Warning Signs

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“Warning Signs” is a new concept for Patient POV. In it, I plan to point to unanticipated changes in health care that warrant a closer look. In some cases, all we see is a snapshot of something awry in one locale, but the change is ominous, has the potential to spread, and the public ought to know about it. I hope to point to exemplary shifts in medicine as well.

In the past week, I found these warning signs particularly worrisome, and applaud the work done by other reporters and bloggers to document them:

  1. If you thought the peanut butter-salmonella scare sounded bad enough on its own, think again. The Center for Science in the Public Interest explains that even though the FDA Food Safety and Modernization Act was passed in 2011, FDA has not implemented measures essential for food safety. “Deadline after deadline has come and gone with the agency taking no action, leaving consumers vulnerable and industry without guidance. Peanut butter and other foods are no safer than they were at the beginning of the President’s term, when he rightfully expressed concern about the peanut butter in his daughter’s sandwiches.”
  2. Concerns over the future of Medicare have gotten lots of attention, but the future of Medicaid has gotten far less scrutiny, particularly for seniors and the disabled. An editorial in the Tampa Bay Tribune takes up Romney’s mean, lean plans for Medicaid and nursing home residents.” The editorialists point to the public’s confusion that nursing home care is solely a Medicare issue and that Medicaid is strictly for the poor.  “But Medicaid is the program that provides long-term care to the elderly and disabled…It was Ryan who authored the plan to convert Medicaid from a strong federal-state entitlement to a block grant program to the states that Romney has incorporated into his campaign. The plan, passed as a budget blueprint by the Republican-controlled House, would gut Medicaid’s safety net and focus instead on cutting funds. The nonprofit Center for Budget and Policy Priorities says Medicaid funding would decline by one-third by 2022 under Ryan’s plan.” Take a closer look.
  3. Electronic health records have enormous potential for improving patient care and tracking health outcomes, but abuses in Medicare billing, identified in a NY Times article, are worrisome. Readers will want to be aware of:
  • cloning, where a doctor copies information from a previous visit to a later one, or duplicates information from one record to another;
  • upcoding, which The Times defines as exaggerating “the intensity of care provided or the severity of a patient’s condition to justify higher billings.”

In response to this article, Attorney General Eric Holder Jr. and Health and Human Services Secretary Kathleen Sebelius sent a letter to five hospital associations, noting “troubling indications” and their intent to prosecute for billing for services never permitted.

4. Ever wonder, why, all of a sudden, you see higher out-of-pocket costs for doctors’ visits. Consider this: the Cleveland Plain Dealer describes how ordinary doctors’ offices have become “hospital departments,” and along with it, come new facility fees for simple primary care.  In one example at Cleveland Clinic’s MetroHealth Center, , a patient was charged a facility fee of $1,655, about four times the doctor’s bill, for 30 minutes in an exam room to have a suspicious lesion removed. The patient states: “There is a much bigger issue and that’s that people won’t get the care they need because they can’t afford these charges. It’s totally wrong.”

“Warning Signs” is new. Let me know if you like it, think of something that I missed, and most importantly, your POV.

 

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6 Responses to Warning Signs

  1. Ricki Lewis says:

    Terrific! Very useful and highly readable.

  2. This is a great idea, Laura.

    The upcoding issue is newly discovered by NYT. The ground-breaking work was done previously by Fred Schulte, whose series began running a full 10 days or earlier than NYT’s piece. Fred is a former Sun-Sentinel investigative reporter who is contributing to do great work now with the Center for Public Integrity. It was his work that prompted HHS’s reponse.

    See the link below, and keep scrolling down for the earliest stories.

    http://www.publicintegrity.org/health/medicare/cracking-codes

  3. Aidek says:

    Don’t forget that if you have Medicaid, it is almost impossible ro find a PCP that accepts it, so you are back to using the ED for non-emergency care.

  4. Sandy Koo says:

    I suspect you could be writing full time on these issues.

    Quite a while ago when my daughter was hospitalized for an orthopedic situation, I noticed that in reviewing her bill we were charged a higher level of care than we were having. I called to question the charges because my daughter was leaving the hospital with us for hours at a time since she wasn’t infectious. She was not having any active treatment except for medication. While the hospital wrote off the charges to me I seriously doubt that they rebated the money the insurance company paid. This definitely was not an isolated issue.

  5. Sandy says:

    Medical record software is sold to professionals and health care organizations as one way to capture every charge. It is appropriate to bill for services done, but the software can prompt for additional charges which may or may not be necessary. We have to rely on professionals to give patients appropriate care and not be guided by programs which are may be looking at financial rewards.

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