Notes on the news:
That said, you have to wonder about the wisdom of the Medicare Recovery Audit Contractor program. As our Washington reporter Jennifer Lubell noted in the magazines Oct. 13 cover story (p. 6), the government is unveiling for the country at large a program it has pilot-tested in five states from 2005 to 2008. The CMS believes the initiative, which relies on third-party auditors to find improper payments, will cut down on fraud and save the U.S. Treasury money. Those auditors will garner a percentage of the improper money they identify and collect from providers. Already, it has detected more than $1 billion in wrongful payments, the CMS says.
Hospital industry executives, not surprisingly, arent enthused. They complain the program assumes that hospitals are cheating the system, and they foresee massive and costly headaches in complying with the audits. Some brand the effort bounty hunting. Hospitals argue that changes made between the pilot program and the new version dont go far enough to solve problems, and questions remain about unresolved appeals.
While the government is justifiably concerned about how its money is spent, the RAC program appears fraught with peril. The history of outsourcing government work to private contractors is not a happy one. Just look at the mishaps and misdeeds stemming from the privatization of work in the Gulf Coast post-Katrina and in Iraq.
Now we have hospitals essentially turned over to private collection agencies (a twist of fate) with an incentive to find something wrong.
For all its faults, the federal bureaucracy at least is accountable to elected officials and, ultimately, the citizens of this country. With the RAC program, we have another layer of administration between providers and the government and murky accountability in between.
Perhaps this will all go swimmingly, and everyone will be better off. Right now, that seems like a contest between hope and experience. A few years down the road, the government may decide it would have been better off shunning the contractors in favor of hiring a few more of its own auditors.
In Selmer, Tenn., the Prime Care Medical Center is seeking designation as a patient-centered medical home even before the state sets standards for such designation.
The medical-home concept is still being defined. In theory, it involves patients having a personal physician who leads an integrated team of healthcare professionals providing coordinated acute, chronic, preventive and end-of-life care. That care would be facilitated by information technology and based on a foundation of safety and quality improvement. Primary-care physicians would be adequately reimbursed for the management and coordination of services.
In principle, its what healthcare should be in this country. Instead, we have a fragmented and chaotic system laden with dysfunctional financial incentives. (See the commentary by Medical Group Management Association President and Chief Executive Officer William Jessee, p. 30.)
Lets hope the doctors in Selmer and elsewhere can iron out the inevitable primary-care/specialist turf battles and insurer and administrative problems to make this concept work and bring some order to the disarray.