Bane of my existence (Score 2)

Figured I would respond to this, I haven't looked at slashdot in a long time. Missed the atmosphere. Anyway, I am physician and have had direct experience with all of this. The way it's supposed to work is to acknowledge that a private insurer who "takes over" medicare (my term) is going to have more cost for certain patients who are inherently more complicated. This seems simple enough, but how do you define what is more clinically complicated or risky? Of course, the Government comes to help in the form of HCC coding, where certain groups of conditions are given multipliers toward repayment, not really to the healthcare providers but really the insurers. And they have to be updated each year, and even if it is permanent the diagnoses "fall off" their risk sheets unless sent back in again. For example, loss of a limb has to be re updated each year, and a trite joke among medical coders is that Medicare thinks the leg grew back each year. Yes, it is supposed to be diagnosed by doctors, but if they get away with it, they get away with it. The insurers get a little aggressive about getting patients "seen" and then ALL their diagnoses listed for the year. They get paid a LOT more based on risk factors like diabetes with eye disease, rather than regular diabetes. Primary care folks are (no exaggeration) hounded for this, and if we don't have supporting documentation then we are "dinged' by our employer and have to attend more meetings/training etc., but we don't get a piece of the action so to speak. They live in fear of the Medicare audit while at the same time hungry for the extra payments. Physicians don't get any kickbacks for the HCC coding from most employers, including my own (I work for a non profit) This breeds incredible scams of course, and there have been more than 1 big court cases about this, some have destroyed the physician whistle blowers, but the fines levied against the insurnace companies are NOTHING compared to profits, and they consider it cost of doing business. Primary care physcians seem helpless to change this as patients love the Medicare Advantage plans that cost them less in the short term, and so about 1/2 of the patients are signed up with them. These insurers are much, much bigger than you think. I'd love to see a grassroots effot to eliminate this and get everyone a basic level of coverage with less greed factor involved.