tag:blogger.com,1999:blog-11034229.post5589691949114178320..comments2023-07-14T02:53:40.719-07:00Comments on retired doc's thoughts: One of the ways Obamacare was to "save money" was to cut Medicare Advantage but now..james gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-11034229.post-32463504408340107282011-08-11T10:48:34.305-07:002011-08-11T10:48:34.305-07:00I sort of got stuck on the statement, Woodrow Wils...I sort of got stuck on the statement, Woodrow Wilson envisioned a government that would be run by experts who would be unencumbered by the messy give and take of politicians who would stray from what was right and good for the people by the actions of various interest groups and their own selfish urges.I also read that, per capita Medicare Advantage payments will increase by 1.6% on average. My problem is not so much by the cost, rather, what is more bothersome, by the level of responsibility:<br />Once or twice a year, the insurance companies connected with Advantage plans hold meetings for the doctors servicing the patients on the plans. They pay the doctors to attend the conference, and they update them on the most profitable use of the ICD-9 coding system. They explain the value attached to each patient on their plan, and why this value increases with the severity or morbidity of each patient’s medical status. <br />The insurance company receives a fee, which depends upon the ICD-9 or ICD-9s in that patient’s medical record. The more complicated, the more the insurance company receives for that patient’s overall care. It is completely understandable, therefore, why the insurance company should pay its doctors to attend these meetings and then bonus the doctors depending on their diligence in coding. The insurance company is in the medical care business to make money, and in this case the payer is CMS. The insurance company is diligently pursuing those dollars to which it is entitled, those dollars, which CMS are only too willing to pay. It is also easy to understand why doctors working for the insurance company would want to attend a handsomely compensated gathering where they learn how to earn a few extra dollars from the government for the work they are already doing. What may be difficult to fully comprehend is why the government is willing to pay so heavily for the coded description of patients’ health. That they want the information is apparent; that they are prepared to pay for the information is a reality; why they need this depth of information about patients’ health is the question I pose, especially considering the current financial woes. No one in the CMS actually physically treats patients. The added depth of coding does nothing for the patients’ wellbeing, yet it does much to increase government cost. <br />Dr. MannieAnonymousnoreply@blogger.com