Home Forums Discussions Meaningful Use Medicaid and Meaningful Use

So, now we're run into a new wrinkle in the joys of Meaningful Use. We're undergoing the Post-payment audit by Mercadien for Year 2 payments and Medicaid threw a wrench into the system. They've asked Mercadien not just to be sure our attestation numbers are correct but that we're using Meaningful Use exactly how we say we are. So now they want to "drill down" into the numerators and denominators for each of the items in the MU dashboard to show proof of the proper use. Problem is, you can't simply "drill down" from the dashboard.

Anyone else going through the MU post-payment auditing yet? As of this moment, it looks like Mercadien and NJ HiTech will be trying to get some answers from AC this coming week. Somehow, I feel the headaches are only about to get worse ....

Shankar
Family Med
Lawrenceville, NJ

Shankar,

I am not implying I told you so, because I do not know the right path to choose (for me), but want to expand the conversation a bit.
But first, no to your question.
I have not pursued the Meaningful use monies but several of my partners have already received theirs.
I am in a state of ambivalence about what to do.
I may eventually pursue the Meaningful use route just to avoid the penalties or I just may opt out of Medicare, and for those providers that have opted out of Medicare is there a process that one can do to determine practice viability with opting out of Medicare? Or does one just jump into the water and swim??
I think this is pertinent to your question, especially if the MU post-payment auditing becomes too cumbersome. If you feel I have hi-jacked your thread just let me know and I will start a new one.

Jimmie...

As an "opt out" adoptee, we just kind of jumped in blind. I looked at our Medicare rolls, figured we would take a significant hit if they all went away and were not replaced, and decided to do it anyway for all of the reasons you know but I was finding no longer tolerable. Our billings actually increased slightly the year following the decision, much to my surprise. I would never suggest our experience was typical, but others in this area who have opted out have not seemed to regret their decision either. We see Medicare under private contract, and as primary care, our charges tend to be pretty low in the scheme of things. We happily discount anyone for whom it would be an issue.

Now, remember, I live in a semi-rural area, there is a relative scarcity of physicians, and no contracts or managed care to deal with. There are certainly physicians on this board who practice in areas with mostly medicare and lots of competition, where medicare pays as well or better than most. As they say, "Results may vary...."

David,

I have a feeling our practice terrain is similar. I do admire your style.....and sorry about the terminology. I am slowly becoming more educated from the fantastic minds on this board, and I am not being cynical.

What exactly are they asking for?

I have always been in line with David. I personally despise MU and our government who created it. I have no Medicare to dump, but I wonder what will happen with Medicaid.

I am going to try to not do MU as long as possible. I am against their MU money, but at least that is a positive thing. If they begin with penalties, well.

At least currently Medicaid pays me a ton of money each year just for seeing Medicaid and for P4P.

Colleagues...

I think it is perhaps good that we have not met face to face. I have been thinking about this thread, and realize that a meeting might be socially very awkward for me, like the gardner who takes a wrong turn and finds himself in the midst of an embassy cocktail party. I feel a need to express this, much as I feel a need to point out what I see as a patient's self destructive behavior but don't want to be offensive, and don't know quite how to put it.

There are things I just don't "get". I do not understand why people dress in uncomfortable and expensive clothes to go out to eat. How could I comfortably eat a bowl of soup worrying about spilling it on a pair of pants that cost more than my first car?

And, I don't get why physicians allow other people to come in to their private office and paw around in records that were meant as private property to assist him or her in providing care to their patients. Yes, I know the rules "say we have to" if we accept their money. Why on earth would someone agree to that? Can you imagine a hardware store allowing your lawyer to go paw through their parts inventory and fine them if they did not have enough 5/32" nylon locknuts? Does accepting city trash disposal give the city rights to come into your home and inspect what kind of liquor you drink? Does Coca-Cola have to divulge its secret formula to the government because soldiers drink Coke?

As I said, I feel there is a big part of our civilization that I really don't understand. All I can think of is the late Ann Landers, when she said "No one can take advantage of you without your permission." I get the same lack of understanding that I get when I hear an opiate abuser complain about constipation. The answer is simple; stop using.

David,

I feel a bit like Linus and his blanket.
I have never practiced without the security of my blanket. A steady 2 week paycheck, patients having to pay little out of pocket for seeing me etc......
However, I have never thought of being without the blanket until I met differing ways of thinking on this board. It is really not revolutionary or new ways of thinking, just new to me.
However, the blanket has become barbed, cold, and now is a noose around my neck that is slowly tightening, and really has more than served its function and really needs to be thrown out, and like you, I should have over a decade ago.
But Linus wasn't ready to get rid of his blanket until maybe now. I have changed, and the group in which I practice has changed.
I think being rid of the constraints of Medicare would be liberating, but it is none the less, quite frightening being without my barbed, cold, noose.

Have you ever been addicted to opiates?

Happily, Bert, I missed that one. I also have managed to avoid jail time and credit card debt. The world is full of choices.

"Come gather 'round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You'll be drenched to the bone
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'.

Come writers and critics
Who prophesize with your pen
And keep your eyes wide
The chance won't come again
And don't speak too soon
For the wheel's still in spin
And there's no tellin' who
That it's namin'
For the loser now
Will be later to win
For the times they are a-changin'.

Come senators, congressmen
Please heed the call
Don't stand in the doorway
Don't block up the hall
For he that gets hurt
Will be he who has stalled
There's a battle outside
And it is ragin'
It'll soon shake your windows
And rattle your walls
For the times they are a-changin'.

Come mothers and fathers
Throughout the land
And don't criticize
What you can't understand
Your sons and your daughters
Are beyond your command
Your old road is
Rapidly agin'
Please get out of the new one
If you can't lend your hand
For the times they are a-changin'.

The line it is drawn
The curse it is cast
The slow one now
Will later be fast
As the present now
Will later be past
The order is
Rapidly fadin'
And the first one now
Will later be last
For the times they are a-changin"

I asked my colleagues in 1988, "Why in the Hell are you letting insurance companies tell you what to do?" They answered, "Oh but we have to. We do not have a choice".

I asked my colleagues "Why are you hiring midlevels? Don't you see you are cutting off your nose to spite your face?" They answered, "Oh but we can see more patients and make more money".

Now insurance companies rule medicine and midlevels will take over Primary Care within the next 10 years if not sooner. Yes, the times they are a changin...we just refused to see it and deal with it.

Twenty years ago I was new to practice, and HillaryCare was the big event on the horizon. It made investing in an office building seem scary. Over the years, it seems that Medicare is not a 800 lb gorilla as much as a sloth. Moving and changing, but slowly, and I doubt that things will be severely different in 20 years when I retire.

Whether we are right or left in our politics, we are part of an industry that is almost 20% of GDP, and twice as expensive as it is done in other countries where it is almost as good, and in some ways better. So we are the only ones that don't want change as the debt mounts.

If we were smarter, we would have become dentists or cosmetic surgeons, so we could bill patients directly.

Instead, we chose to become a part of a cottage industry where we are paid by the piece, just like a sweatshop worker. It did seem like easier work in the past, but now the government is determined to control the industry and squeeze every ounce of profit from it. Ten years ago, a Rotary talk by an ophthalmologist was crying about how Medicare had cut his payment for cataracts from close to $3000 per eye down to $250, when a businessman asked him if it only took him 10 minutes to do the work.

So sweatshop workers, are you going to rise up and take control of our industry, and decide how much each should get paid?

It was so interesting to visit Sweden last summer to see my mothers family. I talked with a family practice doctor relative, and their perspective for work is so different when they see themselves working for the government. The patients are not their patients, and the incentive is just to do the job, like making sweatshirts in a factory. As long as you are not the worst worker, you are okay.

Anyway, I digressed. As EasyRider posted, what exactly are they asking for?

Maine Receives $33 Million Payment Reform Grant

So, this should fix the problem. A 30 million dollar investment for a three billion dollar return.

"....by allowing patients to collect consistent information, patients can compare different healthcare providers and get help in navigating the path to a peer physician who has experience in his or her health condition..."

Maine will receive a $33 million three-year grant from the federal government intended to test whether new health care payment and delivery models will produce better results and lower health care costs than the present system according to an announcements by state and government officials on Friday. Funding will come in the form of a Cooperative Agreement from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Center for Medicare & Medicaid Innovation (CMMI). The Innovation Center was established in the Affordable Care Act (ACA).

Maine will receive a $33 million three-year grant that will test whether new payment and service models will produce superior results and lower costs. The effort, called the Maine Innovation Model, hopes to achieve more than $1 billion in overall savings over a three-year period.

"As a result of collecting consistent information, patients can compare different health care providers in terms of cost and quality and find practices that best fit their needs, regardless of how the bill is being paid." Mayhew said that resources will be available through the grant to assist patients in managing their own health conditions, including help to navigate the path to care from a peer who has experienced his/her health condition.