>"We've had the impediments of the inspector general's opinions on gain-sharing, but if you take quality measurements and evidence-based medicine and make those part of a quality program in hospitals that produces quality outcomes, you can prove that you've improved the quality of care and won't be violating the gain-sharing prohibitions," he says.<
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>Gain-sharing programs align hospital and physician interests by offering incentives to achieve cost savings, but HHS' inspector general has severely restricted the practice.<
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>"We believe that one of the very best ways to confront this issue of civil and criminal offenses is by putting quality programs in place in hospitals to eliminate those concerns," Roble says.<
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>He says hospital chief executive officers are fighting daily battles and don't have the time or resources to look far down the road. "Outside pressures from government regulators could help create the environment that this is a dilemma they must face up to."<
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>Danello says the inspector general's office and other federal enforcers are focusing on quality and have identified more than a dozen areas of interest. "This hasn't been announced as a national initiative, like the clinical lab investigations or DRG upcoding. It's not a formal policy and is much more open-ended. But there is an interest in attacking these problems as opportunities present themselves."<
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>He says that as budget deficits grow and financial resources available for healthcare diminish, enforcement agencies look to quality of care not only to ensure that Medicare and Medicaid beneficiaries are receiving care appropriately, but that the money isn't squandered.<
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>"I think this is a winning issue and a winning argument," Danello says. "It's not just a reimbursement issue, but a quality issue examining how outcomes are tied to reimbursements. I think hospitals would be wise to note the attention this has attracted."<
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>Jim Moriarty is a Houston lawyer representing hundreds of Redding (Calif.) Medical Center patients who are suing two doctors, the hospital and the hospital's owner, Tenet, over allegedly unnecessary heart surgeries. He says the focus of the lawsuits isn't medical malpractice but fraud and
each of fiduciary duty. He says many can be harmed when hospitals and health systems pre-empt the medical integrity of the patient relationship.<
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>"Those who get surgery don't know if they can trust the doctors, people who get surgery they don't need are harmed, and those who receive surgery they don't need in lieu of treatment they require can be harmed the most," says Moriarty, who successfully sued Tenet predecessor National Medical Enterprises on behalf of hundreds of patients who were hospitalized against their will in Texas.<
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>Los Angeles whistleblower lawyer Mark Kleiman says government interest in quality-of-care issues was provoked by what he calls "the Enronization of healthcare."<
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>"In a world where patients are thought of as mass-produced commodities like tacos or soft drinks, injury or harm to patients is considered collateral damage," Kleiman says. "The government has noticed and recognized that if they don't intervene, nobody else will. They've seen decisions driven by money and not patient welfare and that concerns them."<
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>What do you think?<
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>Write us with your comments. Via e-mail, it's mhletters@crain.com; by fax, 312-280-3183.<
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Sick and Tired of Doing t
Joined: 06 Jul 2003
Posts: 1
Posted: Sun Jul 06, 2003 6:00 pm Post subject: I have comments
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I have comments on your letters about the government policing themselves. I am posting them here and you can print them off to use if you chose. I worked with one physician in a small town in KY who scheduled four (4) patients for every fifteen minute appointment slot. That means that the patient was given an average of 4 minutes with the physician. Four minutes for him to obtain the subjective information of your complaint, complete the physical examination, write the treatment plan, and give you your prescriptions. It is physically impossible to do all these takes in four minutes, I don't care how good your are! In an average day, he would see 75-100 patients (nursing home, clinic and hospital) and walk out the door at 5 PM. Did anyone at Medicare catch that he was upcoding and submitting excessive visits, no. When he was turned in did anything happen, no. Why? He was smart enough to be a case reviewer for them, and they wouldn't go after one of their own. I worked with another person who was "seeing" and billing for seeing 30 patients/day in the long-term care setting. This was accomplished by 12:30 each day. It's impossible to see that many patients in that setting and do it properly. This person was turned into Medicare and you know who was investigated? Me. My charges were dismissed, but they never looked at the other persons. Not one chart of the other person's work was examined. Why? I have no idea.<
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>So even when you file a formal complaint, no one listens and nothing is done, except to an innocent person, which is why I no longer work in the medical field. When the person who is doing everything the correct way, documentation, everything, and they are still the source of numerous investigations, and the person who is the slacker continues to get by with it, it is not fair and you lose your heart in caring for your patients the way the should be.<
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>Again there is the issue of doing your job to the best of your ability, using all of your moral, ethical and legal decisions, and no matter what you do it's wrong, and you have the stress of an investigation, although you know that all charges will be dismissed, your life is h*** for six months or more until the investigation is completed.<
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>And then there is the doctor you go see that never places a stethoscope on your chest to listen to your heart or lungs, yet charges the most expensive visit possible to you insurance company. A note to the wise, if you get your EOB and your doctor has charged a 99313 visit and he had not performed a physical examination of you, COMPLAIN!!!! That is technically a 99311 visit and the difference in the billing is over $100 in
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Barbara
Joined: 06 Jul 2003
Posts: 1
Posted: Sun Jul 06, 2003 7:27 pm Post subject: neph rounds
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Are nephs supposed to listen to your heart when they make rounds? Mine never does. How in the world does the govt allow them to be paid so well for coming to your chair and leaving 30 secs, later? My neph does come once a week which is good, because I know patients who say they don't see their nephs for months. But my neph coming every week really doesn't seem to matter anyway because he can never seems to be able to answer a question.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Sun Jul 06, 2003 11:39 pm Post subject: Rounds
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? my neph. doesn't visit me in the center; I have to go to his office and make a 45$ copay! He listens to my heart at that visit and that's it. On the run sheet staff writes that they made an assessment at each and every tx. but they don't. It's only done about half the time! Most of the techs. never listen to heart or lungs, and I can't remember the last time anyone checked my legs or ankles for fluid. Lin.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Mon Jul 07, 2003 4:23 am Post subject: Co-pay
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Lin - once Medicare gecomes primary (30 months on dialysis) then your office visits are no longer billed for.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Tue Jul 08, 2003 11:54 pm Post subject: Yeah!
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Tweny four and counting!!! Ty! Lin.
