What the Patient Wants is….. Well….. Irrelevant
Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy.
At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.
Question: I understand that it is generally illegal for Medicare doctors to sell services to Medicare patients outside of Medicare if Medicare is suppose to provide the same or similar services as a Medicare beneftt.
So what is the rule in this case? If a Medicare patient is denied a virtual colonoscopy, can the doctors sell the patient one outside of Medicare?
It’s clear that what the patient wants is irrelevent. Joe’s question is: is it also illegal?
The patient really is irrelevant. Sad, but true.