Wednesday, December 07, 2011

As Goes the Post Office, So Too Medicare?

With the announcement that the Center for Medicare and Medicaid Services (CMS) will begin auditing 100% of expensive cardiovascular and orthopedic procedures in certain states earlier this week, we see their final transformation from the beneficient health care funding bosom for seniors to health care rationer:

The Center for Medicare and Medicaid Services will require pre-payment audits on hospital stays for cardiac care, joint replacements and spinal fusion procedures, according to the American College of Cardiology in a letter to members. Shares in both industries fell with Tenet Healthcare Corp., the Dallas- based hospital operator, plunging 11 percent to $4.18, the most among Standard & Poor's 500 stocks. Medtronic Inc., the largest U.S. maker of heart devices, dropped 6 percent to $34.61.

The program means hospitals won't receive payment for stays that involve cardiac care or orthopedic treatment until auditors have examined the patient records and confirmed that the care was appropriate, Jerold Saef, the reimbursement chair for the Florida chapter of the American College of Cardiology, wrote in a Nov. 21 letter to members. The review process is expected to take 30 days to 60 days, beginning January 1, Saef said.
This is not at all unexpected. In fact, in our field of cardiac electrophysiology, we have known this day would be coming; our expensive, life-saving gadgets and gizmos are easy targets upon which the government can cut its rationing teeth. And so as it will go for us at first, and then for many other areas of health care.

But the government has no idea how to do this, really. They don't have the data, the cerebral wattage, acceptable information systems, nor manpower. So, the government will grow further to offset it's shortcomings in order to assure they can "save money" for our health care system.

But CMS, like the U.S. Post Office, has a dirty little secret: they don't pay very well. To offset their low pay, they have to offer some pretty nice benefits to attract their best and brightest. And because the government is now going to bite off trying to manage an entire country's medical procedure rationing during a limited eight-hour government workday, they are going to be flooded with calls, many of which will be frustrated, angry calls that have been on hold a very, very long time.

And so they'll hire more people to improve services.

And pretty soon it will dawn on them: this is expensive to do. It will just be a matter of time when, like the Post Office that was seiged by their inability to keep up with pension and health care costs, they'll surrender and turn over their efforts to private enterprise.

That's because health care is local. Health care is complicated and needs lots of data, systems, and capable facile people to make decisions on data the government wants but knows it doesn't have. (Remember when the Department of Justice had to "consult" with the Heart Rhythm Society to "understand" defibrillator implant practices by tapping into their NCDR database?) Further, because the government moves slowly, can print money when it runs short, and must work through politics, government rarely works under budget. (In fact, when money runs out in government, they just shut down - not a great idea when working in health care.)

Of course the insurers don't want this. They already know it's too damn expensive to take on the risk of our paying for the health care of our aging seniors. (They were one of the main proponents of health care reform, remember?) So the government will have to have their back somehow. (Those details still have to be worked out, but it'll happen because politically, it must).

And the final transformation of our health care system of the future will be complete.



More info available at Larry Husten's Cardiobrief blog.


Explanthis said...

While I appreciate the physician perspective, as a patient advocate I have seen the "dark side" of failed "innovative" orthopedic devices(the #1 expenditure of Medicare). Patients are in medical and legal purgatory while allowing failed "innovative" devices to stay on the market and the medical device company to avoid accountability. Orthopedic surgeons and cardiac surgeons are aware that national registries in other countries significantly reduce "revision" surgeries, yet 20 years of promises have gone by and there is no such registry that informs patients (similar to Consumer Reports for basic appliances). Scrutiny is warranted, if annoying.

Keith said...

C'mon Wes!

We have had to preauthorize procedures and MRIs with commercial insurance companies already. It obviously must save money or why would insurance companies do it?

Given the high rate of IVCDs that are estimated to be installed for questionable indications, it seems perfectly reasonable for the goverment to try to limit these unneeded costs. It would seem something that as taxpayers, we want to see the goverment do; weed out unneeded or ill advised procedures that cost the health care system alot of dough, and protect the taxpayers from fraud. But we are in these times when all goverment is considered bad and regulation is considered a big strain on our economy. Recent events suggest we need to have more goverment regulation (think financial services industry).