Can Government Assure Access and Quality Through Penalties?


Under ObamaCare, patients must pay penalties for not having a health plan, and doctors must pay penalties for not reporting quality data. Is this any way to run a government health care railroad? Do penalties work?

In the case of access,it might. Over 16 million uninsured Americans became insured last year, 8 million via health exchanges and 8 million via Medicaid. A goodly proportion of those insured gain came secondary to the realization you had to pay a fine, $95 for not having a plan in 2014, $395 in 2015, and higher amounts thereafter.

With doctors, the story may be different. This year 460,000 of eligible doctors, 40% of 1.25 million providers, will have their Medicare payments docked by 1.5% for failing to submit data. In the other hand, 642,000 complied with the federal reporting quality program, which was launched.

What kind of data? Percent of patients checked for blood pressure, percent asking for smoking cessation counseling, percent ask for what medication they were taking, and so onl.


The 1.5% penalties don’t stop with not reporting quality data. Penalties include 1% more for not having electronic health record in 2013, 0.5% to 1% for not complying with a complicated cost and quality adjustment, The Value-based Payment modifier. Penalties may grow to 9% by 2017 for the three programs combined. And the three penalties are scheduled to morph into one program under the law just passed last month to replace the annual Sustainable Growth Formula.

Most doctors will probably comply by 2017, as 51% already have. Most don’t have mmch choice, since more than 90% of doctors treat Medicare patients, or patients under other federal programs. Another federal program creating more paperwork for doctors will be conversion from the ICD-9 to ICD-10 coding system on October 1. 2015.

What are doctors are other providers to do rather than bow to the Medicare and ObamaCare programs? One choic some 5% to 10% are exercising is converting to so-called Free Market Medicine, which appeals to mann doctors because eliminating coding and quality reporting by cutting out the government/insurer middlemen by foregoing insurance paying directly in cash. This is one option being adopted by growing numbers of self-funded corporations, which effectively eliminate state and federal mandates and Medicare patients. How much this option will progress and what patient market share it will gain is unknown, but doctors are interested in the concept because it eliminates coding, quality reporting, federally-approved electronic records, and reduces overhead, often by 50% or more.