To Save America: Stopping Obama's Secular-Socialist Machine (27 page)

1. Patients and taxpayers have the right to know the cost and quality produced by every facility that receives taxpayer money and how and where scarce taxpayer dollars are spent. Thus, all Medicare and Medicaid claims and patient encounter data should be made public on a depersonalized basis. That data is the mother lode of everything you would ever want to know about both programs. We would be able track all the dollars as well as the health outcomes produced by every provider in the country that accepts Medicare and Medicaid—which is nearly all of them.

2. The federally administered Medicare program and the mostly state-administered Medicaid program must improve their sharing of patient data. Their failure to do so results in significant lost opportunities to coordinate care and catch fraud. A 2009 report by the
Kaiser Commission found insufficient controls and duplicate claims processing agents that invite fraud and abuse.

3. Outsource the authentication of new Medicare and Medicaid suppliers to Visa, Mastercard, or American Express. After forty years of failure, it is clear the status quo in Washington, D.C., is incapable of managing these programs, so let’s turn to experts with a track record of success.

4. The CMS-855S form that prospective durable medical equipment providers must fill out lacks even a simple, “under penalty of perjury” line by the signature. That little tweak alone would help prosecutors and perhaps even have some deterrent effect. Likewise, we should make the submission of bogus claims a reason for immediately revoking a supplier’s billing number.

5. Allow seniors on Medicare the option of traveling to another city to receive major non-emergency surgeries. If a particular set of procedures costs thousands of dollars less in the next state over and the quality outcomes are as good or better, we should allow people the choice of facilities, especially if the individual receiving care can split the savings with taxpayers.

6. Enhance discovery of third party liability in Medicaid. Simply maximizing
self-reported
third party coverage by patients could save state Medicaid programs 1-2 percent per year. That is $4-7 billion a year the insurers would legitimately be paying that the taxpayers currently cover due to bureaucratic incompetence. A GAO report shows up to 13 percent of people on Medicaid with other coverage.
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7. Medicare and Medicaid should use private-sector standards for establishing the number of suppliers for a product or service in a defined area. California’s Medicaid program has been doing this for nearly a decade in durable medical equipment. While there was some pushback from frustrated potential providers, there were no reports of access to care issues from beneficiaries.

8. Reduce the administrative red tape and lengthy appeals that cancelled suppliers often exploit. Currently, suppliers can drag out the process for months and usually get reinstated. In 2007 and 2008 the OIG conducted 1,581 unannounced site visits to durable medical equipment providers in South Florida and found 491 either didn’t have an actual facility or were not properly staffed. All 491 billing privileges were revoked, 243 of those appealed, and 222 (91 percent) were reinstated. Of the 222 reinstated, 111 later had their billing privileges revoked again.
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9. Move to a system of 100 percent electronic remittances. Paper bills and the postage required to mail them cost billions unnecessarily. Furthermore, paper records guarantee the bureaucrats are always many steps and many months behind the crooks. We currently have paper clerks chasing crooks who use iPhones and Blackberries. It is a hopeless mismatch of technologies favoring the crooks over the cops.

10. Use unique ID numbers for Medicare beneficiaries instead of their social security numbers. A stolen Social Security number leaves a person much more vulnerable to theft and fraud.

11. Require more timely updates from states on Medicaid enrollment data. Even senior congressmen, as of April 2010, can only get state-by-state Medicaid enrollment data up to 2007. The latest data available for Maine is 2004.
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Compare that to FedEx and UPS, which track 23 million packages a day in real time, or to McDonald’s,
which collects data or sales from 37,000 stores worldwide every night. As shown above, the existing data collection system urgently needs to be fixed.

12. Experiment with moving to biometric ID for Medicare and Medicaid beneficiaries. Cards are easily lost, stolen, copied, and forged, which contributes to uncoordinated care and fraud.

13. Recognize the shortcomings of isolated fee-for-service arrangements and follow two of MedPAC’s key recommendations: expand the use of risk-adjusted plans in Medicare, and expand the medical home model particularly for people with one or more chronic conditions. Enhanced use of medical homes would be particularly helpful in a Medicare system where specialists are overpaid relative to primary care. The standard fee-for-service model rewards volume first and foremost, with coordination of care, improvement of patient health, and fraud as secondary considerations at best. The same recommendations are appropriate for Medicaid.
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14. Encouraging better data analytics across programs and jurisdictions is a must. The entire healthcare system could benefit tremendously from the same level of inter-agency data sharing that is common in law enforcement, particularly in the tracking of sex offenders. When sex offenders move between states they are required to register immediately with local law enforcement. If they miss their deadline, they are flagged instantly by sophisticated systems pulling information from public sources. Doctors who have been sanctioned for fraud, hospital administrators who have engaged in fraud, DME salesmen with fraudulent convictions, criminal beneficiaries, and others are much freer to set up shop in a new state—or to send a new, unknown member of a fraud ring into the system—without being reported from their prior jurisdiction.

15. Require Medicare and Medicaid to pay closer attention to Medicare ID numbers that show outlier behavior. Individuals who are excessively billing at, say, emergency rooms are likely getting poor, uncoordinated, inefficient care, or their Medicare/Medicaid cards are being billed by fraudulent providers with or without the patient’s knowledge. In either case, both the individual’s health and the taxpayer’s pocketbook would be better served by being instantly identified.

16. Data sharing across departmental jurisdictions and with state and local governments should be done with the same seriousness as in national security. Prior to September 11, the CIA and the FBI rarely communicated. Now they compare intelligence frequently. There are multiple databases of Medicare and Medicaid providers and suppliers along with their disciplinary records.
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But these databases are not as universally comprehensive or as accessible as, say, the National Instant Criminal Background Check System (NICS) used to keep guns out of the hands of criminals. The National Crime Information Center is another law enforcement tool that allows a local officer to have instant, nationwide access to a suspect’s criminal background. These systems are not perfect, but they are good examples showing how individuals with criminal records and/or disciplinary actions in the healthcare field can at least be flagged early. This concept was part of President Obama’s revised health proposal unveiled on February 22, 2010, based on legislation introduced by Congressman Mark Kirk with bipartisan support. We should utilize data from the Social Security Administration and IRS for these efforts as well.

17. Require cost reports for Ambulatory Surgical Centers (ASC) similar to what is currently required for hospitals by the Centers for Medicare and Medicaid Services (CMS). It is understood there are
specific differences between an ASC and a hospital, and the report requirements should be modified to accommodate this.

18. Migrate Medicare and Medicaid beneficiaries into arrangements with personal health accounts in which individuals have direct and immediate financial incentives to engage in behaviors that improve their health. The current system includes nothing to deter patients with Medicare, Medicaid, and most private plans from scheduling as many physician visits as they can. Indeed, a classic 2003
New York Times
article, entitled “Patients Line Up for All That Medicare Covers,” accurately captures a culture where seniors on Medicare can get as many healthcare services as they can fit on their calendar, regardless of cost to taxpayers or the lack of medical benefit.
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