By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Last month the focus of this column was the “ObamaCare time –table” of regulations. That is, when would specific aspects of ObamaCare take effect and begin to impact each of us. I left off with the fact that the “Medicare-population” would be the group most negatively affected by the implementation of ObamaCare. This month I would like to continue to explain how the implementing regulations have begun to affect Medicare recipients.
If you are someone that has paid into the Medicare system and are now of age to begin accessing the benefits you have paid for you may have noticed that they are a bit more difficult to access. Healthcare providers are now required to follow additional documentation procedures with additional non-reimbursable coding that is supposed to “improve the quality of care” according to the Whitehouse. The reality is that this “new coding” distracts providers from the task at hand, which is caring for people. What the Medicare population is finding out is that each time they enter a providers office they will be spending less time with the provider and more time with a clipboard filling out paperwork.
The ObamaCare regulations refer to this “paperwork” as “instruments” to measure “quality”. Healthcare providers on the front lines of patient care refer to these “instruments” as “PPW” or “pointless paperwork”. According to the American Physical Therapy Association, “The new requirements facilitate the intention of the Centers for Medicare and Medicaid Services (CMS) to use this information to reform the future payment process for outpatient therapy services.” This is a fancy way to say the Federal Government wants an excuse not to pay the bill. This is how ObamaCare is going to reduce “healthcare costs” by denying reasonable claims.
Under this new rule, non-payable “G-codes and modifiers” are included on claim forms to capture data on the beneficiary’s functional limitations at the outset of the therapy episode, at a minimum of every 10th visit, and at discharge. The therapist’s projected goal for functional status at the end of treatment is to be reported at those same time intervals. Modifiers are to indicate the severity of the functional limitation. Keep in mind that the “degree of functional limitation” will be based on how the patient fills out the “instrument” and not based on the providers’ examination findings or the patient’s progress in treatment.
So far we see that ObamaCare has put in place paper obstacles to make it difficult for Medicare patients to receive or access their Medicare benefits. Medicare recipients and healthcare providers are currently being asked to fill out more paperwork and will be told after the fact that the claim was denied. Now the Medicare patient will not be responsible for the bill. The provider will be expected to “eat” the claim. At the same time on March 1st provider reimbursement will be reduced 25-40%. It is this type of dictatorial policy that is forcing providers out of the Medicare system leaving the Medicare recipients with shrinking options for treatment and care.
Recently, one of my patients was looking for a new primary care physician. Unfortunately, she kept hearing a familiar line; “we are no longer accepting new Medicare patients”. Not only is this fast becoming commonplace, but also providers are choosing early retirement rather than try and work in an increasingly unfriendly healthcare environment. My 80-year-old mother who is battling lung and brain cancer has also had this conversation with her family doctor. He is in the later stages of his career and is continuing to see his existing Medicare patients but will not be taking on any additional patients who have Medicare as their health insurance coverage. He has stated that many of his colleagues are opting out of Medicare and out of the healthcare field all together; this is specifically because of the additional regulation and oversight as well as the threat of nonpayment as a penalty for failing to use one of the new codes CORRECTLY!
Since we have implemented the new ObamaCare functional limitation and quality reporting system, patients are spending more time in the office filling out paperwork; providers are spending more time filling out daily notes and additional forms; the front desk staff has spent countless hours changing procedures and forms costing over 100 man-hours that will never be recouped because of the reduction in reimbursement. Once again the consumer/taxpayer takes the hit and the insurance industry wins. As I stated in last months article there are better ways to address healthcare; ObamaCare isn’t it!