Wednesday, December 4, 2013

Medicare Flattens Payments for  Outpatient
Despite criticism from hospitals and doctors CMS intends to pay flat rates for Medicare visits to outpatient clinics instead of payments that that vary with the severity of the patient’s condition
“Medicare To Pay Flat Rates for Clinic  Visits,” Modern Medicine, November 27, 201
If you’re President or you’re in a government agency,  you do what you want to do.  You’re in power, and you reserve the right to change the rules  or to rig the game in any way you see fit
With Medicare, for example,  you can change the 10 procedure codes for outpatient clinic visits so the codes  fall under a single code.
CMS explains, “A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit.The new payment rates will be calculated based on statistical averages in 2012 claims data for the five levels of severity.
It doesn’t matter if the patient has an upper respiratory infection or a heart attack.    All patients are equal, and no patient is more equal than the others
Everything has to be standardized,  all must be homogenized, and one-size-fits-all.  Everybody is in the same box.  All thought must flow down in a straight line from the top.   There will be one exception.
CMS will step back from its proposal to flatten the payment rates for emergency room treatments, noting in the rule that more study is needed to make sure the payment structure “would not underrepresent resources required to treat the most complex patients, such as trauma patients.”
So goes the process of linear thinking that everything goes in a straight line from top-to-bottom, that there is no room for lateral thinking or thinking outside the box.   We are all in this together.  We are all in the same box.  No out of the box thinking, please
Actually, this type of thinking is more complicated than that.   In fact,  this thinking can produce a bureaucratic nightmare, because all must abide by the same rules and same procedures
I sought to explain this mindset in a blog I wrote four years ago.  I was trying to describe how the architects of ObamaCare thought
Academic and government experts know better than people themselves what is good for them.

. You can trust government, but you can't trust markets.

• Equality of results and health care equity, with expansion of coverage, is paramount.

• Standardize and homogenize health plans into one-size-fits-all plans that offer comprehensive and coordinated care.

. The power if centralized government transcends the power of individual states.

• Make all health plans and all states comply with federal mandates and regulations.

• Health care is too important to be left to consumers, doctors, hospitals, and private markets.

• Health care technologies should, and must be, be assessed by government before and after introduction into the market.

• The practice of medicine is a rational, measurable science and its technologies and outcomes must be managed by outside experts.

• All physician and hospital practices must be digitized so they can be monitored and paid-for-performance based on evidence.

• You cannot depend on health care stakeholders or competition or markets, or consumers spending their own money, to be self-regulating.

• Big Government and Big Academe know best.

Tweet:   CMS  has ruled that all doctors who treat  outpatients will be paid a flat rate, no matter what the patient’s condition.

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