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View Diary: Medicare: Shifting Costs to Patients (61 comments)

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  •  Doctor, please (7+ / 0-)
    RAC auditors have to adhere to the strict Medicare guidelines in their denials and they have to be certified as RAC auditors which requires a lot of training. They also have to pass a rigorous 4 hour test before they are "RAC" auditors.
    Er, when I'm at a hospital, I'd rather have a doctor determine my medical needs.  Furthermore, I'm not convinced by what you say about conflict of interest.  With a 3 year wait for an appeal, many will give up.  That means the RAC auditor gets to keep his 10% simply because there's not adequate checks on them.  And even if the appeal goes to a judge and the hospital wins, is the RAC able to use that 10% for those 3 years and make money off of it?

    "We all too often have socialism for the rich and rugged free capitalism for the poor." - Martin Luther King Jr.

    by workingwords on Sun Jul 28, 2013 at 03:37:22 PM PDT

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    •  I'd like to believe the doctor knows best too. (12+ / 0-)

      Unfortunately, I've seen otherwise. I've seen doctors call for a CT & MRI scans for a comatose Stage IV cancer patient  2 hours before their death. I've seen a doctor order a pregnancy test for a woman who had a complete hysterectomy. I've seen nurses ram a ventilator down the throat of a terminal patient who had a proper DNAR order.I've seen a Catholic pediatrician deny the necessity of the HPV vaccine to a high risk 15 year old. I've seen a systematic merry-go-round of bouncing a patient from the hospital to rehab to the nursing home simply to keep them qualified for Medicare dollars - and it was all for naught, the patient lived miserably until they succumbed to their ailment.

      I've also seen doctors get crap from family when they tell them there is nothing more to be done other than keep their loved one comfortable until they die. I've seen family member insist on brain surgery to remove a tumor from their 85 year old parent not realizing the steroid treatment was working and surgery would likely destroy their mind and they were going to lose their parent to surgery.

      All this said, I still like your sentiment. I wish it were so.

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Sun Jul 28, 2013 at 05:14:13 PM PDT

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      •  Sadly, you're right (7+ / 0-)

        I see stuff like this all the time too. The pressure to get observation patients out the door before noon is intense, even if it means we have to rush to get tests done, or do tests that are less than ideal.

        I've been cussed out by an ER doc for refusing to do a stress test on a non-English speaking patient without an interpreter, and for questioning orders on a DNR palliative care patient unable to give informed consent, among many other things.

        The pressure comes all the way from the top and it's probably in every hospital to some extent. It's definitely getting worse, and fast.

         I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

        by SteelerGrrl on Sun Jul 28, 2013 at 06:21:51 PM PDT

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      •  The hospitalist who was looking after (7+ / 0-)

        my 90 year old mother with a DNR ordered a CT scan three hours before she died. Had I been there at the time I would have stopped them because my mother always experienced pain when transferring--she was a double amputee with major back problems/pain.

        The only trouble with retirement is...I never get a day off!

        by Mr Robert on Sun Jul 28, 2013 at 07:33:54 PM PDT

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      •  Medical professionals should be reviewed (1+ / 0-)
        Recommended by:
        Cassandra Waites

        for inappropriate care.  There should be criteria under which they lose their license, are restricted in the scope of their practice, penalized for unnecessary expenses.  None of this should involve charging patients more (unless it's determined the patient played an active and conscious role in abuses).  We also need to know that at times doctors may order unnecessary medical work because the hospital they work for pressures them to do so under threat of consequences if they don't.  Since this involves defrauding the government, hospital management should be prosecuted.

        Some of the claims rejected by RAC auditors probably fall into those kinds of inappropriate actions, but it seems clear RAC rejections extend far beyond that.

        "We all too often have socialism for the rich and rugged free capitalism for the poor." - Martin Luther King Jr.

        by workingwords on Mon Jul 29, 2013 at 06:00:36 AM PDT

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        •  Medicare pays fixed rates for hospital care (0+ / 0-)

          based on DRG (diagnostic group related) fees. The CT and MRI scans for Medicare inpatients would be done at the hospital's expense.

          There would be a radiologist's charge to read them. The figure of $42 comes to mind. The Medicare Part B patient co-pay would be 20%, or $8.40.

        •  They are reviewed. It's called PEER review and (1+ / 0-)
          Recommended by:
          sillycarrot

          it's doctors reviewing other doctors orders. It started out as a good thing, but unless it's egregious no one is second guessed.

          If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

          by JDWolverton on Mon Jul 29, 2013 at 09:41:55 AM PDT

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          •  Is it Peer reviewed or collusion? (0+ / 0-)

            Sometimes I get caught up in the two...

            Eventually it is overseen by a bean counter that flips a coin. HMO heads. PPO tails. Medicare? Ummm go to the code charts.

            I hope not but really fear in some circumstances this is possible.

        •  they are working on it. DOJ is (0+ / 0-)

          very active in ferreting out these scams. They can be hard to prosecute.

          60 Minutes recently did a segment on one hospital chain which has ordered it ER doctors to admit to meet a quota, 20% as I recall with a higher percentage for Medicare and Medicaid.  Hospitals: The Cost of Admission   6/9/2013 is well worth watching.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Tue Jul 30, 2013 at 03:32:38 AM PDT

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      •  Absolutely and worse too. (0+ / 0-)

        Doctors kill more people with preventable medical errors than die from lack of medical care.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Tue Jul 30, 2013 at 03:22:20 AM PDT

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