Home Forums Discussions General Discussion CMS giveth and CMS taketh away

Well, first I will admit my ignorance to the entire MU thing. So, other posts will likely be more accurate. But, it seems that the government is paying quite a bit to doctors to use EHRs, but now they are paying CPA firms to audit them.

This quote on the website of Ober | Kaler, Attorneys at Law seems particularly ominous.

"It seems likely that the results of these broad, basic audits will be used by CMS as the basis for further and more extensive audits under subsequent initiatives at a later date."

CMS fits my view of evil incarnate. Hence my decision to have nothing to do with them. Freedom is priceless.

Same here. Ask (former) GM CEO Rick Wagoner about taking government handouts.
Dave

Am I reading this correctly? You must send these summaries, but it doesn't count if the receiving doctor has the same EMR? I suppose I understand that it is more important to show that EMR1 can send to EMR2 rather than to EMR1.

We all know that some physicians are slow to adopt technology, but no email address? Really? How many is many?

OK, let me figure this out. 10% for me would be 200 patients. I probably average emailing with 30 patients annually (their starting the convo). Now, I would have to send 200 messages. And, they have to be secure? (which I know can be done through portals). But, I guess the only way to accomplish that would be lab results or appointment reminders.

And, 200 of my patients need to access their chart online? What do they mean by access on their own?

Again, not saying it is wrong. Just saying it doesn't make sense to me.

This is exactly the reason people should think twice about any government mandated insurance, I could tell you that the MU was just money that you are owed for being physicians and taking care of patients at lower rates. However, now they will try to take away your hard earned time and money. Buyers beware! Oh yeah if you are a wheelchair or Diabetes company selling to CMS patients you are getting away with millions and taking it away from us hard-working docs! Alas the only to suffer is our patients, families, etc... go to docsforpatientcare.org if you care! Well worth the money and they tell the truth!

Which makes perfect sense.

It's called accountability. If you pay someone to do something, it is reasonable to check that it is being done as specified.

Every time I read a Bert post, my BP goes sky high, and I have to double up on my Lisinopril and start 12.5 mg of HCTZ.

Calcium channel blocker? Not yet.

Marlene

Marlene

Please keep your comments to the topic at hand. So you disagree with me. Fine. But, no need to be derogatory.

I would ask you to criticize other users.

Bert,

Tracking my BP is not derogatory. It's MU.

You know what your comments were alluding to.

I wasn't saying their shouldn't be accountability. It just seems to have a lot of attestation and not enough objective areas. So, they pay out these billions of dollars and now they have go out and pay a lot more to check on what they paid.

I wasn't alluding to anything. I was pretty clear that I think it's not unreasonable for the govt to ensure MU compliance. I would expect it and if they simply doled out money without ensuring compliance, that would be irresponsible. I don't think this is an issue with AC users as AC makes it fairly easy to document MU.

Do you not consider this derogatory?

It's not clear what you are trying to say here. I am not trying to pick a fight (but it's "there" not "their"...can't help myself when a doc mixes them up).

No, it was simply an observation of a perceived correlation. Sometimes NOT taking offense is the best way to go. I did not mean to offend you.

You're right about the there. Let me make it clear.

Saying that every time you read a Bert post your blood pressure goes up is a criticism that was not necessary.

This is a warning. Take it how you will. If you would like to stay on the message board, then please do not insult other users.

Then keep your perceived correlations to yourself.

k

Thanks Bert! Marlene, go to docsforpatientcare.org and realize that obamacare is 1997 pages of mandates on hospitals/docs/nurses, etc... and 3 pages of "possible" tort reform where 30-35% of healthcare dollars are wasted so that we are protected from attorneys and rogue patients. Oh yeah, there are supposed to be 150,000 new jobs in the government to "help" implement these mandates at a cost of 100's of billions to pay for it and none has been implemented due to the fact that we as the government do not have the money to do that!

Ron Paul, 2016 :rolleyes:

Jack, I don't necessarily disagree with that stuff. I was replying to Bert's post. That is all (do not want to get b*nned).

Couldn't find the site. I think you need to use a 4 for the for.

So, it would be http://docs4patientcare.org

Thanks for that correction, Bert. Is Obamacare all that bad? I have a lot of uninsured patients and both they and my practice would seem to benefit from it.

I'm in a rural area with a lot of patients who can't afford to see me, so it's slow for me and they are not getting care that they seem to need. I talked to one such patient who works at the grocery store and she told me she would like to come in but didn't have insurance. It's a difficult situation and I don't know the answer. I am not trying to politicize this, but am interested in any other views and experiences about this mess.

Marlene,

No one knows less about healthcare politics than I. But, I am reading on the site that Jack recommended, and it is somewhat eye opening and educational.

Indeed. It's complicated but something we're going to have to grapple/deal with one way or the other.

BTW, it is nice that we are now getting along. I d/c'd the HCTZ and started a large bore IV for crystalloids to keep me from fainting.

Yes it is. Much safer to go with the crystalloids.

Sorry guys, it is docs4patientcare.org. I do not mean to politicize this either, but we as physicians are allowing are field to be ruled by other people, lawyers would NEVER stand for this, we should not either. Also, if we got paid what we deserved, Marlene and Bert, we would all be able to do what physicians used to enjoy doing, giving away part of our care for charity to take care of those people without insurance. I already do this in my area, but I am the only one out of 20 docs that will do that at this time. It is pretty sad actually. No easy answer. However, we need to start paying attention, the last twenty years docs have allowed their field to deteriorate. We no longer are revered for our stature in society, only the bottom of the barrel in terms of being "providers." It will only get worse until we all stop putting up with this!

Marlene, I have the benefit of 40 years of practice hindsight to call on here. Looking back only a very few years that what happened was that CMS slowly dropped its reimbursement, (at least relative to usual and customary) and then announced this "bonus" to complying physicians. And, looking back even further (say 30+ years, which I sadly can do), this is what happened with Medicare in the first place. Medicare became law, with budget figures pulled out of thin air to get it passed. Then... OH MY!!!... it cost a LOT more than budgeted. So, naturally, instead of being truthful and saying "Oops.. my bad. I missed a decimal place in my adding machine..." the assumption became it must all be due to fraud and waste. At that point, we entered into the coding game, with physicians documenting reams of useless stuff to try and stay ahead of auditors who were sent forth with the instructions "we KNOW there is massive fraud and waste out there, and if you value your jobs you will find it."

Yes, healthcare for everyone would be a wonderful thing. If they put all physicians on salary and let us stop playing these stupid reimbursement games it might even work, after a fashion. Otherwise, believing that the powers that be will treat us fairly when we ask to be paid for work already done is I believe naive. History has proven otherwise.

Because for the most part, lawyers aren't paid by 3rd party payers. It is either pay by the minute or contingency. And, I don't think they have to worry about antitrust. But, good for you for doing charity work.

I would just like to go on record of saying that while I don't participate in MU and don't think it is good for (my patient care) and agree wholeheartedly with David and Jack, I don't begrudge anyone who does do MU.

I think it is a personal choice and, for those who do MU, I respect you for the extra work. And, I suppose, if done right; it may have some benefit for patient care.

I just don't find myself looking to join an ACO anytime soon.

Would love to hear from those who are doing MU.

I would also like to hear from those who are doing MU/and not doing MU and if it is not too much to ask, could you frame your reasoning why you chose to participate with MU/or not, strictly from running your business.

Why did you choose to participate?
Will the capturing of data affect your own efficiency and your billing department's efficiency?
If there is a reduction in efficiency, will the reduced office efficiency over time be worth not collecting the meaningful use monies +/- penalties, if you had decided not to participate?
If you have chosen to participate in MU have you been able to quantify your office efficiency before and after participation?

My best guess is that if I did not choose to participate, I would lose the 44k incentive money and in addition be penalized 4.5% of my medicare charges each year (13,500 dollars per year if you have 300,000 in medicare charges/year). Also some of the quality metrics incentives would fall outside this argument, I believe.

Thank you for your responses beforehand.

I would like to see a show of hands. Since Obamacare, who else has had over a 10% increase in their personal health insurance cost? The only thing Obamacare is doing is creating a nation of underinsured. It will do nothing except increase the already extreme burden on those of us trying to keep our small businesses in business. How in the world can government expect us to hire more people when we cannot even afford our own almost $800/month insurance premium. Has anyone seen an increase in patients coming in because they now can afford the insurance? God help us all.

Mine is closer to 25% increase in the past 2 years. It looks like less, but the insurers keep raising copays and deductibles to hide the true cost.

Soon, the 50% of Americans who let us pay their taxes for them, will let us pay their health insurance too.

But, don't we pay the insurance for the Medicaid and Medicare already?

Well, if we want to talk about the increase over, let's say, 4 years, mine would be almost 100%. The insurance industry is really nothing but a racket. They do not have to abide by any of the Fair Trade rules (nor does Major League Baseball, the only other industry in this country to be exempt). So, rather than insurance companies taking the good with the bad, like it was meant to be (spread the risks over a large number of insured) they can pick and choose who they want to insure and, those they do not want or are too expensive for them, raise their premiums until the poor soul cannot afford to pay.

In the last 5 years I have had 3 air-conditioners stolen (for the copper) and had roof damage from hurricane Ike. At my expense, I moved the air-conditioners to a less secluded side of the building, put up video surveillance cameras and put in ADT alarms. The policeman who came out after the theft said the only thing he could think of to deter further thefts would be to put cobras in the units. Nothing I can do to prevent hurricane damage. After paying the last air-conditioner claim, my insurance company dropped me. No real reason given other than I no longer fit into their business plan. Sure wish I could get away with doing business like that (not that my conscience would let me). It seems like every way we turn anymore, someone is trying to scam us.

Except for AC.