6 ms·

There is a lot of controversy in this area. Medicare rules are pretty clear that to the extent tools like that are used systematically to enhance bill-ability t

There is a lot of controversy in this area. Medicare rules are pretty clear that to the extent tools like that are used systematically to enhance bill-ability they are prohibited. Malpractice litigation is having a field day with computerized systems which is why so many states are being pressure to institute caps. Pretty much everyone tries to use templating tools to increase bill-ability to some extent. Healthcare is rife with conflicting goals. The underlying problem is that we need an economical way for doctors to have more time to spend in the room with patients but no one, patients included, wants to pay for that. I really hope "concierge" medicine, a lot of that now happening on the lower priced end not only for "luxury patients", continues to take off. You pay some cash out of pocket but get care that is dramatically better and more preventative.

anonymouse008 6y ago
Woa -- do you have a link to the regulation (chapter, but looking at Medicare fully now) to things that are designed to "systematically to enhance bill-ability"? So you're saying if you use a templating tool to be more efficient and save time, it's explicitly not allowed AND you're opening up either yourself or the technology tool to malpractice litigation?! Goodness!
- duffpkg 6y ago
  Malpractice is a totally separate thing from Medicare Fraud. With respect to malpractice, having automated or semi-automated encounter notes with huge systematic similarity looks absolutely terrible if something goes wrong. Don't take my word for it, consult your attorneys. With respect to Medicare fraud see the False Claims act and its interpretation in the enforcement actions against many parties beginning in 2016. Keywords would be like "not medically necessary" and "upcoding". I believe the monster enforcement action just this week against GHC also involves that.
  - anonymouse008 6y ago
    Goodness -- thank you very much for this potent thread. Good wishes to all your works!
  - manapause 6y ago
    Let us not forget “stand in your shoes” Stark provisions which made many a brother-in-law who owned a DME company very sad. Hospices dropping off cookies with their contact information is kosher. Incentivizing a medical office to hit 100 nebulizer-orders, or cpap referrals -> federal prison.
nradov 6y ago
Concierge medicine won't solve anything at scale. We have a shortage of physicians, especially in primary care, and it's only getting worse as the population ages. What we really need is just more doctors. The federal government should remove the bottleneck by boosting funding for residency program slots.

anonymouse008 6y ago

Woa -- do you have a link to the regulation (chapter, but looking at Medicare fully now) to things that are designed to "systematically to enhance bill-ability"? So you're saying if you use a templating tool to be more efficient and save time, it's explicitly not allowed AND you're opening up either yourself or the technology tool to malpractice litigation?! Goodness!

duffpkg 6y ago
Malpractice is a totally separate thing from Medicare Fraud. With respect to malpractice, having automated or semi-automated encounter notes with huge systematic similarity looks absolutely terrible if something goes wrong. Don't take my word for it, consult your attorneys. With respect to Medicare fraud see the False Claims act and its interpretation in the enforcement actions against many parties beginning in 2016. Keywords would be like "not medically necessary" and "upcoding". I believe the monster enforcement action just this week against GHC also involves that.
- anonymouse008 6y ago
  Goodness -- thank you very much for this potent thread. Good wishes to all your works!
- manapause 6y ago
  Let us not forget “stand in your shoes” Stark provisions which made many a brother-in-law who owned a DME company very sad. Hospices dropping off cookies with their contact information is kosher. Incentivizing a medical office to hit 100 nebulizer-orders, or cpap referrals -> federal prison.

nradov 6y ago

Concierge medicine won't solve anything at scale. We have a shortage of physicians, especially in primary care, and it's only getting worse as the population ages. What we really need is just more doctors. The federal government should remove the bottleneck by boosting funding for residency program slots.