January 29, 2014--Uncle Eli's Tongue Factory

While the Obama administration is thinking about publishing a list of individual doctors who are off the charts in the amount they bill Medicare as a way of exposing them to public scrutiny and potential prosecution if there is evidence of over-billing, Health Management Associates in Naples, Florida is already publishing data of its own about doctors affiliated with its South Florida chain of hospitals.

In Naples, according to a report in the New York Times, scorecards are posted for all attending physician to keep track of how many over 65-year-old patients they admit to the hospital each day.

Doctors hitting the target to admit at least half of the Medicare and Medicaid patients who entered via the emergency room are color-coded green; the doctors who were close to that 50 percent target are coded yellow; and those not admitting enough to the hospital are red-lighted.

Since the HMA hospitals, reflecting national changes in the way medicine is practiced, employ more and more doctors rather than just granting them attending status, pressure on these salaried doctors to increase income (and their own bonuses) by admitting more patients who have good insurance is increasing. So much so that at a HMA Naples hospital a Medicaid-elegible child was admitted with a diagnosis of having "fever" when her actual temperature was normal, 98.7; and an 18-year-old with a minor knee laceration was admitted though the wound could easily have been treated in the ER and the patient sent right home.

These are not isolated cases but rather examples of routine business.

These hospitals, like most in the nation, are technically "not-for-profit," but beyond that IRS designation, they are very much in the business of making as much money as possible so as to be able to pay doctors top dollars and hospital administrators seven-figure salaries.

It is thus no wonder that the money-driven healthcare system in the U.S. is by far the most costly in the world and for "average" people far from the best.

With thousands of lobbyists keeping the pressure on politicians not to change anything, very little does change. Big Pharma, the AMA, health care unions, medical equipment companies, hospital associations all join hands in assuring that their bottom lines, not patient care and cost-containment, are paramount. And thus far they have pretty much had their way.

Occasional exposés and law suits as the one being launched against Health Management Associates are rare and only chip away at the problem.

But there is a simple way to keep an eye on quality of service and billing practices.

Years ago, an uncle of mine owned a meat processing plant in the South Bronx. While trying to "find" myself I went to work for him and spent long days unloading truckloads of hams, pork butts, and beef tongues.

The Department of Agriculture required that the meat be inspected and, if it passed, labelled as such--USDA Inspected.

So in Uncle Eli's plant, on site, there were two full-time federal inspectors. They wandered around at will in their long white coats, randomly selecting a rack of curing tongues for careful analysis. They were incorruptible, permitted to work at any single establishment for only a month or two so as to inure them from being approached for bribes. And, in order to contain costs to the government, Uncle Eli was required to reimburse the Department of Agriculture for their salaries and benefits.

It worked rather well and this approach to safety and quality control could easily be extrapolated to all hospitals that are allowed to bill Medicare and Medicaid.

These hospitals, like Paramount Meats, should be required to have a team of on-site inspectors who they would pay for and who would keep an independent eye on services and billings. If, for example, they discovered a red light-green light system designed to defraud taxpayers (which that in fact does), they would have the power to intervene and, if necessary, report abuses to the Medicare-Medicaid Administration which in turn could refer cases to the Department of Justice.

This would lead to a significant decline in medical scams and reduce costs to those of us--really all of us--who through our taxes are paying the cost of abuse and fraud.

Doctors, then, could again be held to the Hippocratic injunction to "do no harm."