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Doctors put off reform with help from Washington

When doctors say they want to practice in their own way, it seems what they're saying is they want to spend as much of your money as they want.
Written by Dana Blankenhorn, Inactive

Health reform, whether public or private, is predicated on changing how doctors do business.

But doctors have a secret weapon against reform. Health reformers. (Picture from Wikipedia.)

Doctors are practiced at dancing this dance with Medicare. Government demands cuts, doctors refuse, government eventually gives in.

It's in the process of happening again. A 21% cut in Medicare reimbursement, needed to get some handle on the deficit, is being put off by Congress, and when the Senate refused to go along, the Administration simply promised not to put through the bills until they do.

This game has been going on for years, which is why the cuts have appeared increasingly draconian. Rather than enforcing discipline, it merely makes the call to delay more urgent.

Medicare isn't the only place where fudging happens. It is also happening with simple fraud.

Example. Congress created what it called "red flag rules" in 2007, meant to deter identity theft. One would think doctors would be anxious to comply.

But identity theft doesn't just happen over the Internet. It's common among those in the country illegally, or those who can't really pay for the care they need. The cutest manifestations of this are on the old TV show M*A*S*H, with a line of Koreans pretending to be "Kim Luck" and the doctors laughingly going along.

It's still going on, but doctors don't want to become agents of the government when it comes to immigration law, denying care to those who need it, calling ICE in on their patients. So they're having enforcement put off.

The excuse is this is a burden on small practices. Yet the rules are pretty straightforward. Be suspicious of documents, of suspicious identities, of suspicious activities, and pay attention to government warnings. Set out rules and enforce them.

That's too much for small practices (even veterinary practices) so, in addition to the FTC's delay, S. 3416 would exempt the medical profession from the rules, as lawyers are exempted based on a court ruling.

Why set rules if you're not going to enforce them? Why use savings to push through reform if you're not going to realize them?

The hope has always been that a way will be found to make this painless. Rules are needed to do that.

Dr. Donald Berwick, whose 100,000 Lives campaign cost nothing to implement but did indeed save that many people through adherence to procedures on infection control, was nominated recently to head the Centers for Medicare and Medicaid.

But since real health reform would require doctors to follow rules, he's being called radical, because he has dared work on comparative effectiveness research which uses data to determine best practices, treating more people with fewer dollars.

What's at issue here are enormous differences, not just in testing, but in diagnosis of disease in different parts of the country. Outcomes are no different, but more people are being called sick in some places than in others, and by applying the lessons of low-cost areas to high-cost areas we can save billions of dollars.

That's comparative effectiveness. It's rules doctors will be expected to follow if they wish to get paid, rules based on data, on what works, on best practices.

But doctors don't like rules. So the Berwick nomination is being fought. And even if the nomination is approved, you can be certain everything he tries to do will be fought, just as Medicare cuts are fought, just as red flag rules are fought.

When doctors say they want to practice in their own way, it seems what they're saying is they want to spend as much of your money as they want. Health reform was one legislative battle, but it was really only an opportunity to fight the long war against this attitude of entitlement.

This post was originally published on Smartplanet.com

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