HEALTH CARE COSTS

The Times and the WSJ continual to run frequent articles about what is bad in the ACA created Health Care System.

For this blog forget about the too often long delay to see a doctor or to have tests or procedures. All of which is becoming the norm often to the point of endangering the life of the patient.

Forget about the fact that there is now a new layer of care givers who more often than not are the only ones in contact with a patient. Despite this the bills are as if a physician rendered the service.

One of the focuses of the news media is the extraordinary costs that ae now prevalent in the system. Much of this lies in the fact that Hospitals, Nursing and rehabilitation facilities and doctor practices have learned how to game the system.

Tuesday’s Times had a detailed article on how nursing homes/rehab facilities were gaming the system by supplying adulterated data about care, accidents, staffing, patient outcome to Medicare to get a better Star Rating and higher payments.

Almost all of the data used for the ratings are supplied by the facility and are rarely checked. Indeed one chain in California would supply higher staffing statistics to Medicare than the more accurate ones to State supervised Medicaid. Medicaid makes more inspections, several in a year.

Other gamers reported include PT facilities, laboratories and doctors. Medicare has broken down the reporting on a visit to many small detailed sections which have been subject to false reporting of being done or justified.

Too many claims have had the number or need for the service falsely reported.  

This type of fraud has run into multimillions. With large sums being paid on padded claims, there is less left to improve the quality of care or the lessening of waiting for care.