Recovery audit contractor program draws readers' ire, and other letters

Regarding the recent article “RACs recouped $3B for Medicare in 2013”, I am a healthcare statistician who works very closely with pre- and post-audit compliance risk and mitigation issues. I would strongly disagree with the validity of the 18.1% reversal rate claimed by the RAC trade group. This number is so low because so few, if any, of the appeals made it to the administrative law judge level in a timely manner where, historically, the reversal rate runs between 72% and 85%, depending on which study you read.

This is a classic tale of how to lie with statistics and grossly exaggerates the effectiveness of the RACs. Because the RACs have done such a dismally poor job, there is a backlog of over half a million appeals waiting for ALJ hearings and a two-year moratorium on even scheduling a hearing. If you really want to get an accurate handle on the reversal rate, wait a couple of years and match the appeals back to the findings in 2013. I am very disappointed to see that number appear like this, because it hurts the efforts of providers and their associations to get compliance reform in place.

Frank Cohen

Regarding “RACs recouped $3B for Medicare in 2013”, the 68% settlement deal proves that this is not about fraud, but only about cutting costs to the CMS. If there is that much provider fraud in the system, why is the government settling instead of prosecuting? The recovery audit contractor program is just another layer of government costs that eats up valuable dollars needed for patient care.

Alan Muratet

Regarding the Sept. 29 cover story “Spotlight on physician payments”, are we surprised that those who receive payments from persons and organizations who might thereby influence how products and services are rendered to the public are afraid that the public might “misinterpret” that information? Their fears might be justified, but join the open market, my friends.

Now, how about some open disclosure on personal and corporate political campaign contributions? To spin the proverb, “Congressman, legislate thyself.”

Patrick Casey

Regarding the Vital Signs blog post “ACOs struggle with advanced IT, interoperability, survey shows”, accountable care organizations will continue to have challenges with information technology, not just because of the many IT systems involved, but also because the Health Insurance Portability and Accountability Act and the HITECH Act work against electronic sharing of patient information. HIPAA/HITECH hurdles and super-high penalties—even when best intentions are made to safeguard patient data—severely limit the free flow of patient data.

Why does our government keep adding to the high cost of healthcare? Just as with federal education policy, federal healthcare policy dances around the elephant in the room. Patients should be responsible for their health—not providers—and parents should be responsible for their kids' performance in school—not teachers. That being said, providers and teachers should be held to performance standards for professionals in their industries.

Holly Sailers

Regarding the recent article “More Medicare Pioneer ACOs head for the hills”, no doubt the ACO trend is cycling, similar to integrated delivery systems, physician-hospital organizations and other strategies that health systems have used to grow their markets when responding to government and private payers' attempts to rein in costs. In forcing providers to look at quality and costs, the result is increased competition for market share, which stimulates industry growth. While spending increases, unit prices decline and care improves. This is a good thing.

Conrad Vernon

Regarding the story “Oklahoma judge rules against Obamacare subsidies”, there is little argument that Congress passed a bill that specifically exempted a national insurance exchange from subsidies, in the thought that it was such a poison pill that no state would dare not open their own exchange (or partner with other states to open one). Oops, it didn't turn out quite how they expected.

I wish the legal wrangling would go away, but I'm not ready to throw out the whole legislative process the country has used since its inception by allowing the administration to say the equivalent of “My bad, let's try this instead,” and completely ignoring the actual law as they implement it. When RomneyCare was passed in Massachusetts, it was a true bipartisan bill, so if the law needed tweaks, it was a relatively simple matter to ask the Legislature to do it. We are seeing the fruits of passing a decidedly partisan bill when one party controlled both chambers of Congress.

Jason Smith