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Feb 19, 2009

Medicare Witch Hunt

Dear Mr President, Medicare Stinks
02/03/09 - Distractible.org by Dr. Rob

Medicare is controlling waste, fraud, and abuse by driving doctors out of Medicare. We can wonder who will be left to treat Medicare patients "for free".

[edited] I am a primary care physician. About 20% of my patients are covered by Medicare. I consider it an honor to be a doctor to the elderly. The complexity of a person’s medical problems goes up exponentially as they near the end of their life. I spend more time per patient for my Medicare population - which is OK if I can be paid for my extra time and effort.

If Medicare auditors find “problems” with our charting we will be told to send money back to CMS for our whole Medicare population. We are obligated to prove that we did not defraud Medicare to reclaim the money for the work we did. We will be presumed guilty unless we can prove that we are innocent.

They are looking for inconsistencies in the charting and the billing. These can be little things like:

  • Failure to mention in the note the EKG we ordered, even if it is in the chart.
  • The appearance of a “cookie-cutter template” in our notes. If all of our physical exams, review of systems, or impressions look similar, then it will be assumed we are trying to defraud Medicare.
  • Forgetting to document a discussion about a diabetic eye exam.
  • Certain ICD-9 codes will be accepted, but will “flag” that we are possibly trying to cheat Medicare. We need to be specific in our coding to avoid immediate suspicion.

We practice very good medicine and probably save money for the system, as a higher percentage of primary care in a community means lower cost. We use an EMR and are NCQA recognized for our diabetes care, and I think that our quality of care and documentation is in the top 10%. Yet we fear that your government employees are going to use us as scapegoats for the out-of-control costs of Medicare and put us out of business in the process.

We see what is being done to the hospitals by not accepting “No Pay” diagnoses (Never Events). That debacle is irrational and unfair, but the hospitals have no recourse.

That makes us extremely pessimistic about our odds when facing the hit-men from CMS. If a hospital with its lawyers and other resources can be hung out to dry, what chance does a primary care physician have?

We have never considered our acceptance of Medicare as something that actually makes business sense - we just like to care for the patients. But the increasing hostility we are seeing from the witch-hunters with their torches and angry mobs is making us really consider whether we can afford to stay on board.

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