his arm because the surgeon forgot to take the gauze out. Are you really going to argue that the doct
Re:The real fraud... (Score:4, Informative)
Republicans like to bang the malpractice is causing all the problems drum but they are at least honest it's a minor addition of costs.
You are (deliberately, it seems) missing the big picture. It isn't malpractice, per se. It's the enormous use of people, supplies, fantasitcally expensive equipment, time, space, and a mile-long wake of paperwork that comes from practicing over-the-top procedures, tests, and drug use designed to fend off spurious malpractice suits. So something like a $10 urine dip-stick test that could be done a couple of times over a couple of 5-minute office visits becomes a $2500 speciality lab visit to the hospital so that the doctor's favorite specialist can do a bladder exam ... so that one in a hundred thousand people who might have more than a the normal drop of blood in their urine and also happen to have something else you might catch through the multi-thousand-dollar exame might be caught sooner, though not likely.
Multiply that scenario by thousands of other conditions and tests, mostly involving entire teams of people operating hideously expensive radiological devices or blood sniffing devices, and all of the record keeping, etc., and you've got your ridiculous costs. And it's all done to avoid making malpractice insurance premiums go even higher, because of slimes like John Edwards who get rich over nonsense suits. The suits are down because spending to head them off has gone through the roof, by untold billions of dollars.
Re: (Score:2, Insightful)
Even if you factor all of that in, it probably represents something like 20-30% of the 'extra' costs in US medicine. It's a significant and important aspect of the problem, but it's not the sole nor major driver.
Briefly you have:
- The issue of 'defensive medicine' as you point out.
- The issue that much of US medicine is set up as a for profit entity with expectations of increasing growth and profits. Many of the big players are heavily leveraged.
- The multiple sacred cows - physicians, insurers, hospitals
So let's say we do away with all that (Score:2)
a) Rates drop since Insurance Companies couldn't just check up on their competitors rates and use that information to fix prices without colluding (*cough*auto-insurance*cough*).
c) Insurance Companies pocket the savings and pay them out in the form of big cash bonuses for the board of directors?
Re: (Score:3)
You are (deliberately, it seems) missing the big picture. It isn't malpractice, per se. It's the enormous use of people, supplies, fantasitcally expensive equipment, time, space, and a mile-long wake of paperwork that comes from practicing over-the-top procedures, tests, and drug use designed to fend off spurious malpractice suits. So something like a $10 urine dip-stick test that could be done a couple of times over a couple of 5-minute office visits becomes a $2500 speciality lab visit to the hospital so that the doctor's favorite specialist can do a bladder exam ... so that one in a hundred thousand people who might have more than a the normal drop of blood in their urine and also happen to have something else you might catch through the multi-thousand-dollar exame might be caught sooner, though not likely.
That doesn't make sense. If the hospitals are behaving rationally, the amount of money they would spend on avoiding malpractice suits would be in proportion to their expected cost of loss from the suits themselves. If malpractice actually accounts for a very small amount of money, then either these people have no idea and are going way over the top, or there's other reasons to over-treat.
The real reason, I reckon, is that the medical system in the US is internally antagonistic. *Everyone is screwing each ot
Just socialise the damn thing already (Score:3, Insightful)
You know, I was reading an article where it stated that socialised medicine would cost *less* than what what it costs to run Medicaid and Medicare (on a per person basis)
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
i apologize world, it is embarassing (Score:3, Insightful)
universal healthcare will result in longer lives and less healthcare spending in the usa. just like every other goddamn country with it
but, much like gun control, there is a certain feverish moron in my country that will never listen to reason on the subject, and he enabled by special interest groups in washington: the NRA and the healthcare insurers
maybe the feverish morons will shoot themselves and die waiting in the emergency room
Re: (Score:2, Insightful)
Re: (Score:2)
Dude, seriously, if you want Gun control then change the fucking constitution. Until then, stop saying I do not have a right that is imbedded in the constitution simply because you don't like it and want to read into it things that never existed. If you are allowed to succeed, then your right to free speech, your right to be secure in your papers, person, and effect from unwarranted searches, your right to a fair trial without unusual and or cruel punishment, your right to retain the rights other citizens h
Re: (Score:3, Informative)
i don't have to change the constitution. what the constitution says about gun ownership has nothing to with what certain morons believe it justifies
Re: (Score:2)
This is what I love about self appointed intellectuals who think they have all the answers and know what's good for all us poor unwashed masses out here. The way they can take a simple sentence written in plain English and reinterpret it to mean whatever they feel it should have said to start with. Returning to the topic, I agree the current system is so totally screwed that even something as fucked as socialized medicine would be better than the cluster fuck we currently enjoy. I think the entire idea b
Re:i apologize world, it is embarassing (Score:4, Insightful)
Why do you maintain that socialized medicine is a bad thing when all the evidence suggests that the opposite is true? Are you equally critical of America's use of socialized police and fire departments?
Re: (Score:3)
Actually, it's an entirely different thing. The gun market is operating well and shows inflation comparable to the total inflation rate. Few people actually NEED a gun, but those who do (and most who just want one) can afford it.
In contrast, everybody needs healthcare from time to time but many can't afford it at all and the rest are forced to spend an increasing percentage of their total income on it. Healthcare costs have inflated at several times the rate of general inflation for decades now.
Re: (Score:2)
Soon the bureaucrats will be in total control then things will get better. The same people that run the post office are on the way to help.
Re: (Score:2)
That sounds like a good thing. The post office provides reasonable service at an affordable rate to everyone who needs it.
Re: (Score:2)
You heard wrong, propagandized moron
Re: (Score:2)
universal healthcare will result in longer lives and less healthcare spending in the usa. just like every other goddamn country with it
but, much like gun control, there is a certain feverish moron in my country that will never listen to reason on the subject, and he enabled by special interest groups in washington: the NRA and the healthcare insurers
maybe the feverish morons will shoot themselves and die waiting in the emergency room
Actually wether or not we have universal healthcare or free market health care really doesn't change life expectancy. On the other hand, how much junk food a country eats, does. Our problem is that we have neither universal healthcare or the free market. Instead we have some bastardization of the two. Personally I think we need to bring back a pure free market. The only regulation from the government needs to be that the doctor has a medical license from an accredited school. After that, let the insur
you're ignorant beyond belief (Score:5, Insightful)
a free market in real life translates to "give as many expensive tests as we can get away with"
healthcare isn't a MARKETPLACE. it is not driven by best price, because the buyer has no control to seek the cheapest service. no knowledge of medicine. no time when he is having a heart attack to shop around
face reality: there are some issues in life, where, believe it or fucking not, market forces do not help, and make things worse
i say this as a committed capitalist. capitalism works. but i'm not a looney tune frothing at the mouth ignorant free market fundamentalist who believes the magic unicorn and rainbows marketplace is a magic elixir that solves all problems. it doesn't
Re: (Score:2)
If one wants governmental control over health care, then that person isn't a Marxist.
The contradiction between the vocation and the good intentions of the administration on the one hand and the means and powers at its disposal on the other cannot be eliminated by the state, except by abolishing itself; for the state is based on this contradiction. It is based on the contradiction between public and private life, between universal and particular interests. For this reason, the state must confine itself to formal, negative activities, since the scope of its own power comes to an end at the very point where civil life and work begin. Indeed, when we consider the consequences arising from the asocial nature of civil life, of private property, of trade, of industry, of the mutual plundering that goes on between the various groups in civil life, it becomes clear that the law of nature governing the administration is impotence. For, the fragmentation, the depravity, and the slavery of civil society is the natural foundation of the modern state, just as the civil society of slavery was the natural foundation of the state in antiquity. The existence of the state is inseparable from the existence of slavery.
-- Karl Marx
Re:you're ignorant beyond belief (Score:4, Insightful)
I feel your pain. I read through this and can see talking point propaganda every step of the way. It baffles the imagination that such mindesets can exist in the modern information age. But wait, it will only get worse. Notice the use of the term "Marxist". It's a buzz word for them, it allows them to excuse their actions and thoughts towards those that don't agree with them. It's a mob mentality that wants to take a baseball bat to your head in a fit of rage.
They have been fed hate filled nationalistic "religion" based propaganda by "hate radio" and Faux News for years now. This is carefully cultivated and well crafted propaganda that Goebbels would get an erection over. As this election draws nearer and the pressure builds exponentially in the days before and after it, this propaganda will come to fruition. Regurgitating the lies will not suffice and we will see violence from this ilk like this country has never seen. You can smell the madness between the lines even now.
For every action there is an equal and opposite reaction. Weapons grade propaganda doesn't just vanish like smoke when the politicians and their puppet masters are done spewing it on the masses. There are minds steeped in it, poisoned with hate; there are consequences.
Re:you're ignorant beyond belief (Score:4, Informative)
Re: (Score:3)
you don't understand the subject matter
patient -> healthcare system
is what we want
patient -> (useless drain for insurance CEO) -> healthcare system
is what we have
what exactly is the point of preserving that parasite? why must the USA spend gobs more cash and live shorter lives than other nations like us?
Re: (Score:2)
universal healthcare will result in longer lives and less healthcare spending in the usa.
I'm going to call you an idiot if you think longevity is a good measurement for the quality of healthcare in a country.
Re: (Score:2)
i agree
a rural dweller should have a shotgun for security
if only there were some way to change gun laws based on population density
Re: (Score:2)
You mean, like all the articles that said it would cost less to switch to electronic records?
Re:Just socialise the damn thing already (Score:4, Insightful)
>
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
You Wanks assume Yanks are all the same. That is not a valid assumption.
The majority is the same (Score:2)
The majority of voting yanks are wankers. Those who do not vote do not matter.
The half that vote has severely limited choices and are misinformed most are probably wankers.
I'm a yank but I'm in the minority; the voting informed who are not wankers.
http://www.youtube.com/watch?v=B5OWRRJh-PI [youtube.com]
Re: (Score:3)
I'm just thinking of all the social benefits of this.
Less employes, more automation, and somehow it costs MORE with LESS effort on their part.
Seems legit. Score another one for Medi*** reform. Wake me up when they actually do something about campaign financing.
Re:Just socialise the damn thing already (Score:5, Insightful)
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
You're parroting a commonly held misconception about how politics in the United States works. Firstly, your elected representatives come from more than two parties; Your voters have a wider diversity of candidates to choose from, and are less apt to vote along party lines. This also spreads out the concentration of money paid to your elected representatives by private interests. Put more simply, it's harder to buy legislation in your country. As well, the disparity between the rich and poor is far less pronounced. This results in your legislators being more likely to represent the actual will of the people, rather than the apparent or manufacturered will.
It's also no small matter that the UK has the BBC. It's more important than you guys give it credit for: The licensing fees you pay are amply repaid not just in terms of quality programming, but also unbiased programming. The BBC can't be co-opted with a corporate buyout. In our country, the media is largely controlled by a few dozen men like Murdock. An informed voter is a voter that can't easily be duped; And the BBC provides a mechanism to prevent your media from becoming too biased towards any one political view. Compare the US section of the BBC with any major news network here -- stories that make front page there, or are internationally relevant, simply don't make it. They aren't reported. It's not just that there's bias in what is reported, there's also things that the public simply isn't told about. You can probably deduce what this means for the political landscape.
Lastly, the UK was bombed into near-nothingness. The US never has been. The closest we've come to having to reassess economically was the Great Depression. Because we never had to rebuild from scratch, we never learned the social lessons that an experience like that offers -- specifically, we never really developed a cultural center of "We're all in this together". American culture has long been based on individualism -- which during times of material prosperity is great, but during economic trouble, it creates a "blame the victim" mentality. You are poor because you want to be poor, not because some bad shit just happened to drop on your head. The American Dream has become a political crucible -- maintaining our collective ego has forced us into social policies that are ultimately harmful and destructive to our way of life. It's a societal-scale version of the Just World phenomenon.
It's not socialism per-se that we're afraid of -- it's the idea that we aren't in control of our own fate. That we aren't individuals, but actually part of something more than ourselves, and that our success is determined only in part on our own choices, rather than entirely by it. It's ego protection, individually and collectively. And when you read anti-socialist opinions in our media, they may use the same words you know and understand, but they don't mean the same things. It all goes back to the cold war, the super power stuff, and that collective ego I mentioned earlier.
For us, socialism is a sign of weakness; It's a sign that we've become like the russians, the iranians, and all the other boogie men we've bomed the hell out of. So even when it would be good and proper for us to adopt socialist social policies, we don't... we'd rather go on maintaining the notion that We're Number One. America is on a path of self-destruction because it simply can't acknowledge, individually or collectively, that we need help and we need to work together. Our problems are world problems too -- but until that fact ingrains itself into our culture, it's pointless to expect change. America, as an idea and as a culture, would rather die than admit defeat.
Just like the British did at the height of their empire. It's a phase we'll outgrow eventually, just like you guys did. But it won't happen quickly, or easily, or gracefully.
Re: (Score:3)
I'm afraid you've got things a bit wrong.
BBC chief Mark Thompson admits 'Left-wing bias' [standard.co.uk]
Mark Thompson: “There was massive left-wing bias at the BBC” [newstatesman.com]
That has been found more than once, by the way.
Re:Just socialise the damn thing already (Score:4, Interesting)
Some valid points, but we already have socialized medicine and have for decades. It's called Medicare/Medicaid and a large segment does understand. Just try taking away those two programs from seniors and the AARP will be down on any politician that tries.
True, but the same logic that prevents us from throwing 4 year olds in jail for life for stealing candy bars (something that can and has happened in California to adults) also prevents us from packing old people into railroad box cars and disappearing them; There's simply no way we can rationalize it. We can't tell them to just "get a job", because, well... they can't work. It's obvious they can't work. It simply can't be denied. So, for those people whom we can't rationalize away their healthcare... we grudgingly give it to them. But only enough to keep them alive, not enough to be comfortable. I know many elderly who are in substantial pain. You think they're cranky because they're old? Not exactly -- They're cranky because they have a long list of medical problems, and only a short list of medical answers.
There was a guy recently who found out he had cancer -- a semi-famous member of the open source community (I disrecall the name). He was already disabled and on SSDI, but he made too much money to be on medicaid and wasn't old enough to get it automatically. He didn't have enough money for the surgery, which he needed in a matter of weeks. If he got it in time, his chance of survival with complete recovery was around 85%. Wait any longer, and he dies a slow, agonizing death. The government told him they wouldn't cover the surgery or any health care costs...
At least, not until he was declared terminally ill. Then they would pay for health care. That, sir, is the system we have today. There is nothing dignified about it, and most countries would consider such treatment not only barbaric, but a violation of basic human rights. It's not socialist medicine if the only reason its offered at all is because the alternative would result in social chaos and unrest costing more than the service offered. It's barbarism.
World Bank data (2010) (Score:3, Informative)
Sticking to wealthy countries (source [worldbank.org]):
Country | % Health spending/GDP | % Public health spending/Total health spending
USA 17.9 53.1
Netherlands 11.9 79.2
France 11.9 77.8
Germany 11.6 77.1
Switzerland 11.5 59.0
Denmark 11.4 85.1
Canada 11.4 70.5
UK 9.6 83.9
Sweden 9.6 81.1
Japan 9.5 82.5
Norway 9.5 83.9
Finland 9.0 75.1
I'm fairly certain that the total U.S. government spending per capita on health care is more than the UK spends per capita for its universal system.
Re: (Score:2)
Socialized Medicine: Because if someone can't afford excellent care, everyone should have mediocre care.
There's a reason people come to the US for medical treatments.
Re: (Score:2)
People come to lots of different countries for medical treatments. Don't delude yourself that USA is somehow special in this particular case.
Re: (Score:2)
I guess we don't want the disaster like the British NHS inflicted on us by "well meaning" but clueless idiots.
'Tis a shame... (Score:2)
Re: (Score:2)
there are always some who will push the legal and ethical envelope in order to make a larger profit. Such is the way of Capitalism, it appears
Isn't is more the way of Socialism, as these doctors are billing the government?
If they were actually billing the patients, the patients would probably say "screw you, why am I paying you twice for the same procedure? See you in court!"
Re: (Score:2)
Why capitalism? Every human system ever devised is rife with corruption.
Exactly, look at how corrupt communism was.
Be fair (Score:4, Insightful)
Forgive my AC status, but for obvious reasons I can't divulge too many details. I was a contractor for a state government to facilitate writing an EHR system to integrate various state repositories for the purposes of the grants relevant to this story.
Of course this is going to cost more up front. We had to bring online hundreds of medical facilities who were operating with paper only with processes who's roots go back to the 1950s. The purpose of the grants was to MITIGATE the costs, not cover them completely.
The fact is that in the long run this will save money and is well worth the increase now. That increase would have been larger for every year longer we waited to bring some of these places into the modern era.
Not necessarily fraud (Score:5, Informative)
Fraud. (Score:5, Insightful)
So the fraud is now exposed... (Score:4, Interesting)
My impression is that the US health care system has been doing this for as long as it has existed. Having digital records should be a great help to the insurance companies to make it easier to track down fraudulent health care providers.
Since I live in Sweden I don't usually have a problem with health care bills, but once during a vacation to the US I had to visit a hospital due to severe stomach pain. Four hours and a trip through the CT machine later I was released with a prescription for some pills. Six months later (back home in Sweden) a bill for $14000 arrives...
When I brought this to my insurance company and explained that the examination I went through couldn't possibly have cost that much they just shrugged and said "yeah, they always try this when dealing with foreign insurance companies". A few weeks later they had everything settled at just under $3000.
So what's the point of this story? If a system is open to exploitation you need someone to monitor it. Monitoring is easier with good records of what's been going on.
Re: (Score:2)
B-but what about all the job creators! :(
Re: (Score:2)
Re: (Score:2)
An electronic record system would have allowed automatic sanity checks that would have prevented an incident I know about.
The patient's daughter was a nurse, and reviewed an itemized bill. The daughter challenged one of the items. The billing department patronizingly reassured her that it was correct. The item was a prostate exam for her mother.
Re: (Score:2, Informative)
The current American system isn't so much open to exploitation as it is designed to punish those without insurance. The insurance lobby has made it illegal to bill an uninsured patient a price different from what they would charge an insurance company. This sounds fair enough on paper, after all its not exactly fair to charge an insurance company $14000 and then go and charge $3000 dollars to a patient without insurance for the same procedure. After all, that drives the prices for insurance up for everybo
Not restricted to Medicare (Score:5, Informative)
Simple Fix (Score:2)
Just allow billing per hour at a fixed rate, regardless of what the procedure is. Problem solved.
Fee for Service is the problem (Score:2)
If you reward medical service providers for providing as many services as they can (or in fraud cases billing for services they don't provide), then you should not be surprised to find costs growing out of control.
Ancient Chinese Proverb went something like: "Pay doctor when you are healthy. Stop paying doctor when you are sick." That creates the financial incentives for the medical profession to be efficient.
There are some providers in the USA that break out of the fee for service model and provide good,
Re: (Score:2)
It's Obama's fault for oversimplification of the problem and with his Democratic cohorts, Pelosi, Reid et al. for doing a lot of backroom deals [washingtontimes.com] to push bad legislation through. Do we all want affordable health care? Yes! Do we want to be able to make sure that we can get care for pre-existing conditions? Yes! Do we want 16000 new IRS agents enforcing the insurance mandate? No.
Ask yourself why an industry like the health care industry has seen increases in costs much faster than inflation? Sure, the num
Re: (Score:2)
Clearly the benefits of electronic systems outweigh the risk, just like owning a car. Sometimes your car might not start when you need it to if you fail to properl
Re: (Score:2)
"paper doesn't go down."
A valid point, but paper also doesn't double-check your work and detect errors and inconsistencies. Working with EHR systems, I can tell you that a paper system has a lot more entry errors than an electronic system has failures.