We do not have to wait for the Obamacare’s Death Panels to see how over regulation from the Federal Government will kill Americans. It is happening right now and will get worse in 2012 for at least 11 states.
Dr. Melissa Walton Shirley wrote an eye opening piece entitled “Why Micro Managing Cardiology from the White House Won’t Work” and you should read it in its entirety. It is a bit technical and written by and for doctors so you’ll have to skip over some of the medical jargon but you can get the gist of the article even with no medical education.
The heart (no pun intended) of the rant is aimed at new Recovery Audit Contractor Prepayment Review Demonstration Program that the Centers for Medicare and Medicaid Services (CMS) issued on 15 November 2011. This new program was detailed by Shelley Wood at Heartwire and I’ll highlight two paragraphs which tell you all you need to know.
“Last month, the CMS announced a new “Recovery Audit Contractor Prepayment Review Demonstration Program,” geared toward making sure Medicare dollars are actually going toward procedures that are medically appropriate and necessary. To be implemented in 11 states for a three-year period, the program will allow Medicare recovery auditors to review medical records and gauge the appropriateness of procedures performed, devices used, and claims for procedures or hospital stays prior to paying those bills. The new program goes into effect January 2012.
At least one state—Florida—has provided a list of the 15 diagnosis-related groups (DRGs) that will require prepayment medical reviews: more than half of the DRGs listed pertain to cardiac procedures. These include ICDs, pacemakers, and stent implantations, PCI procedures without stents, and other vascular and circulatory-system procedures.”
Americans suffer from cardiac related problems that require stents, catheters, pacemakers and Implantable Cardioverter Defibrillators (ICD’s). More than 900 Americans die every day due to sudden cardiac death and a vast majority of these deaths could be prevented from using an ICD so this isn’t some rare medical condition we are talking about here. With our lifestyle that still embraces fatty foods and smoking and with the aging baby boomers, this situation will only get worse and the government is realizing that they won’t have enough money to pay for these programs and, in typical fashion, are seeking to attack the symptom instead of the problem.
Dr. Shirley notes that there are a small minority of doctors who perform unnecessary cardiac surgery and do this to pad their wallets and like Kr. Shirley I welcome investigations of these practices and those medical professionals who are guilty of this should see the inside of a jail. But this isn’t what the CMS new directive is targeting and the new regulation by the CMS in addition to previous regulation from the DoJ are causing doctors to not implant devices in cases that would benefit the patient for fear of investigation.
Here are some pertinent quotes from Dr. Shirley’s post.
“What I don’t need is a “White House consult” every time I schedule a patient for a cath or a stress exam, and the tone of some of the language in this plan suggests there will be a ripple effect.
The opportunities to save money in all walks of medicine are as abundant as eggs on the White House lawn on Easter weekend. They are free. All you have to do is to bend over and pick them up. For the love of all things sacred in medicine, CMS–who in the world are you talking to? Do you ever ask anyone who is actively engaged in a full-time practice what they think will work to rein in cost? I’ve said it until I’m blue in the face. When you are looking at a budget and need to cut costs, the very first thing you do is examine the most expensive items on your expenditures, and I submit to you with absolute confidence that that is NOT CROOKED MEDICINE!
Furthermore, we cardiologists, who employ a substantial work force to fill out your forms and do your billing inquiries and kill trees and wreck carpal tunnels from all the necessary keystrokes, do not deserve to have our salaries reduced on a whim. Every year, it’s a new threat of a 20% or 30% reimbursement cut when there is an opportunity to save billions by just having a conversation with the White House. Insist on driving real campaigns that target compliance, make all public buildings in the US smoke-free, and map America for timely primary PCI. Quit just talking about malpractice reform and DO it! Offer incentives for hypertension screening, dietary instruction, and access to and utilization of exercise facilities for every business in America. Do not engage in a pathetic witch hunt, but go ahead and lay a trap for the crooks that are few and far between in cardiology.
If you are running for public office, especially the highest level of office in our country—specifically I am addressing you, President Obama, and you, Mr. Romney or Mr. Gingrich—you owe it to us to sit down with a physician who is actively engaged in full-time private practice to understand the most important issues we face in our country. Instead of just being reactive, let’s become proactive and at the same time react wisely and logically. Go ahead. Be bold. Focus on detection and prevention. Don’t be afraid to drive up the immediate cost of healthcare by looking for renal-cell carcinoma or triple As or carotid disease. It will save in the long run by preventing two years’ worth of chemo, radiation, and hospice care. Save billions of dollars in nursing-home stays for stroke. Drive the utilization of calcium scoring to detect asymptomatic coronary artery disease. Incentivize easy access to blood-pressure screening. Teach America how to check their pulses and screen for undetected afib. Make PE and health curricula in grades 1 through 12 just as important as math and science. After all, if we can’t teach kids how to live longer, healthier, and more productive lives, we have taught them nothing of value.
A great first step, and about the only thing the CMS has done that makes any sense whatsoever, was to make a feeble attempt at obesity screening and counseling. Someone must have had a TIA up there to have actually tried to address a real issue. I applaud that, but it was a drop in the bucket. Politicians cannot micromanage what goes on in a cardiologist’s office, but you can help us by laying the groundwork for success by just convening for a week on cardiovascular issues alone. If you don’t know what to do, instead of just picking some crazy scheme, for the sake of the future of American cardiology, why not pick up the phone and ask someone who is actually practicing it? CMS, by putting all the drivers of our most expensive DRG under the political microscope in cooperation with the scientists who actually fight in the trenches of cardiovascular disease every day, you can be successful in putting American medicine on the right track. It is only through the utilization of this formula that we can successfully improve healthcare spending. Otherwise, you will fail, and so will we.”
Here we have the real potential of a government agency over ruling medical diagnosis and care that was recommended by a medical professional. As was stated in the post by Dr. Shirley, if you want to reduce health care costs then start with encouraging healthy lifestyles and providing incentives to do just that. If someone has abused their body their entire life then why should the Federal Government pick up the tab and pay for the end of life care the same it would do for someone who took responsibility for their health?
And who do you trust to take care of yourself or your loved ones? Should that job reside with your doctor or a bureaucrat in Washington DC?
We don’t have to wait for the Death Panels. Our Federal Government is taking steps now to lower health care costs by allowing its citizens to die from denial of medical treatment.
Further reading – Regulations are Literally Killing Us
I love reading about medicine, and it is interesting to tie in politics with the subject, albeit under grave circumstances. I used to read PDRs at night when i worked as a CNA in a hospital and was going to college to train to be a psychiatrist. Switched to politics, the “master science,” as Aristotle put it, for such reasons as this. Thanks for keeping us posted and for providing a good source to read up about it.
November 30, CMS issued a new directive that will allow nearly 15 million obese Medicare patients to see their primary care doctor for “free” up to 20 times in one year for face to face obesity counseling.
That’s potentially 300 million doctor visits which is 100 million more office visits then Medicare patients see their primary doctor now for all reasons. (There are nearly 50 million Medicare patients who see their primary care doctor an average four times a year). CMS set the reimbursement fee at $34 for each visit.
Do the math and this new unfunded benefit could potentially cost $10 billion.
Before CMS issued this ruling, they did no actual cost benefit analysis; no estimate of the total cost of the program or whether this new service can even be delivered. (Isn’t there a well known projected shortage of primary care doctors?)
The Affordable Care Act gave CMS the power to do this which rivals anything Soviet era central planning ever tried to accomplish.
How is this new CMS benefit any different than when the Central Committee set wheat production goals by fiat and then set the price of bread without any concern if the wheat could be grown or the price of bread could cover the cost of production?
The Affordable Care Act is an oxymoron if there ever was one. Remember when Pelosi said the bill would have to pass before we could find out what was in it? Surprise!
Unbelievable! Thanks for the link and yes this is just another instance where the federal government comes in and causes costs to rise and benefits to shrink. As you pointed out, this is no different than a Central Committee controlling the supply and demand of consumer products.
Thanks for posting, I appreciated your comments.
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