"The bottom line: Under Medicare’s bizarre rules, hospital doctors are paid as much as three times more for patient care than those in private practice."
And absolutely nowhere in the article does it talk about how the cost of preventing fraud by single practitioners is the similar to the cost of investigating a single hospital. [1]
Trying to administer a national system to individual providers leaves gaping holes which crooks drive dump trucks through to load up on 'free' taxpayer dollars. So fix that problem and payments can get normalized.
The actual bottom line is that Medicare doesn't make "bizarre" rules, they make rules to try to minimize fraud and maximize patient benefit, if a rule seems "bizarre" you need to then go back and figure out what the motivations for that rule are.
"In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, "I don't see the use of this; let us clear it away." To which the more intelligent type of reformer will do well to answer: "If you don't see the use of it, I certainly won't let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it."
This paradox rests on the most elementary common sense. The gate or fence did not grow there. It was not set up by somnambulists who built it in their sleep. It is highly improbable that it was put there by escaped lunatics who were for some reason loose in the street. Some person had some reason for thinking it would be a good thing for somebody. And until we know what the reason was, we really cannot judge whether the reason was reasonable. It is extremely probable that we have overlooked some whole aspect of the question, if something set up by human beings like ourselves seems to be entirely meaningless and mysterious. There are reformers who get over this difficulty by assuming that all their fathers were fools; but if that be so, we can only say that folly appears to be a hereditary disease. But the truth is that nobody has any business to destroy a social institution until he has really seen it as an historical institution. If he knows how it arose, and what purposes it was supposed to serve, he may really be able to say that they were bad purposes, that they have since become bad purposes, or that they are purposes which are no longer served. But if he simply stares at the thing as a senseless monstrosity that has somehow sprung up in his path, it is he and not the traditionalist who is suffering from an illusion."
Excellent quote. This idea can be applied almost everywhere, and I wish people would do it more. It's easy to simply declare that some feature is a result of blind stupidity, but rarely correct.
The actual bottom line is that Medicare doesn't make "bizarre" rules, they make rules to try to minimize fraud and maximize patient benefit
My inclination is to believe that anything that comes out of government, including Medicare, is going to have a lot of bizarre rules whose actual purpose is to make a lobbyist happy.
Well in the US it seems like they do. Rates and rules are changed to achieve a certain revenue level, and there is pro-forma evidence that this is means taxing those least able to construct plausible evasions. Its only after that tap starts drying up that the more 'complicated' targets are gone after.
Watching the UK Parliment tear into the tech guys for using legal ways to avoid paying taxes in the UK is an example of legislative bodies turning their sights from the 'easier' (but now nearly tapped out) tax payers to the less easy ones.
> And absolutely nowhere in the article does it talk about how the cost of preventing fraud by single practitioners is the similar to the cost of investigating a single hospital.
This is not even remotely plausible. Forensic accounting and investigation has a cost roughly proportional to the number of transactions. Transactions do not become magically cheaper to investigate merely by conducting them on the same real estate.
There have been a number of stories on this and ABC news did a pretty good 20/20 segment on it as well. The math works sort of like this, one investigator's salary is $S, and one investigator can handle one transaction 'stream' in real time. We'll call $D the number of transactions a doctor is approving, and 'N' the number of doctors making transactions.
Hospitals tend toward either 'having fraud' or 'not having fraud' so the one investigator ($S) covering a hospital can decrease the at risk transactions by Nh*$D where 'n' is the number of Doctors at the hospital.
To investigate a private practice you have a small number of doctors "Ns" and busting them recovers a much smaller 'transactions per investigator' value. So an investigator looking into one doctor doesn't have an impact on the other doctors that have private practice in the same building.
As the cost of investigation is part of the budget (as are the payouts) you can afford to give more of the budget payout to Hospitals because your your per doctor investigator cost is lower. (zero sum game here).
And absolutely nowhere in the article does it talk about how the cost of preventing fraud by single practitioners is the similar to the cost of investigating a single hospital. [1]
Trying to administer a national system to individual providers leaves gaping holes which crooks drive dump trucks through to load up on 'free' taxpayer dollars. So fix that problem and payments can get normalized.
The actual bottom line is that Medicare doesn't make "bizarre" rules, they make rules to try to minimize fraud and maximize patient benefit, if a rule seems "bizarre" you need to then go back and figure out what the motivations for that rule are.
[1] http://www.gao.gov/products/GAO-13-104