Gaming Medicare
Performing two scans in succession is rarely necessary, radiologists say, yet some hospitals were doing that more than 80 percent of the time for their Medicare chest patients, according to Medicare outpatient claims from 2008, the most recent year available. The rate is typically less than 1 percent, or in some cases zero, at major university teaching hospitals.
Full article on hospitals administering double scans to Medicare patients.
People need to internalize the costs of their behaviors more often.
And they get paid for doing both, right? If only there was a way to ensure that unnecessary treatment was not compensated. Hmmm…
Just providers maximizing against reimbursement formulas. What else is new?
If the first scan is of such poor quality that a second scan is needed, why should Medicare reimburse for it? If two scans are performed and only one was needed, why should Medicare reimburse for it? I suspect that private insurers don’t allow this type of waste happen. I wonder why Medicare does?
I’m as incensed as anybody, but the story states that the double scanning cost Medicare $25 million a year. That is a rounding error. “Bruce” writes that this is simply maximizing reimbursement but that cannot be the case, because the story also makes clear that a very small proportion of hospitals account for almost all the problem.
Putting the spotlight on these hospitals is fine, but expecting that squeezing them will save Medicare money is unrealistic. Medicare should not be paying for CT scans at all. Instead, it should be moving in the direction of Paul Ryan’s voucher (sorry, “premium support”) proposal.
Incentive structures need to be evaluated more closely to determine the root cause of these actions.
Double scanning could also be caused doctor’s fear for being penalized by not meeting quotas and standards set by the PPACA.
Medicare costs the government about $400B/year. the $25M cost is 0.0062% of that. Actually Medicare denies a larger fraction of claims than most private insurers. Only Anthem denies a slightly larger fraction of claims.
Devon Herrick the article said:
Double scanning is also common among privately insured patients who tend to be younger.
So private insurers are victimized too. Medicare has lower admin costs. Single payer countries have far lower overall costs and better results. Private insurance is an unnecessary expense heaped onto an industry where overcharging is the norm but should not be.