Sunday, January 2, 2011

Non Compliant Physicians: Guilty Until Proven Innocent

 

Liberty Loves Justice

Richard Reece, MD in his blog, Medinnovation today discusses increasing regulatory action, “drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes and the suspension of the government’s need to prove “intent” will create a compliance environment many physicians will find problematic”.

Henry Faird, Computer Scientist , Dartmouth, NY Times January 1, 2011

“With every technology, there is a dark side. Sometimes you can predict it, but often you can’t.”

Many call this ‘the butterfly effect”or another interpretation, ‘remote causation’.

“It uses different techniques and approaches to bring physicians into compliance - whistleblowers to spot offenders, computer protocols to guide ordering behaviors, electronic federal audits to identify coding abuses, new regulations compelling compliance, and creation of new organizations – accountable care organizations – using capitated payments to end fee-for-service billing”,and by identifying those physicians who violate compliance rules, reformers hope to shed light on what they consider to be a dark side of medicine - physician ordering practices that enhance income for themselves and hospitals in which they practice.

 

As with any top-down, Washington-based government program to regulate private behavior, there are dark sides to what government is trying to do.

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    • In the first place, government compliance is by its very nature retrospective. Regulators are not present at the physician-patient encounter and have little idea of the circumstances, dynamics, or context of what occurred or what was ordered at the point of care.
  • • Second, medical coding is so confounding, confusing, and byzantine that nobody – including government – understands its nuances and complexities. The reality is that about 20% of physicians under code while about 5% over code.
  • • Third, much if not most of the $60 billion of fraud and abuse that occurs in Medicare, is carried out by non-physicians who steal patients’ Medicare identity cards, set up storefront Medicare and Medicaid mills, and bill for items such as wheelchairs and other equipment or devices.
  • • Fourth, herding doctors into accountable care organizations and consolidating care in large medical institutions, which have the administrative skills only large organizations possess, will not necessarily lower costs. Costs are invariably higher for hospital charges for inpatients and outpatients, in part due to “facility fees,” than for those performed by physicians outside hospital walls or jurisdictions.
  • Fifth, some 70% to 80% of care is delivered by independent private physicians on a fee-for-service basis, usually through existing, often very sophisticated billing systems.. Converting or modifying these systems or integrating them with electronic billing systems will be a herculean, long-term task, fraught with certification and standardization difficulties.
  • • Sixth, there is a Big Brother aspect to all of this. Already computer controlled camera surveillance systems are being installed in hospital rooms. These systems come with ominous computer-generated voices that announce to doctors and nurses, “ You have not washed your hands.”

An entire new industry is spawning, with consulting specialists, compliance attorneys, and their legions of clerical assistants.

And finally Dr. Reece forecasts these ‘dark aspects’ of health reform,accountability, and non-compliance.

“I can foresee camera. face recognition, and computer surveillance systems in doctors’ offices. I pray this will not occur. These systems have the potential to destroy confidentiality, limit personal freedoms, and induce physicians paranoia. Privacy is central and essential to effective medical care. “

Crazy ideas,  I think not !  Who would have ever forecast the use of body scanners at airports, invasive monitoring of routine electronic communications, emails, data mining without consent or prior knowledge…who would have thought a President would bypass congressional consent for appointments (such as the head of CMS.), nor the congress sending sweeping health regulatory law , empowering the Secretary of HHS with total control over health care reform.without reading nor analyzing it’s ramifications not just for health care, but the overall secondary impact on the foundering U.S. economy.

Citizens should be outraged an should not be duped into  believing (Doctor) Sam will “care for them”. 

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