Here's another compelling argument that describes how improving primary care is the key to improving healthcare.
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Michael Doring Connelly
Let me briefly connect some dots on the Wall Street Journal’s (WSJ) recent coverage of private Medicare Plans known as Medicare Advantage (MA) plans. The investigation of this 11/14 article concludes that the sickest patients eligible for Medicare are “fleeing” MA plans because of inadequate insurance coverage. At the same time, these private plans collect 20 percent more from the taxpayers for their patients because the MA plans claim they care for sicker patients. The MA plans use coding to assert that their patients are sicker. This 10/24 WSJ article offers compelling evidence that the MA plans manipulate the coding system (rather than care for sicker patients) to receive higher taxpayer payments.
To make matters worse, MA plans also pay less to doctors and hospitals for care than regular Medicare. They achieve this outcome by denying claims and paying providers lower payments. This lower payment level has caused providers to cancel contracts with MA plans because they are losing too much money on these contracts, as noted in this USA Today article.
In summary, taxpayers and Medicare are overpaying MA plans by billions of dollars, and patients and providers are being harmed by these plans. The coding system, which is ridiculously complicated and easily manipulated, makes all this abuse possible. These abuses will continue as long as healthcare utilizes coding to determine insurance and provider payments. Alternatives to coding exist for paying providers and insurers. Visit www.thejourneys-end.org to learn more about these options. Hopefully, the new Administration will be open to these innovative solutions.
September 16's Wall Street Journal Opinion Comment ("Blame Friction, Not Fraud, for the Cost of Healthcare") by Robert Charrow, the past general counsel for the U.S. Department of Health and Human Services (HHS) is revealing. Mr. Charrow states: ”Of our $4.6 trillion annual health bill, anywhere from 20% on up goes to costs, many of which have been dictated by Congress. Transaction costs include electronic health records, HIPAA code sets, anti-kickback and Stark compliance, preauthorization paperwork and unnecessary diagnostic tests designed to thwart malpractice suits.”
Few people seem to understand or appreciate the accuracy of this observation. After a lifetime in healthcare coping with these mostly ineffective regulations, hearing these observations from a senior member of HHS brings solace to my heart. These regulations and the dominant use of coding as the driver of all healthcare payments are powerful acknowledgments of why U.S. healthcare today is in shambles. Regulations and coding, in particular, are destroying healthcare and costing taxpayers trillions.
As Mr. Charrow highlights, Congress self-induces this cost and destruction. Alternative solutions to healthcare are possible. My book, The Journey’s End, offers practical and meaningful alternatives. Reforming healthcare is possible, but it requires cooperation from Congress.
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