CEO: “Soul-Crushing Regulations” Driving Entrepreneurs Out of Health Information Technology
Jonathan Bush, CEO of athenaHealth (NASDAQ: ATHN), testified to a Congressional committee on the impact the federal government has on entrepreneurship in health IT.
“You guys have made things that work in every other industry illegal in healthcare,” he said. “You can be drunk and in the wrong country and you can get your bank balance reconciled because the bank that needed the info can pay the other bank $3 to get it. If that happened between a doc and hospital, it’s prison time for that crime of supply-chain partnership.” (Veronica Combs, MEDCIty News)
(It is always a good idea to pay attention to athenaHealth executives when they speak on public policy. They never churn out the “go along to get along” PR-speak generated by too many corporate spokespeople when they are trying to get something out of Uncle Sam.)
Regulations can be rather depressing. However, I was unaware that they could literally crush your soul! I wonder if a soul crushing regulation can result in a bruised soul? If so, can a bruised soul or a crushed soul prevent you from gaining entrance into Heaven?
Well, that’s assuming there’s a soul there to begin with.
I think he was referring to the American soul- that spirit that takes risk head on, that stares down any challenge, that never sees itself as a victim but rather an overcomer…in short, the soul of most Americans who built this country into the most powerful nation in history.
Now, that soul is being crushed by government regulation through bureaucrats who are never harmed by their own horrible decisions.
Now that I would agree with.
I don’t think you can crush the American soul. But you can suffocate it. And the American soul is being suffocated by all of the bureaucrats. We have to find a change and give it a lifeline.
Well the regulators souls have already been crushed. What is crushing is to the bright-eyed entrepreneurs that haven’t been hit by the reality of government regulation yet.
Good for you Mr. Bush, telling it like it is! How come we treat healthcare so differently from the market for other products? None of the government’s interventions make sense. All they do is distort prices, warp incentives, and result in a worse system…one that penalizes innovation and entrepreneurship and rewards those with no skin in the game.
Health care unfortunately has unbalanced advantages to all of the regulators. They gain while everyone else loses.
It crushes your soul when you’ve shipped a million dollars in medically necessary catheters to Medicare patients over a year but due to shipping program errors you shipped them the day after you billed them and Medicare audits your records and says that’s Fraud and Abuse and wants the million dollars back. The CMS regulation says you must bill for the product the same day you ship it to the patient or else it’s an invalid placement. That sort of non sensical over regulation would crush any small business owners soul, I would think.
How about if Medicare paid the patient and the patient paid the supplier?
The problem is that if you are going to rely on Uncle Sam for payment, there will always be micro-regulation and lack of flexibility.
Medicare managers do not (cannot) have the incentives to manage these issues in a more face-to-face manner, as private buyers and vendors would.
John, Medicare pays the patient and the doctor collects money from the patient – considered non participating relationship. In a non-par arrangement, The patient may pay a 15% limiting charge out of pocket to that non par Dr in addition to the 20% copay. This used to be more prevalent but it seems to me that most doctors are par, probably bc it’s harder to collect from patients with no money compared to the fed govt.
My point is that CMS and it’s vast array of oversight regulating agencies are more interested in using their limited time pursuing companies that haven’t crossed the t or dotted the i on their paperwork and fining them versus pursuing real criminal fraud. With the arcane and complex regs out there, pretty much any healthcare entity could be accused of fraud and abuse – as the Athena Health CEO alluded to in his testimony.
Until circa 1960, every doctor accepted that he had to collect almost all his income from patients directly. Today, most physicians find it unfathomable!
According to the Kaiser Family Foundation, citing an unpublished CMS source, fewer that one percent of physicians in clinical practice have signed affidavits to see Medicare patients on a non-participating (a.k.a. opted-out) basis.
Frankly, I get a little frustrated with doctors who participate in Medicare and complain bitterly about their fees. They could increase them by 15 percent if they organized their businesses to collect directly from Medicare patients.
In any case, the 15 percent extra payment does not appear to compensate for the increased credit risk. What if it were increased to 20 percent? 30 percent? Unlimited balanced billing?