The Doctor Weighs In

Maggi Cary, MD MBA MPH

During my residency training “Private pay” entered on patients’ check in sheets often meant “no pay.”  Anyone with financial assets to protect would have medical insurance.  “No pay” was code for negative wallet biopsy.  Two words took less time to write than “Doesn’t have medical insurance, assets or salary to cover bills so this one is free.”

If these folks landed in a private hospital, they were often shipped to the county hospital.  This was before EMTALA (Emergency Medical Treatment and Active Labor Act, also known as the patient anti-dumping law) made this illegal.  The transferring physician would say to the resident on call, “This is a good teaching case,” another synonym for negative wallet biopsy.

In my last essay I mentioned Medicare would no longer pay for some hospital-acquired infections and medical errors.  The headline on Robert Pear’s front page story in Sunday’s New York Times reads “Medicare Says It Won’t Cover Hospital Errors.”

Medicare funding has joined the “no pay” ranks for some avoidable errors.  As Medicare mandates, so will other payers line up behind Medicare. 

Lots of consulting opportunities here.  Hospitals and consultants may focus their efforts on following the spirit of the Medicare guidelines, perhaps even aspiring to the goals I mentioned in my last essay—that we should have a system that is transparent, quality-driven and does not distort economic incentives.

Or maybe not.

Skip to the last paragraph in the Robert Pear article and read the quote from Ken Kizer, who had the vision to turn the Veterans Health Administration from backwater healthcare system to the best in the country.

“I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”

Well said.

Yes, there are numerous consulting opportunities here.  When I had my own medical practice I took the billing courses that taught us how to unbundle services, separating medical treatment components into separately billable procedures.  This was legal then, at least in the letter of the law.  We could get paid more for exactly the same services.

Except that merely getting paid more for the same work does not create value to anyone but the folks who are getting paid.  It does not include transparency or quality and certainly does not align economic incentives.

I wonder whether in the short term hospitals and consultants will follow the spirit of the Medicare guidelines or focus on gaming the system.

Dr. Maggi Cary is Director of the Washington, DC office of the Institute for Medical Leadership. Click here to read her other posts. You can reach Dr. Cary at mcary@medleadership.com.