From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 21 May 1999 07:35:49 GMT

In <3744F64F.7C79@lucent.com> Martin Braff <braff@lucent.com> writes:
>
>Richard M. Poniarski, MD wrote:
>
>>         If you could make doctors private contractors, without the limits
>> that HMOs impose, and find a way to fund it better without the real
>> gestapo tactics that the US government uses (think about this: all
>> senior citizens are being told to examine their Medicare bills, and can
>> get up to $1000 if they find a mistake; this so the HCFA can prosecute
>> doctors for bad billing and "fraud"! That does wonders for the
>> doctor/patient relationship!!!) it *might* work...but I wouldn't bet on
>> it.
>
>
>You consider patients examining their medicare bills and reporting errors
>or fraud "gestapo tactics".  I think its a good idea. This is not about
>mistakes.  There is a huge amount af fraud in the medicare system.  If
>patients were paying their own medical bills you know they would examine
>those bills very carefully.  How is medicare going to know if the doctor
>who billed $200 for an hour of critical care only stopped in for 5
>minutes, and let the house staff manage the patient.
>
>Marty Braff



Comment:

   I don't know how Medicare is going to know-- but whatever they do,
obviously they need to figure out how much executive-level decision
making is worth, and quite trying to make a bunch of professionals
punch time clocks for them.  How do you know if Steve Jobs supervises
every circuit put into every new Apple computer, or whether he just
sits around in his office and grapples with the big picture?  And are
you cheated if he does the latter?

   However, Medicare is not the real outrage, as we all can understand
at least the governments motivation to keep from being defrauded by
doctors of "public money."  The real outrage is the federal
government's more recent intrusion into doctor-patient relationships
that have NOTHING to do with public money.  Zip, nada.  Under the
Kennedy-Kassebaum fiasco passed in 1996 as an "insurance portability
act," what we now have is essentially an extension of Medicare billing
paperwork standards for EVERY patient which a doctor sees, under any
circumstances, and even if the arrangement is cash-in-hand or
professional courtesy or charity, IF the doctor has billed for ANY
Medicare patient in the last several years.

   Yes, folks, you have that right.  According to law, and backed up
penalties of $10,000 per instance and several years of prison time, a
doctor who occasionally bills Medicare cannot bill ANY of his/her
patients, private pay or not, less than he does for the comparable
service under Medicare.  Which means he or she has to have all kinds of
complicated stuff in place to show that he takes reasonable care to
insure that never happens.  Why the goverment cares about this is
somewhat mysterious, but has something to do with wanting to put HMOs
which bill less than Medicare, in their place.  Alas, it now applies to
all doctors, who (as noted) now need to do some billing codes in the
medicare style for every patient they see, just to protect their
posteriors.

   Now, it's not as though this guarantees every patient now must pay
at least medicare rates, for the law only requires the doctor bill out
that much, not that he can't accept less, or nothing.  What's in a
bill?  Everything.  It satisfies bureaucracy.  So long as accepting less
than the bill is written up in a nice policy and procedures manual,
with lots of forms and SOPs, it is permitted.  Charge what you like, in
effect, just so long as the bill you sent out has the proper numbers on
it, even if these are intended to be ignored.  The government fines and
jailterms in effect insure only that a lot more paperwork is done to
ensure this Alice in Wonderland state of having the bills read out
numbers higher than medicares, whether or not these numbers mean
anything at all.  You think I'm kidding.  Wrongo. I'm not.

   Now there is blame enough for this monumental stupidity and
infringment of civil rights, to go around.  It's was a joint Republican
Democratic bill, so both parties are to blame.  There was a lot of
pussyfooting to make sure that senators didn't get much chance to see
the 150 page thing, and I believe that only one Senator from California
caught on.  Everybody else, whose job it was, was too lazy (talk about
a group which needs time clocks).  The AMA, for it's part, was not very
good on preemptive lobbying,. and when it found out the real scoop
after the fact, found that it had cried "wolf" so many times in the
past that doctors now ignored it.  For the doctor's parts, they were
their usual arrogant selves, figuring the government was not going to
do anything to them, so long as medicare patients weren't involved.
Most doctors still do not fathom what has happened-- do not believe it
when told, in fact.  Non-doctors who now do understand, are to be
blamed for figuring that if this causes problems for doctors, that's
just too bad--- doctors need to be taken down a peg anyway.  They never
stop to consider that one of the reasons they can't get time to talk to
their doctors is that the doctors increasingly are tired up with
foolish paperwork.  No man is an island.  Each man's professional
misfortune diminisheth me, for I am involved in business arrangements
with mankind.  Therefore, never send to know which profession the feds
have screwed this week: ultimately, whichever it was, they have screwed
you.

                                       John Donne

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: talk.politics.medicine,sci.med
Subject: Re: Medicare and Bret's Reality (was: Disappointed and confused--don't
Date: 27 May 1999 20:34:11 GMT

In <slrn7kr428.4bs.rusty@adams.patriot.net> rusty@adams.patriot.net
(Frank O'Donnell) writes:
>
>>with mankind.  Therefore, never send to know which profession the feds
>>have screwed this week: ultimately, whichever it was, they have screwed
>>you.
>>
>>                                       John Donne
>
>Steve, shouldn't that be thee?
>
>Rusty
>--
> "If what you say is true, you may be right."- Jack Corboy




   Yes.  They have screwed thee.  Thou hast been screwed.  These forms
are the remainders of the old English familiar mode (analogous to the
German "Du") which is now gone.  Appropriate for the thought, in this
case.  Verily, verily I say unto thee, thou has been PERSONALLY
screwed.