Here is government thinking for you: they start the article with ONLY. Only 10% of ED visits under Medicaid are unnecessary. As ED visits account for 4% of the Medicaid's total spend the wasted money is in the BILLIONS, that's billions, with a b. In 2012 the spend according to the Kaiser Family Foundation on Medicaid was $415,154,234,831. Four percent of that is over $16 Billion dollars, ONLY 10% of which is wasted. As they say in Washington, a billion here and a billion there and soon you're talking about real money.
In their attempt to claw back money for Medicare and Medicad, CMS pays private auditors as part of the RAC program (recovery auditing program). Auditors get from 9% to 13% of the money they accuse hospitals of miss-billing for. Unfortunately they have a dismal record because a large percentage of claw back funds get returned to hospitals. So the question is with such a large financial incentive are the auditors making up these false charges against hospitals? AHA answers that in this whitepaper to CMS.
CMS is considering reducing reimbursement once again for services that hospitals provide impacting rural and the community space the most. "Hospitals should view this move toward site-neutral reimbursement as a harbinger for the future." Pretty cavalier about taking money away from already struggling hospitals in MSR's opinion.
The American Medical Association fought a 35-year battle against the release of this data. Guess they don’t believe in transparency either. Routine office visits accounted for the single largest share of Medicare physician billings in 2012 even though they amounted to just one-seventh of the $77 billion paid by the government for physician services through the nation's senior citizen healthcare program.
"Essentially it wipes out any profit we would have next year, so that's kind of why we're struggling with it," said Jackson Health System chief financial officer Mark Knight, noting the state's largest public hospital had operated in the red for years before turning things around. Jackson stands to lose $47 million in Medicaid funding with this one issue. Tampa General would be out $13.3 million.
"The president's budget directly counteracts the administration's efforts to reduce healthcare costs and encourage advanced manufacturing in communities across our country by instituting a burdensome prior authorization system," said MITA Executive Director Gail Rodriguez. "Inserting a bureaucratic middleman between physicians and patients will limit seniors' access to diagnostic services, while resulting in wasteful healthcare spending and fewer investments in research and development."
Medicare has a 2 night stay rule for patients in a hospital in order for the provider to get a higher level of reimbursement. This rule has dramatically reduced hospital admission and bed days. However it is hated by hospitals and one of the most contentious rules implemented to drive down Federal costs of healthcare. Known as the "two-midnight rule" hospitals may get regulatory relief although they want repeal.