Need to be alert to 'dark side' of Affordable Care Act

Regarding "CMS should not pay for regular CT screenings for heavy smokers, panel says", this is the beginning of rationing? I've only been a doctor for 45 years, so maybe I've slept through something, but it sure looks to me like there's been wholesale rationing for years—only it's been hidden or accepted as “the way things are.” Even today, there is rationing that has nothing whatsoever to do with the Patient Protection and Affordable Care Act. Look at the various drug shortages, to name one area.

This decision made by an independent panel of clinician experts is no different from many panels before that have made many decisions before—some recommending Medicare payment for a test or procedure and some recommending nonpayment. This is no different—and they had some pretty good reasons for making that recommendation.

Oh yes, if the person really wants the test, they can still pay for it if they want. Sounds pretty much like American free choice at work to me.

Dr. Keith Marton

Regarding "CMS should not pay for regular CT screenings for heavy smokers, panel says", I hope we keep a keen eye on this trend. I say, hmmm, well, it has begun. This will be the first of many denials from the panels to outright deny or greatly mitigate benefits or care. I understand the concept, but we must be careful this does not cross into DNA swabs and testing to determine the possibility of a future disease.

Let's not fall asleep here. The Patient Protection and Affordable Care Act's tendency toward “the greater good” has a dark side. I hope we are able to corral this before we all fall into “certain” categories that deny coverage or payments. The panels must have some accountability, especially for those over the age of 75, as the legislation does seem to exercise some implied authority to deny based on age discrimination. Some of this is good—I just hope we don't fall asleep here and sacrifice compassion because it does not serve “the greater good.”

Dan Erler

Regarding the letter "Smokers should pick up the tab for their habit", ah yes, punish the medical criminals. It's an idea that has been around for decades. So while we're at it, punish people who eat fast food, people who don't exercise, people who over-exercise, or those who play risky sports. The list goes on.

We already tax the heck out of cigarettes and liquor, but little goes to healthcare.

And while we are having this discussion, why does the government subsidize sugar, corn and many other “bad” products? Reducing the costs of healthcare is a societal problem, but history has shown that in the U.S., we as a society are not willing to deal with it across the board.

Frank Poggio

In the article "Few hospitals, docs at Stage 2 meaningful use, CMS official says", the CMS' Elisabeth Myers says there aren't enough data to assess the success of Stage 2. Which planet is she on? Providers have told the CMS repeatedly that certified software isn't ready, key requirements such as transitions of care and patient portal adoption are ahead of common practice, and reporting of performance indicators needs to be fine-tuned, to state a few of the issues.

Bill Spooner

Regarding “Physician anxieties linger as CMS sets Oct. 1, 2015 deadline for ICD-10”, by all accounts, end-to-end testing is an absolute requirement prior to moving forward to “go-live” with ICD-10. The linchpin in testing that few seem willing to address is the huge variability that exists in clinical documentation by providers even under ICD-9. Those who will make this transition successfully will evaluate the current state/compliance of their clinical documentation; educate all providers to the requirements (many of which are not new); and work with IT vendors to complete product revisions to provide the electronic infrastructure to support ICD-10.

Sandra Sperry