Dancing with the devil

I don’t mean to identify in the title with the profane and hateful screed some might call “music,” rather to reflect on the hand-wringing that has been occurring in my business over the last week or so. I refer to the crap sandwich that sailed through Congress just in the nick of time to kick down the road the can known as the sustainable growth rate (SGR) cuts in Medicare payments to physicians.

Warning: for those not in the medical services industry, there’s lots of inside baseball involved. I’ll try not to get too bogged down in the details; rather, I’ll try to interpret this mess for lay people.

Back in 1997, the magicians in DC pulled a rabbit out of their hat with the Balanced Budget Act. One of the tricks up their sleeve was the way they made the numbers work out with respect to physician reimbursement under Medicare. If too much is paid out one year, the rate for the next year is supposed to be cut by a similar amount. (Otherwise the budget wouldn’t balance in the out years.) Except that every year, the doctors’ lobby has successfully convinced the Congress critters to okay a postponement of the cut. It’s literally known in the business as the “doc fix.” They, figuratively, roll the snowball down the hill, and the amount in question keeps getting bigger and bigger. So now, in 2014, without either a permanent solution or another doc fix, Medicare payments to physicians would have been slashed 24% on April Fool’s day. (How apropos.)

Of course, “Congress” and “permanent solution” do not belong in the same sentence. Though some alternatives were floated, none of them stood, um, a snowball’s chance in hell given the dysfunctional nature of our current legislative branch. Thus, another doc fix was drafted. And, somewhere along the line, lobbyists (who have not yet come forward to claim responsibility) managed to add various ornaments to the bill, causing it to resemble a mistimed Christmas tree. It got the rush treatment due to the tight deadline. And, not surprisingly, it has come to be like another one of Forrest Gump’s box of chocolates. At least one provision, for additional mandates around imaging systems, was never reported on until after the bill passed.

Two other provisions, which were talked about in the trade press, amount to a yummy caramel and one of those coconut-filled ones that a person either loves or hates. The first delays enforcement of the hated two-midnight rule that CMS imposed upon hospitals last year, under the aegis of Obamacare. What—you don’t know about the two-midnight rule? Read here what kind of havoc it is going to wreak on seniors across the country, even before it’s enforced. The other delays, by at least a year, the deadline for healthcare organizations to bill using the new (relatively speaking; it has been out there since 1992!) diagnosis code set known as ICD-10. Because many existing billing systems were hard-coded for the previous version, ICD-9, lots of health IT folks have been in a mad dash to meet the October 1 deadline. It has been likened to healthcare’s version of Y2K.

Nobody, yet, really knows who snuck the ICD-10 adoption delay into H.R. 4302. But it is now law, and the CMS chief who promised health IT leaders in February that there would be no more delays—I hopes she likes eating crow.

To me, by far the bigger issue is that my industry now toils at the whim of the likes of John Boehner, Nancy Pelosi, Harry Reid, and Mitch McConnell, along with their cronies. We signed that deal with the devil many decades ago, when we allowed our “leaders” to insert government into the health insurance business; it started with Medicare and Medicaid, and the slope has been getting more slippery ever since. This is a dance many of us don’t like, but without radical alternatives, we have little choice but to snuggle up to our diabolical partner.

I am doing some research into the dissident outfit out in the heartland, the Surgery Center of Oklahoma. Seems like a promising model, if only we can extract our Medicare population from the grips of Congress, the CMS, and their whims. I’m tired of dancing….

(As always, posts on this blog reflect my views alone, and not those of my employer.)

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