Over the last few weeks, a disproportionate amount of time has been spent by many of us trying to navigate thru the exemption process bestowed upon us by CMS.  We are told that in order to circumvent the “theater of the absurdity” more commonly known  as the combination speech and physical therapy $1740 cap that we have some hoops and ladders to navigate (side note:  which is more complicated-Medicare part D drug benefit for patients or the cap exemption process to PT’s?).

My back of the envelope analysis shows that as long as you are willing to go thru the maze, anything and everything qualifies as an exemption. As this article points out, the potential savings of having such a process versus complete abolishing of the cap is meaningless from a CMS budgetary perspective.  Is this surprising?  Didn’t many private sector insurance companies go from tightly controlled utilization review driven policies to one of loosening the reins based largely on the fact that monitoring costs (e.g. approval processes) drive up costs rather than lower them.

In addition to not lowering costs for the CMS budget, the process drives up costs for us the providers which in essence lowers are reimbursement rate (oh yeah, a cut-didn’t we have to deal with that as well?).  Would you rather have a cut in pay or a cap?  Trick question-they both are equivalent.

Will some providers that are busy enough simply ignore medicare patients who arguably need our services the most (aah, the unintended consequences of bad policy).

Along these same lines (the cost of “monitoring costs” thru administrative tasking), there is some compelling evidence (I just remembered that this is an EBP site!) about the impact of using administrative data to determine health care quality a.k.a report cards.

In Comparison of Administrative Data and Medical Records to Measure the Quality of Medical Care Provided to Vulnerable Older Patients. they used 182 measures of health care quality using medical records and administrative data during a 13-month period for a random sample of 399 vulnerable older patients enrolled in managed care in order to determine how performance based on administrative data and medical records compare.  Guess what-they don’t!

So, more costs, less reimbursement, and no correlation to quality of medical care will prevail-at least temporarily.

Thoughts?

Larry