Medicare Rounding Errors and the Real World

Yale and Columbia University researchers studied three million Medicare patients for unnecessary readmissions between 2007 and 2009 and found that almost 25 percent of those with heart failure, 20 percent of heart attack patients, and 18 percent, of those with pneumonia were readmitted within 30 days, often for the same condition. The cost: an estimated $26 billion.

Other studies peg unnecessary readmissions within 30 days at about one third of all patients, costing Medicare in excess of an estimated $26 billion annually. A rounding error for the Federal government, but about $200 for each of the 130 million or so working stiffs out here in the real world.

And, no surprise, the primary culprit is the Federal government, specifically HHS and HIPAA regulations that smother care-coordination technology, and Congress that has given HHS the ability to write law without oversight or consequence.

The new labyrinth of HIPAA regulations appear to make things even harder, particularly one provision that requires patients to personally see their physician, be counseled and to sign an approval to see their own medical records in a secure online venue. This would be the keystone of care coordination -communication between care providers.

Federal regulations gone wild, or gone stupid, or simply written without a clue to the consequences to their own budgetary problems is not politics, but an affront to common sense, fiscal, and clinical responsibility. 

The critical balance between protecting an individual’s personal information and the provider’s duty to share that information when it is in their patient’s best interest has been corrupted and misaligned by regulations and penalties imposed by those who have no experience in providing or coordinating care.  Caring, which needs to be enhanced, has been regulated in such a way as to put privacy before welfare.  We now live in a regulatory environment that requires us to provide care in a vacuum, or risk the wrath of government intervention and penalties when seeking to coordinate amongst others.

Sadly, this is only one example of Federal regulatory expansion at cross-purposes to getting control of the floodgates of waste and the human toll in needless suffering and death, a daily toll paid in health and wealth by the very people these regulations are supposed to protect.

Physicians and those of us in healthcare administration don’t get a pass, either. We dutifully pay for these unfunded mandates and focus, and in some cases exhaust, our energy on compliance instead of advocating for the very people we are duty bound to protect and care for. Too many others work to find ways to sidestep rule after rule instead of working and advocating for solutions.

As the venerable Walt Kelly popularized in his comic strip “Pogo” many years ago, “We have met our enemy, and he is us.”

It doesn’t have to be that way.

Join by constructively speaking up against bad law wherever you can, won’t you?

It’s the only way out of this increasingly complicated regulatory mess.