Thursday, August 7, 2008

And We Wonder Why Healthcare Costs Skyrocket...

It was one of those "Are you serious?" moments. My partners and I were required to carve out an hour and a half of our day (uncompensated, of course) to listen to a consulting firm that our hospital paid to come in to help "charge capture".

The situation we're facing is as follows:

The Medicare gods made up a term called the DRG (Diagnosis Related Group). The DRG is supposed to group diagnoses based on the severity of illness, and presumably the resources that patient will require. (Read: How much money do you get from the government to take care of this patient.) Depending on what diagnoses I document in my note, the DRG (i.e. cash-flow) changes. In premise, this sounds like a good idea. Sicker people are more expensive, right?

I truly am all for good documention. But for the purspose of conveying important information about the patient's condition and plan for their care to all parties of the healthcare team (doctors, nurses, physical therapists, etc.). I am not down with the shell-game.

But as most of you realize, "documentation" became less the basis for paying for the patient's care, and more and more the reason to deny payment for the patient's care.

So when the Centers for Medicare and Medicaid Services (CMS) decided to increase payment for the higher DRGs and lower the payment for the lower DRGs, hospital's got a fire lit under their asses. They scurried like cockroaches to figure out how to keep as much of this money as possible. How did they approach it?

They started paying consultants to tell us how to document "better". We now have a small army of people in white labcoats embroidered with "Documentation Specialist" circling our charts like vultures, fighting for chart-review time. We now get "suggestions" from them about how to make the patient sound sicker than they are. "Pardon me, doctor. 'Urosepsis' doesn't pay any better than 'UTI'. Do you think it would be appropriate to document 'sepsis with UTI'?"

Me, " Uh.... sure...."

How much money are hospitals shelling out in this effort to squeeze more pennies out of Medicare? CMS's efforts to lower what they're paying out makes the entire system more expensive by driving costs up across the board to claim the breadcrumbs. Healthcare systems grow into the income. It's not a simple proposal to ask them to trim the fat, when there isn't any fat in the system (expect, perhaps, proceduralists' salaries).

The part of my little "class" I found most incredulous was CMS's own admission that they expect that documentation will get better once they make these mandates. And so to compensate for the fact that people are expected to document better and therefore capture more money? They're going to lower payments.

When is our government going to realize that the promises they have made the American people are going to become interminably more expensive year-after-year unless they start telling people "No."? Their ONLY solution has been to simply give hospitals (and therefore the doctors that employ so many of us) less money, and that this will magically make costs contract.

It's beyond absurd. CMS seems to have realized they can't simply decree that they're going to pay 10% less for services that are being used more and are more expensive. So what are they going to have to realize they need to do?

Ah yes. The evil R word. RATION. It's going to have to happen. It's not a question of if. This WILL happen. The big question is, when Medicare refuses to pay for Procedure X, will hospitals be held liable for medical outcomes of not performing said procedure?

Oh what a tangled web we weave.

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