BrooksHCSolutions

This is definitely true. The worst thing is when groups become rivals and it spills over to the hospital. The hospital staff doesn’t want to hear you bed mouth fellow physicians. Help out a physician in a competing group when you both are on weekend call. We all get in a jam and appreciate genuine help. You will gain the respect of your fellow physician and the hospital staff. We need to support each other!

beckersasc.com/asc-coding-bi… This article chronicles the never-ending pricing disparity between ambulatory surgical centers and Hospital outpatient departments. The cost at hospital outpatient departments is 58% higher than at physician offices or ambulatory surgical centers. Patients are overcharged 58% for the identical service whenever they walk into a hospital or hospital outpatient department. Medicare hospital pay increased 70% versus a 9% increase in physician payment from 2001 to 2023. This price discrepancy is unfair to both patients and physicians. The math is so clear that even politicians can understand it.

statnews.com/2024/07/25/unit… Action Items: • Corporations should not be allowed to own medical practices. •The risk adjustment system needs to be eliminated. • The Federal Government needs to recoup any money paid for diagnoses that were not active or pertinent to the patient. • The DOJ should prosecute United Health Executives if they find a pattern of False Claims or Fraud This is another concerning article demonstrating why the corporate practice of medicine harms patients and is bankrupting the country. This article vividly illustrates the staggering scale of UNH's reach, with its control over 10% of all US physicians. They are the leading provider in the Medicare Advantage program and have written a guide on how to capture more diagnoses per patient, which is known as upcoding. Upcoding is the process of including diagnoses on the patient's chart for conditions that you are not actively treating, that are vague and subjective, and that you haven't discussed with the patient. This is done because the US Government will pay the insurance companies additional money for these diagnoses. The Medicare Payment Advisory Committee, or MedPAC, is a group that advises Congress on Medicare. They estimate the following: • Overpayments to Medicare insurers from upcoding patients will cost $50 Billion this year. • MedPAC estimates that Medicare Advantage insurance companies have received $217 Billion from upcoding patients since 2007 Richard Liberman is a coding expert who helped design the risk adjustment system used in Medicare Advantage. He states that there is gaming of the system in not just the diagnosis codes but also the documentation justifying it. Physicians in the article describe the following process by which United Health encourages upcoding: • Paying bonuses • Performance reviews • Increasing the number of patients seen • Instruct Physicians to document conditions they didn't think applied to the patient. • Holding hours long educational seesions on how to code Medicare Advantage patients • The EHR required checking off Medicare Advantage codes prior to closing the record. Not choosing the codes required additional work. The bottom line is that the idea of valued based care has been changed to maximizing payments and not focsuing on the patients health according to this article. @DOJCrimDiv

You know you're on the right track in healthcare when Mark Cuban agrees! Even though I graduated from Medical School in 1985, I never had the time to really understand the intricacies of the health system until this year. We need novel approaches to reduce costs and maintain quality, which I want to uncover and highlight. There are entrepreneurs who are active in direct patient care, cash payments for services, and eliminating middlemen. These actions serve to save money and help patients afford their medications and healthcare.