Tuesday, September 3, 2013

Why We Hate Government Run Healthcare

Do you know why doctors despise Obamacare? Not because it will provide health insurance to more people in the country, which we can all get behind. Not because of potentially disastrously low reimbursements, which I'm sure we will all work around eventually. Actually it is because of the hassle of complying with the byzantine rules the government has formulated to receive the money in the first place that draws the greatest ire.

Take for instance this urgent email I received from the ASA. The organization is asking for all anesthesiologists to respond ASAP to changes being considered by Medicare for how anesthesiologists should be reimbursed. I'll reprint it below for you to understand what I'm talking about.

Many ASA members use the “claims-based” method of reporting PQRS measures since it permits successful reporting when there are fewer than three measures applicable to an eligible professional (EP). At present, the Centers for Medicare and Medicaid Services (CMS) has criteria in place for physician anesthesiologists to successfully report quality measures; however, the proposed rule for the 2014 Medicare Physician Fee Schedule seeks to alter the criteria in a way that will place physician anesthesiologists at a great disadvantage.
CMS is moving toward elimination of the claims-based reporting mechanism and is seeking comment as to whether that mechanism should be eliminated in 2017. Some of the actions described in the proposed rule would sharply curtail claims-based reporting even sooner. Specifically, of the more than 40 proposed new measures CMS intends to add to the 2014 PQRS, none allow reporting via claims.
Additionally, CMS proposes to increase the required number of measures that must be reported from the current three (3) measures to nine (9). These nine measures must cover at least three of the National Quality Strategy (NQS) domains: Patient and Family Engagement; Patient Safety; Care Coordination; Population and Public Health; Efficient Use of Healthcare Resources; and Clinical Processes/Effectiveness.
Currently, there are a maximum of three measures applicable to most physician anesthesiologists. They all are within a single domain. Accordingly, if Medicare’s proposed rule is finalized, anesthesiologists will be unable to satisfactorily meet reporting requirements.
This change would have a significant impact on anesthesiologist’s practice because 2014 is the performance period for your 2014 PQRS incentive and for the 2016 PQRS penalty adjustment.

See what I'm saying? Does anybody outside of political action committees and government lobbyists even know what that means? Just for your information, PQRS isn't a teaching moment on an episode of Sesame Street. It stands for, wait while I look it up, Physician Quality Report System. Click on the link if you want your mind melted by more alphabet soup of arcane government red tape.

The older doctors lament the days when they could just turn in their bills to insurance companies or Medicare and a check would arrive a few weeks later, no questions asked. But unfortunately, through a combination of greed, fraud, and fiscal austerity, the era of blank checks are over. Now we younger doctors are the ones to face the consequences as payers seek ever more creative ways to save money by not paying doctors. Is it any wonder doctors prefer to sell their practices and work for giant healthcare organizations as paid employees? You need to have an army of lawyers to understand all the new rules that are being created under modern healthcare. No independent doctor can afford that can of overhead to stay in compliance and get paid. Welcome to the future.

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