The attacks on medicare have been coming fast and furious this year as Conservatives try over and over again to eliminate the program. While both parties recognize that the largest problems with Medicare is abuse and waste, they are divided as to which sector is causing it. Republicans put the blame completely on users of the program, many of whom opponents say are not eligible. Democrats on the other hand say the problems come from inefficient payout systems and too little accountability from providers. The facts are however that all of these factors contribute to the high costs of maintaining the program.
When fraud happens it is usually conducted by large scale confidence groups who set up fake clinics and submit paperwork. The FBI has arrested and prosecuted literally hundreds of these cases, costing tax payers hundreds of millions of dollars, and if provided with more agents or inspectors, could be extremely successful in preventing this type of fraud. Individual collecting medicare when they are not eligible is actually very rare. Other problems, like real doctors and hospitals charging for services never given or grossly overcharging Medicare cases, when compared to private insurance cases, and many other factors. Finally there are a great number of errors that are made by medical coding and billing specialists that are simply not caught by Medicare, leading to a waste of resources.
But the largest part of the problem is the inefficiency of the program and this comes from the fact that the agency is Legislatively hampered. One excellent example can be found in the post-discharge treatment of Medicare patients. When a patient is released from the hospital, especially older patients, see a much faster recovery rate and experience fewer readmission if, for the first 30 days after leaving the hospital, they see a physician at least one time or engage in some form of therapy. A doctors visit to access progress can catch any problems before they require readmission and the exam will cost about $100 while a readmission to the hospital, counting transportation and emergency care, and first days room, can cost over $1,000. One Washington based research group, the Center for Studying Health System Change, found that more than 35% never see a physician during the first 30 days after release and this is leading to more than a 40% rise in readmission’s.
Some hospitals are taking the initiative and setting up post discharge clinics for patients. One clinic for instance, the Tallahassee Memorial Health-care Transition Center, offers two months of out patient clinic care, which can be extended with a doctor´s orders, for patients with a high risk readmission. The clinic has served more than 600 patients since opening its doors and the readmission rate for high risk patients has dropped 61%, giving the hospital, and hence insurance companies, including Medicare, savings of millions of dollars. These types of changes will also open the job market for more jobs like medical assistant and nurse, as well as many technician jobs. The entire question must revolve around efficiency if it is to work at all.