Sequester and ACA Hit Physicians, Hospitals Hard

There are only so many choices when dealing with three major, and conflicting, problems, and Congress, the Administration and CMS misfired badly, derailing initiatives under the Affordable Care Act by cutting Medicare payments when they should be investing in physicians to cut waste. Pulling the rug out from under its efficiency programs and dumping the cuts onto the private-sector insurers and employers who are making actual progress in cost containment simply makes no sense. Limiting the cut to Medicare Advantage programs to only 2.4 percent with a last-minute reprieve is a tacit recognition, but too little.

Tepid and scattershot as CMS’ attempts to rein in costs may be, they almost cannot help but to eat into the enormous waste and inefficiency that permeates the U.S. healthcare system. Even a little. But, by piling on 15,000 and counting pages of regulations, penalties, and unfunded mandates is hamstringing the process and the wrong people.

The administration’s position seems to be that healthcare providers, particularly physicians, need to be controlled and starved instead of being made partners in solving these pervasive problems. That is why insurer HMOs of 30 years ago failed: They tried to control physicians instead of enabling them to control patients and the process. Surely there is someone in authority within the administration who can make this connection.

And, Congress’ response? Senior members of two committees “blast CMS” for $42 million in uncollected overpayments for durable medical equipment charging that surety bond limits are too low.

This is the focus while hundreds of billions of dollars are wasted every year? And, they wonder why nine in ten people think they do a poor job. The money is there, particularly if a dollar wisely invested could return 50- or 100-fold or more in savings.

New, promising private initiatives that retool medical practices to meaningfully cut waste and improve outcomes have been gaining momentum. The question for those innovators is whether these reductions will steal the resources from programs that could make a meaningful difference, or whether they represent an opportunity to take advantage of this misguided policy.

Private enterprise looks more and more like our only hope - if it doesn’t get regulated, starved, and taxed out of business.

A public/private partnership is the direction that holds the most promise, but not with giant corporations and one-size-fits-all solutions. That is equivalent to having an elephant hatch a thousand eggs with a thousand ideas - they only get crushed. HHS and CMS have armies of people. Wouldn’t assigning and enabling a few hundred of them to work with the folks who have the best ideas make the most sense?

I am a dreamer, but dreams come true when enough people get behind them and either work with or in spite of the powers that be.