Gaming the System

This post was originally published by  The Health Care Blog  on February 11.  As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many.  Value-based care, determined by statistical analysis, is going to replace fee for service. Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared to most practices in the region.  This was perplexing as my patients tend to avoid ER visits at all costs and can be found milling about in my parking lot at 7am on Mondays with their sick children waiting for my office to open. I requested more detailed reports on ER utilization and was given a 20 page list with codes that needed to be hand matched to patient names.  Being a committed and diligent physician, I spent a random Saturday evening matching up 420 names to individual 15-digit codes after putting my children to bed.  Of my top 20 utilizers, only 8 were actually patients.  The remaining 12 had been “on my panel list” during the reporting period but had never set foot in my office.  Of the top 100 utilizers, only 42 were patients.  In the interest of accuracy, I requested they re-run the numbers using my patients only.  Mr. IT informed me the inaccurate panel would make no difference.  He might have failed statistics in college but wh...
Source: Disruptive Women in Health Care - Category: Consumer Health News Authors: Tags: Medicaid Source Type: blogs