- Del Meyer, MD - https://delmeyer.net -

The Big Squeeze

Congratulations to Sister Bridget McCarthy for being selected by the Sacramento Metropolitan Chamber of Commerce as the businesswoman of the year. Sister McCarthy, former CEO of Mercy General Hospital, is president and CEO of Mercy Healthcare Sacramento and was lauded for dedication to community health care through memberships on a variety of boards and committees. She chairs the California Association of Catholic Hospitals’ Board of Directors. She currently is spearheading Process Redesign, an ambitious reform effort of MHS. The second series of three day 24 hour sessions was held in January and February. The segments of the team present included administrators, managed care, doctors’ offices, MedClinic, Psych West, nurses, physical therapist, dietitians, home care, hospice, other hospital departments, and patients. The discussion covered interfacing of our offices with all these different departments, variances in care, priorities, what added value, what added no value, what was repetitious, the norms, beliefs, and assumptions of our current health care design and what they should be for a new design. One of the goals of the series of conferences is to have all segments of the health care establishment participate in Mercy’s effort to squeeze $30-35 million out of their operating expenses by 1998. It is indeed a noble effort and we hope that eventually doctors will also take ownership in the reduction of health care costs.

Squeezed out of this conference were the psychiatrists who were represented by the Business Developer from Psych West who said it was too expensive to bring them. He said they had to stay in the office to continue earning the money for the group.

Patrick Hays, former CEO of Sutter who resigned, was not “squeezed” out. He has obtained the position as CEO and Prez of the National Blue Cross and Blue Shield Association. We knew that whenever he resurfaced, he would have an even more prestigious position. Congratulations and best wishes, Pat.

Mary Gooderham of the Chronicle Foreign service reports on cost-cutting in Canada. The total health care tab in Canada was $33 billion in US dollars last year; in the 1980s, their federal government picked up 40-50 percent of it, but that figure has now been squeezed down to about 20 percent… Do we really comprehend that with gov’t medicine, the federal gov’t picked up only 20 percent of the health care costs? We should be spending our efforts making sure our seniors have adequate health care (Medicare) and our poor people continue to have access to adequate health care (Medicaid/Medi-Cal in California)… It seems like all government programs always outstrip the ability of taxes to fund them. Some program or segment of society gets the “squeeze.” Do we want US healthcare to perennially be part of a national squeeze?

The IRS is planning to get to know you better according to Frank Greve of Knight-Ridder Newspapers. The IRS is planning to vastly expand the secret computer database of information it keeps on virtually all Americans. Additions may include real estate, DMV, and child support records. Agency officials concede some of the data collected will be inaccurate. But taxpayers won’t be allowed to review or correct it. This would in fact wipe out the line between the private sector and government. The IRS is in the process of creating dossiers on everybody in America as it watches our every action with computer surveillance to assist them in “squeezing” more tax dollars from us.

Recently, at one of the periodic Medicare conferences, physicians were told that the Medicare computer was so sophisticated it could reassign the CPT codes to reflect what we did for the patient more accurately than what we, in fact, thought we did and that these computers would review our records in the future. If they couldn’t be read, and no one in our office could decipher every word, sanctions would be taken against us. Sherry, the conference presenter, stated that they would be checking to see if we had all eight parts of the HPI recorded, at least 2-9 organ systems reviewed for one code and all 10 organ systems reviewed for another code, etc. Dr. Molyneaux warned the doctors that “Big Brother is Watching you.” Medicare can, at any time, begin implementing reduction of the codes, paying less, and possibly reducing codes for prior years on physicians. Medicare may then seek to recover what it determines to be prior overpayment, which may go over $100,000 on some doctors. It appears that Medicare could “squeeze” both current and prior reimbursement without due process as guaranteed by our constitution to non-physicians.

We can envision the scenario now. A patient with a 15-minute appointed requires 45 minutes to stabilize and prevent hospitalization. The $40 office call is increased to the next level of $60 to more accurately reflect the $100 worth of service to save a $10,000 hospitalization. The extra time now means that three extra patients are waiting, which then causes the documentation to be squeezed to a few salient notes… Two years later, Medicare comes by to review the record and says it is being generous to allow even a $40 call and demand a refund from the $60 extended visit. You will be forced to refund $20, which, in effect, reduces the reimbursement to $20. The $100 worth of medical services saving Medicare $100,000 was squeezed down to $20… And there are still physicians who say if it wasn’t written down it wasn’t done. Whose team are we on?

In 1987, the USSR threw out 70 years of totalitarian rule in which the KGB or “Big Brother” was watching everything they possibly could. And now we have IRS and Medicare computers that warn and threaten us with “Big Brother is Watching You,” as ominously as and more thoroughly than the KGB ever dreamed. Fellow physicians of Sacramento, of California, of America, we must unite for our common good or the welfare of our patients will be squeezed.

UCSF plans to eliminate 550 jobs over the next 18 months in response to the “squeeze” by health insurers demanding reduced costs. They have delayed all construction. Similar restructuring will occur at all 5 California medical schools according to Hospital Director Kerr. Roseanne Demoro, president of CNA representing 1600 nurses at UCSF said, “This is one of the wealthiest hospitals in Northern California. But, in the name of managed care, they are lowering the standard of care.” Kerr also is considering consolidation, or outright elimination, of unprofitable clinical programs. Will our students then only learn those clinical programs that are profitable? Don’t we have a higher mission in medicine?