| EDWARD D. HARRIS JR. President of the Medical Staff A VIEW FROM BOTH SIDES |
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 Viewed from one side . . . - Last month, while attending on the medical services working with an exceptionally competent group of residents, I spent a lot of time obtaining family histories from patients and then dutifully dictating them. This is not to say that the residents did not take family histories. The point is that in order to bill appropriately for a new patient admission, I had to take significant time away from analysis of patients and their problems and, instead, invest it in redundant paperwork. - In order to root out fraud and abuse in billing for federal programs such as Medicare, the Department of Justice will be hiring 150 additional assistant U.S. attorneys. Each new lawyer will be given a quota of turning up $2 million in fraudulent bills. In a worst case scenario, this is a major opportunity for harassment, conjuring up images of IRS agents and even used-car salesmen swarming through your examining rooms. Viewed from the other side . . . - It is estimated that 14 percent of bills submitted for payment to Medicare are fraudulent. Every fraudulent bill takes another inappropriate slice out of the Medicare Trust Fund. - Reimbursement for inadequate care may be better than for expert care. Consider the surgeon who performs sloppy surgery, necessitating the patient's return to the operating room. That surgeon makes much more from the case than the skilled surgeon who got it right the first time. - Organized medicine has abdicated its responsibility to encourage physicians to play by the rules. As a result, the feds must do it for us. The reality lies somewhere between these divergent views. Many of us docs are disgusted with what we perceive to be meddlesome, trivial regulations that take time away from patient care. Those assistant U.S. attorneys, on the other hand, will probably identify their $2 million quotas in the first week of work. These attorneys perceive that there are a lot of "ice-cold criminals" in the medical profession, predicts Eileen T. Boyd, UCSF Stanford Health Care's compliance officer. For Ms. Boyd, who came to us from a top position in the U.S. Inspector General's Office, the challenge is to ensure that physicians in UCSF Stanford Health Care understand and accept the importance of compliance with regulations and to the need to implement a pattern of practice that embraces and incorporates compliance. Boyd has identified old approaches and characteristics of compliance that contrast with the new approaches thatshe hopes can be implemented at UCSF Stanford Health Care. |
COLUMNS
Chief of Staff
Fact File: Neuropsychology
NEWS
Conference Explores Benefits of Art, Music in Health Care Leaders Look for New Inpatient Beds CALS Survey Site Visit Scheduled April 6-10 Physicians Recruited as Mentors Swain, Reitz Co-Chair Relaunced Search for Surgery Leader Powerful Web Resource Available for Physicians PAST ISSUES
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| Old Approach Inspect, Detect Reach |
New Approach
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| Can this happen? Chances are that if we physicians agree to learn the rules and then work with Larry Blevins, our chief information officer, and his Medical Information Services colleagues to insert systems that document compliance, maybe it won't be so bad. And maybe, if we at UCSF Stanford Health Care always document meticulously what we are doing right, we can then become a powerful voice in working toward a fairer and more equitable reimbursement system for everyone. | ||