Reform Anxiety: Medicaid Hike, Docs Overbilling, and Congress Wants War Effort to Foot the Bill

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Anxiety about the impact of national healthcare reform reverberated throughout the halls of lawmakers, policymakers, and federal administrators this week, as America tries to decide where and how its healthcare system will bear the burden of increasing patient populations and the costs of treating them.

For starters, a bipartisan Congressional initiative debuted that would draw down federal dollars from the war effort in Iraq and Afghanistan to fund Medicare reform, dodging CMS reimbursement rate cuts that would otherwise take effect January 1, 2013.

According to the Wall Street Journal, this latest doc fix, cosigned by Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.), would increase physician reimbursement throughout the upcoming presidential term. It would also implement regionally and specialty-variable payment models that would seek to stabilize the delivery of care.

The proposal comes a few days after CMS offered up a plan to increase minimum Medicaid reimbursement rates for primary care physicians—the better to incentivize caring for indigent patient—while a new report from the DHHS Inspector General suggests that some 5,000 physicians across the country already may be inflating their billing codes by a significant dollar amount.

“What it amounts to is being able to pay your bills at the end of the day, and a doctor cannot pay his bills with a large Medicaid population,” says Scott Cubellis, CEO of medical biller Affiliated Professional Services, Inc.

“If you look at it from a business standpoint, it makes perfect sense,” he says. “The practice has to look at what payers and percentages can they accept and be able to survive.”

Cubellis, a Massachusetts resident, has seen the implementation of state-backed universal healthcare in his own community, and although he says, anecdotally, that it has improved access for a certain patient population, there is still a subset of indigent residents who cannot afford to pay.

“It’s the same pie, and they’ve divided it a little differently, but it’s the same amount of money,” Cubellis says. “More people are participating, but it doesn’t add any more revenue to the healthcare system.

“Every year insurance companies go down on their allowables, they go up on their premiums and claim that they’re not making money,” he says.

Unless the burden of increased costs is born equally, the only thing that will go around is misery, Cubellis says.

“Everybody needs to share in this problem that we have, and working together, we can solve this problem,” he says. “But if you’re going to target a hospital, a doctor, the delivery system, that’s not going to fix it.”