In his “Stories I’d like to see” column, journalist and entrepreneur Steven Brill spotlights topics that, in his opinion, have received insufficient media attention. This article was originally published on Reuters.com.
1. Fiscal cliff Medicare meddling:
According to this report in The New York Times, last-minute negotiations on the fiscal cliff included new congressionally imposed limits on what Medicare will pay for “nonemergency ambulance transportation of kidney dialysis patients” and “would reduce Medicare payments … for stereotactic radiosurgery, complete course of treatment of cranial lesion(s) consisting of one session that is multi-source Cobalt-60 based.’”
Yes, Congress really does get that far down in the weeds when it comes to dictating how Medicare doles out more than $500 billion a year. This includes, for example, overseeing the payments Medicare allows, by state, for designated categories of ambulance rides (“critical,” “emergency,” “air evacuation,” etc.).
There are two obvious stories here: What scandalous overpayments or abuses in those nonemergency kidney dialysis ambulance trips triggered this intervention, and who in Congress pushed for it? Similarly, what’s the story behind those Cobalt-60 treatments?
Beyond that, either of those tidbits would be a good lead-in for a broader story about the more typical type of congressional intervention when it comes to Medicare. Members of Congress on both sides of the aisle habitually succumb to lobbyists in ways that keep Medicare costs far higher than they need to be. For example, except in a few regions of the country, Medicare is not allowed to conduct competitive bidding for medical equipment ranging from canes to wheelchairs to oxygen supplies. The result is billions in overpayments every year, with Medicare paying more per cane to buy tens of thousands of canes than you would pay to buy them one at a time at Wal-Mart. At a time when Medicare cuts are center stage in the ongoing deficit debate, why not try to identify the cost of this congressional meddling?
2. Surprise! Gannett makes news for its journalism:
Two weeks ago a Westchester, NY-based daily newspaper, the Journal News, ignited a firestorm by publishing a map showing the locations of all those in the communities it covers who had received handgun permits. Those who clicked on the electronic version of the map on the Journal News website were shown the names and addresses of all the permit holders.
“We felt sharing information about gun permits in our area was important in the aftermath of the Newtown shootings,” publisher Janet Hasson told Reuters.
But supporters of gun rights complained that the permit holders had been singled out as bad guys even though they had done exactly what gun control advocates support - comply with a screening and registration process. FoxNews.com quoted an “ex-burglar” as saying that having a list of households that have guns would have made his job easier because he would know which places to avoid.
The reaction to the story became so heated that by last week the Journal News had posted armed guards outside its office.
The paper’s unusual project gave new context to the issue of whether disseminating information that is legally available to the pubic - in this case, records of gun permits - can become invasive of privacy when digital technology allows it to be made so accessible that it is arguably too public. But there’s another angle I’m waiting for a media reporter to explore: how the controversy generated by this local paper contrasts with the culture of its corporate parent.
In Brill's first item, last paragraph, his description of the Medicare bidding program is way off. In fact, bidding is well underway in 100 market areas throughout the U.S. and more reimbursement cuts for 91 regions will be announced in a matter of weeks. Lobbyists have not only never stopped the program, they have been unable to achieve any significant improvements to the design of the bidding system, most recently described the the Math Trek blog at Science News. U. of Maryland economist and auction expert Peter Cramton is one of the most articulate critics of the bidding program that Medicare implemented for the tiny durable medical equipment sector, which has been subject to deep, disproportionate reimbursement cuts over the past 10 years.
#1 Posted by Michael Reinemer, CJR on Wed 9 Jan 2013 at 02:26 PM
I would further add one cannot compare buying a cane at Walmart to getting a cane covered by Medicare. Walmart does not require you to have a doctors order with all relevant information, have medical notes/history that show:
"o The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home; AND
o The patient is able to safely use the cane or crutch; AND
o The functional mobility deficit can be sufficiently resolved by use of a cane or crutch", have to check eligibility to verify patient can get a cane, might have to deal with multiple insurances and verify coverage, show proof of delivery and training on use of unit, and finally submit a claim to Medicare who pays 80% within 21 days and get the balance from all other payor sources after that. Moreover Walmart gets the money upfront while DME companies might have to revolve credit while waiting to get paid. So its not a fair comparison. I would say then the system needs to change to have a transaction like Walmart for simple items like canes, walker, and the disposable supplies. The reality is that the high cost of a cane is related to the administrative requirements for proof of medical necessity placed on the DME company. One would think the doctor should have already informed Medicare of such a need through their own billing eliminating the excess paperwork allowing competitive prices. I say patient sees doctor, doctor bills Medicare saying they have and need x,y,z, patient gets some sum whether recurring or one-time based on doctors requests, and allow the patient to price shop (let market forces work). If the patient needs more due to need or cost of an item, there is a method to authorize for a larger stipend by the physician. Its my ecommerce way of how light equipment and supplies should be.
#2 Posted by Nathan, CJR on Wed 9 Jan 2013 at 08:13 PM