I WAS OBSESSED, NOW I'M FURIOUS

For some time we have been hearing about the need for healthcare reform. There are many reasons cited for the need for reform. Certainly, it would be hard to argue against trying to provide better healthcare to everyone at affordable rates. We also hear a lot about cutting costs and eliminating waste. We've been lead to believe that the best minds in the country are working to accomplish these goals. I am not convinced this is true. I actually believe the worst minds in the country are working on these issues but not as a means of achieving worthwhile goals. I think the only goals being met are that these incompetent people are saving their own jobs. Here are two examples.

I work in a physician office. This past week we received a letter from an insurance carrier reminding us that they were getting out of the Medicare Advantage business and that as of January 1, 2010 they would no longer offer a Medicare Advantage plan. They then went on to explain that they needed to amend our current contract to participate in their Medicare Advantage plan because it was not in compliance with current Medicare guidelines. So, despite the fact that they will abandon this plan in approximately 45 days they spent a great deal of money sending these notices to all their participating providers. Is that waste or stupidity or what?

Second example. The following is a quote from Trailblazer our local Medicare provider who issued this statement in a recent notice to providers. "Although enrolled in Medicare, many physicians ........... do not have current enrollment records in Medicare. A current enrollment record is one that is in the Internet-based Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/NPP’s NPI." Can you please repeat this for the intelligent. I believe Medicare just said that despite being enrolled in the Medicare program many physicians do not have a current enrollment record in Medicare. Is that even possible? Apparently, it is. A provider could have enrolled in Medicare 25 years ago and because they have not had the need to update their enrollment record for any reason, i.e. they did not move, they did not make any changes to their corporate structure, etc. they do not have an enrollment record in a new and separate system that was created to contain provider enrollment records. So even if there are no changes to report providers must now re-enroll in Medicare to obtain an enrollment record in this new system. Was it not possible for Medicare to transfer all their current enrollment records into the new system that they created? This might just have been too easy.

So, can anyone tell me how either of these situations will help provide better healthcare for all at a reasonable cost while eliminating waste?????? Help!