After a recent year marked by scandals and mishaps among Britain's royal family, Queen Elizabeth told Parliament she would not look back on the previous 12 months with "undiluted pleasure."
Unless they take some definitive action, healthcare providers will not reflect on 1997 with undiluted pleasure, either.
The events of this month alone are enough to induce amnesia: FBI agents raiding Columbia/HCA Healthcare Corp. facilities for evidence of improper billing, a government report asserting Medicare loses $20 billion annually to fraud and waste, and HHS' inspector general rejecting industry calls for a moratorium on billing investigations.
The federal government, feeling its coffers have been abused for too long, is clearly on the warpath against any bilking of Medicare or other government insurance programs. Unfortunately, in their zeal to protect the public purse, government officials may be tarnishing the reputations of honest providers and jeopardizing future Medicare funding for everyone.
The stories of fraud and abuse are cascading in the consumer press. The healthcare industry stands in imminent danger of being lumped in the public mind with the makers of $600 toilet seats, wealthy farmers drawing subsidies and other perceived treasury raiders. Lawmakers intent on slashing Medicare spending will use this perception to fuel their payment chain saws.
As we observed on this page previously, simplifying Medicare's horribly complex reimbursement system and embracing competitive bidding, risk assumption and capitated payments would go a long way toward reducing improper billing. But these reforms will take time. Until then, the industry needs to restore trust with the public and its elected officials. Excuses about complex Medicare rules won't resonate well, especially when there are cases of blatant gouging. And most people will figure that an institution smart enough to perform brain surgery should be able to submit a reasonably accurate claim.
At both the association and grass-roots levels, healthcare executives should immediately launch campaigns to prevent fraud and waste and to assure the public that they are concerned about patients' tax money as well as their health. These efforts should be visible, to build confidence, and have teeth, to maintain credibility. Hospitals should secure the accounting and legal expertise necessary to ensure proper billing. And the message should go out loudly and clearly to everyone in the organization that greed is not good and theft-in any form-is intolerable.
The worst thing industry executives can do is wait for the next pummeling in the press or on Capitol Hill. This is a time for leadership, not defensive reaction. The right steps now will determine whether the industry comes to view this year with diluted pleasure or undiluted pain.