Federal laws are complex and made more complex by regulations enacted under the laws. Health care has more than its share of federal laws and regulations to deal with. So it shouldn’t be surprising that those laws and regulations sometimes conflict with each other or that one federal law or regulation ends up being a barrier to another federal initiative, much less private innovation in health care. The Government Accounting Office finds that this is in fact the case in regard to pay-for-performance efforts, and also likely for value-based purchasing. (GAO Report) The Centers for Medicare and Medicaid Services has made these programs a cornerstone in its effort to turn payment from focusing solely on the volume of services delivered to rewarding provision of better quality and outcomes. A large number of private payers have followed suit, beginning their own similar programs. But the GAO found that one concern providers have is whether such programs may run afoul of federal fraud and abuse laws. In particular, the GAO cites the Civil Monetary Penalties Law, which prohibits hospitals from paying physicians to reduce or limit services, and which the Office of Inspector General has interpreted, in its incredible wisdom, to apply to both necessary and unnecessary services!! You can get exceptions through an advisory opinion process, but anyone who has gone that route knows what an expensive and lengthy effort it is. The whole issue is simply absurd and illustrates the need to just repeal all the federal health laws and start over with something much simpler and with a little more logical basis. Among other things that might lower costs in the health system.
Regulatory Impediments to Pay-for-Performance
By Kevin RocheMay 3, 2012Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
For those who would like to read more on the crisis of fake and bad science, read this excellent report from the National Association of Scholars. just click this post.
June 4, 2023
CVS has finalized its $10.6 billion buyout of Oak Street health, which operates primary care centers for Medicare members. People may think CVS is a drug store company, but it...
May 4, 2023
Option Care, a large home health care provider is acquiring Amedisys, another large player in that market, for $3.6 billion, as consolidation ramps up across health care, likely meaning higher...
May 4, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
June 8, 2023
Yet Another Comprehensive Look at Lockdowns
Another major report finds that lockdowns had very little efficacy, in regard to infections or…
June 7, 2023
More and More on Jobs Reports
More BLS machinations around jobs numbers, this time in regard to seasonal adjustments.
June 7, 2023
Me on a Podcast
Your opportunity to see and hear me, courtesy of the Michele Tafoya podcast.