Progressives imagine that government workers, free from the evil profit motive, are able to perform their selfless functions for the good of their subjects, unworried by the need to save money to line the pockets of their masters. (Why so few Progressives are able to generalize from their experiences at the DMV remains a mystery for another time; perhaps they don't own cars or ever drive?) Consider: [HT: John Hinderaker]
According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%
It actually gets worse. In their zeal to ferret out fraud and waste, the apparent cause of of all government deficits without which, we are assured, we would certainly be able to have a surplus in our budget, Medicare treats its providers as potential criminals, all of us apparently attempting to maximize our profits by charging for unnecessary tonsillectomies, phantom services, and the like. Two years ago, when I still accepted Medicare coverage (though had stopped accepting new Medicare patients) I was audited by Medicare. I was asked to supply detailed notes on every one of my Medicare patients (4 patients, at that time) for the prior 3 months and asked to justify my billing code. I had been billing for 90807, Psychotherapy, 45 minutes, with Medication Management; all of the patients were on various medications and part of my sessions always included an assessment of the efficacy of the approach, though I did not formally note or evaluate their reactions to medication. Please note that this was how I was trained and billing for such services had been unobjectionable for the last 25 years. Apparently, unbeknownst to me, Medicare had decided to challenge payments for 90807 (Psychotherapy, 45 minutes, with Medication Management) because they thought my patients were only receiving 90806 (Psychotherapy, 45 minutes, without Medication management). Unless I could prove I was managing my patient's medications every week when I saw them (perhaps I could have taken their BP or asked some perfunctory questions about side effects?) I was committing Medicare fraud; the notices (there were many, in part because I am not terribly assiduous about my paperwork) detailed all the punishments I was risking if I did not comply with their audit request and failed to document 90807.
Here is the best part: The difference between 90807 and 90806 was ~$3.50 a session. It was likely I was overcharging Medicare by as much as $12.25 every week! (Two patients had supplementary insurance so paid the full $3.50 difference; another had the means to pay the difference; the fourth patient had very little money and could not afford to pay his half of the Medicare acceptable fee.)
Under the new Medicare guidelines, I was guilty as charged until proven innocent. I sent in my notes (scrubbed of any important information) and was told that I was only allowed to bill for 90807 on average once a month for my patients based on my documentation. Over a 3 month period, I had overcharged Medicare by almost ~$150! I had the right to appeal but just sent them a check. Considering the number of letters sent back and forth necessary to threaten me to gain compliance and the time spent perusing my submitted notes, I suspect Medicare lost money on the exchange. However, a bureaucrat somewhere was earning his pay!
(Ignorance of the law is no defense, and I freely admit that I never read the notices Medicare sent me, seemingly several times a month, about changes in their billing. I had neither the time, nor the interest in keeping up with Medicare billing; they paid less than I would accept from a new patient and I only had continued in the system for my legacy patients. The less I had to do with them the better I liked it. I did not believe in abandoning patients simply because they could no longer afford my fee and accepted Medicare in full for their treatment. Since Medicare authorized a low fee, and only paid 50% of that, unless the patient had supplementary insurance, I was not about to get rich treating Medicare patients with Psychotherapy. I could make a lot more money seeing patients for Med management under Medicare and/or private insurance; I could see many more patients and since the fee for Psychotherapy is much less on an hourly basis than the fee for Med management, the volume would bring in much more money. Unfortunately for me, I prefer treating people as if they are more than a collection of neurotransmitters; a quaint approach admittedly and not a good fit for everybody.)
Hidden within the new healthcare bill is a change in status for insurance companies from independent, for profit entities, to something more along the lines of a public utility, with rates set by anonymous boards, insulated from public reaction by the usual layers of bureaucratic obfuscatory edifices. Insurance companies have always defaulted in their rates to converge on Medicare fees. With the new government control of the insurers (who gain a new, captive group of healthy rate payers, ie guaranteed profits, while giving up risk and freedom; the insurance companies are not at all unhappy with the bill and that should be informative) we will all be the beneficiaries of a system which is designed to see patients and Doctors as adversaries costing money for no benefit to the bureaucracy.
Don't say I didn't warn you.