Thursday, August 24, 2006

Bumbling Medicare to Drive Health Care Quality Improvement?

The Bush team continues its fumbling ways as a government operator. Just days ago President Bush issued an Executive Order requiring the government to produce price and quality data. It charged several government departments including Health & Human Services to “develop and identify practices that promote high quality health care”. As Medicare and Medicaid insure nearly 80 million people in the U.S., one might expect their operations to be examples of high quality government operations.

Many health care providers will have to make do next month without a government paycheck or two. The Bush administration says it will not make any Medicare reimbursements to hospitals, doctors and scores of other providers during the last nine days of the current budget year, from Sept. 22-30. By delaying payments, the government moves $5.2 billion in Medicare expenses to next year's budget, rather than the current one.

In a shell game the federal government with Congressional approval is pushing their bills into the next fiscal year. Is this a sign of a quality operation? It gets better.

The federal government erroneously has reimbursed about 230,000 Medicare recipients for monthly premiums they paid this year for prescription drug coverage. For many, the checks - totaling nearly $50 million - have already arrived.

The refund will undoubtedly cause confusion, particularly because it comes with a letter that mistakenly instructs older people that their monthly premiums will no longer be deducted from their Social Security check.

Mark McClellan, who oversees the Centers for Medicare and Medicaid Services, said people who get the check need to know two things. One, the money has to be returned. Two, their prescription drug coverage will continue.

"It's very important for people to know their coverage is continuing," he said. "There's no disruption at all."

Medicare officials say they caught the glitch just after the checks were sent out last week. As a result, they sent a second letter Tuesday letting people know about the problem. The average overpayment comes to about $215.

In many cases, older people get their Social Security payment through direct deposit. They, too, should set the extra money aside and not use it for other purposes because the payment will have to be returned, officials said.

How much will this “glitch” cost? Had someone made such an expensive error in private industry, what would be the consequences?

McClellan said his agency will make sure that insurers who administer the new drug benefit continue to get paid for the beneficiaries caught up in the error. He said that his agency was responsible for the error and that the subsequent letter contains an apology.

I wonder what systems exist in the Bush administration to prevent errors in the first place? This significant botch is certainly not the first in Bush’s term in office. While it pales compared to the $8 billion unaccounted for in the rebuilding of Iraq, it's important as Medicare is one of the government groups collaborating on improving quality of health care for Americans.

A key part of the Bush plan involves “pay for performance”. According to Family Practice Management the data for this initiative is not in the solid win category.

Virtually all major payers, including Medicare, are piloting pay for performance programs and will soon be measuring physician performance and offering financial incentives to those who meet quality targets. Although early results of these programs were not entirely positive, and although much debate surrounds this movement, there are no signs of a slowdown.

Yes America, the Bush cabal will bring his deft bull in a china shop touch to our health care system. While it badly needs improvement, the Bush prescription will be lucky to be a placebo. It just might have life threatening side effects.

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