Federal healthcare policy’s unhealthy obsession with prevention and deterrence of “waste” now elevates excessive measurement and auditability over patients and patient care.
It’s time to put our healthcare policies focus back where it belongs – on patient care.
Federal reimbursement and other rules now presume that care provided or prescribed to patients is wasteful, unnecessary and presumed to be criminally fraudulent unless the prescribing physician proves The appropriateness of the care provided and the amount billed under a progressively more complicated and care hostile maze of federal reimbursement, quality and other standards.
Not surprisingly,the cumulative intent and effect of these laws and their implementation and enforcement by an army a faceless bureaucrats, auditors and Administrators is to batter doctors and other caregivers into holding off or avoiding caring for the patients except for the government has provided a pre-existing stamp of approval.
Oversight initiatives originally intended to ferret out and punish true fraud now have been bastardized into a systemized process for determining physicians and other healthcare providers from providing the best care possible to patients and their families. These rules and processes now apply an artificial definition of fraud to care that the government and its non medical beancounters from the safety of their ivory towers use carefully selected and manipulated population health statistics and data to decide should not be paid for without regard to the actual needs of individual patients. These pontificators from their ivory tower population health mountains then impose these standard without ever looking at an individual patient to verify that the patient falls within the assumptions justifying these reimbursement and care guidelines. Instead they threaten, harass and even increasingly persecute physician and other healthcare providers for prescribing care their medical judgment leads these professionals to conclude best meets the needs of the patient based upon the actual examination and treatment of the patient. Physicians and other healthcare providers that insist upon putting their patients needs in front of these artificial population health paradigms are pressured if not forced, to force their patients to fit into the accepted care guidelines by reimbursement, discipline, audit and prosecution guidelines. In the process patients that don’t tolerate the average suffer or even die. Meanwhile the excessive resources wasted harassing good doctors and healthcare providers with excessive audit and compliance demands does nothing to prevent and is totally ineffective at recovering the millions of dollars stolen by the criminals that game the system my billing for care never provided or intentionally fraudulently billing the system.