Politics: May 2013 Archives

How Government Killed the Medical Profession - Reason.com

A surgeon explains how the Federal Government's requirement to use standard coding for Medicare reimbursement has led to the bureaucratization of the entire medical profession: "The coding system was supposed to improve the accuracy of adjudicating claims submitted by doctors and hospitals to Medicare, and later to non-Medicare insurance companies. Instead, it gave doctors and hospitals an incentive to find ways of describing procedures and services with the cluster of codes that would yield the biggest payment. Sometimes this required the assistance of consulting firms. A cottage industry of fee-maximizing advisors and seminars bloomed....

"As the third party payment system led health care costs to escalate, the people footing the bill have attempted to rein in costs with yet more command-and-control solutions....

"Twenty years after the fall of the Iron Curtain, protocols and regimentation were imposed on America's physicians through a centralized bureaucracy. Using so-called 'evidence-based medicine,' algorithms and protocols were based on statistically generalized, rather than individualized, outcomes in large population groups....

"What began as guidelines eventually grew into requirements. In order for hospitals to maintain their Medicare certification, the Centers for Medicare and Medicaid Services began to require their medical staff to follow these protocols or face financial retribution....

"These rules are being bred into the system. Young doctors and medical students are being trained to follow protocol. To them, command and control is normal. But to older physicians who have lived through the decline of medical culture, this only contributes to our angst."