Tuesday, November 12, 2019

Is CMS's Value-Based Healthcare System Already Being Gamed?

Take a look at the address of the American Board of Medical Specialties (ABMS) that owns the Maintenance of Certification (MOC®) trademark that is the subject of at least six anti-trust lawsuits (see here, here, and here for instance) underway because MOC binds physicians to their hospital privileges and insurance payments to made to hospitals on behalf of their employed physicians:

Now look at the address of the American Medical Association (AMA)-sponsored PCPI Foundation with board members from UnitedHealthcare, Premier, the American College of Cardiology, the American College of Physicians, several trustees of the AMA, and others:

Recall that the AMA maintains a monopoly on the procedure codes (CPT® codes) for every medical procedure performed in the United States and sells the rights to use that database to insurers and electronic medical record companies. Each of the AMA codes, then, have particular "value" to hospitals and insurers.

The AMA also determines the "relative value system" used by the government coding for weighting physician compensation that strongly incentivizes physician behavior. Some procedures, then, have more "value" to physicians than others. Hospitals know this, too.

Gee, I wonder, with all these codes and friends that stand to profit on the backs of working physicians and our patients, is the Affordable Care Act's value-based healthcare already being gamed?



Anonymous said...

The AMA has been trying to get Saudi Arabia to use their CPT codes also. ABMS working on them too.

They want a global monopoly?

I think they have become so large and powerful, they have lost touch with objective reality. They no longer serve us.

Anonymous said...

We are all being gamed. Physicians and patients. 99.99% of the population don't have any clue about the facts, because there is a circus going on in the media. Call it what you will, but it certainly is not journalism.

Why do we have to read about something as important as this on a cardiologist's blog, and not from professional investigative journalists. How about a concerned congressman or senator crying foul.

The loss of press freedom shows how far the gaming has progressed when circus distractions are the focus of America's attention.

Maybe that deception/distraction we get from the media is part of the manipulation/gaming as well. 6 large corporations own our media.

Anonymous said...

I still keep getting a bill/ad every month from the AMA asking for dues. They want to sell me all kinds of insurance as well (mailings/emails).

My medical specialty board now needs to be fed with PI and QI exercises, redundant CME, data and money collection ever more frequently. Stuck, but not by choice.

AMA advocacy for us here in America? ABMS advocacy or support? ACP? Forget it. Corrupt.

PCPI "Foundation" appears to be a secret society. A consortium of conflicted corporate gangsters doing "business as usual" in Chicago.

Again the truth is more surreal than any fiction you get from a mobster movie.

Anonymous said...

Insurance companies wrote the Affordable Care Act!

Criminal-Span: Grubergate said...

Glib, Thoughtless and Inexcusable Conflicts of Interest

"The Stupidity of the American Voter"

Gruber's "Non-disclosure of HHS contract

In January 2010, after news emerged that Gruber was under a $297,000 contract with the U.S. Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some commentators suggested a conflict of interest. Paul Krugman in The New York Times argued that, although Gruber didn't always disclose his HHS connections, the times when he didn't were no big deal. In response to Krugman's contention, Salon's Glenn Greenwald wrote, "What will make it impossible to effectively call out wrongdoing by future corrupt administrations (by which Krugman seems to mean: Republican administrations) is the willingness of some people to tolerate and defend corruption when done by 'their side.'"

"Grubergate" videos controversy

In November 2014, a series of videos emerged of Gruber speaking about the ACA at different events, from 2010 to 2013, in ways that proved to be controversial; the controversy became known in the press as "Grubergate". In the first, most widely publicized video, taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money". He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage. Gruber said the bill's inherent "lack of transparency is a huge political advantage" in selling it. The comments caused significant controversy.

In two subsequent videos, Gruber was shown talking about the decision (which he attributed to John Kerry) to have the bill tax insurance companies instead of patients (the so-called "Cadillac tax"), which he called fundamentally the same thing economically but more palatable politically. In one video, he stated that "the American people are too stupid to understand the difference" between the two approaches, while in the other he said that the switch worked due to "the lack of economic understanding of the American voter".

In another video, taken in 2010, Gruber expressed doubts that the ACA would significantly reduce health care costs, although he noted that lowering costs played a major part in the way the legislation had been promoted.[39] In another video, taken in 2011, Gruber again talks about manipulation behind the "Cadillac tax", this time also stating that the tax is designed so that, though it begins by affecting only 8% of insurance plans, it will "over the next 20 years" come to apply to nearly all employer-provided health plans. Journalist Jake Tapper noted that Gruber's description of the "Cadillac tax" directly contradicted a promise that Obama had made before the bill was passed.

After the first of these videos came out, Gruber apologized and conceded he "spoke inappropriately".