Ah, the Cadillac. A car that epitomizes personal success, classic style and a unique type of American luxury. But what does "Cadillac" have to do with health care?
It’s not a new phrase. Insurance companies and payor entities have used it for decades as a catchall to mean "too expensive" or "un-necessary from a cost point of view". It never takes into consideration medical necessity and is usually subject to someone else's point of view or economic standards.
Over the years, those providing medical services of all types have become all too familiar with the phrase, "why pay for a Cadillac when a Chevy will do?"
In one practitioner's office, an organization was contacted about the substitution of an item on a physician's prescribed treatment protocol, the Texas State government official said that, "either item [sic] listed replaces the amputated part, and we will only pay for the less expensive one [the Chevy]." When the practitioner explained that each item has its own purpose and that the more expensive one was the one prescribed as medically necessary to treat that individual's condition, the official stated, "Why should we pay for a Cadillac, when a Chevy will do?"
Invoking the term "Cadillac", recent media reports have advanced the belief shared by many in insurance and government that the services paid for and provided are: a unnecessary luxury, over priced or undeserved and fraudulent.
Postulating that somehow those health professionals that provide these services warrant extra scrutiny for "daring to cost the system precious dollars". There is also a growing use of the phrases "waste, fraud and abuse". However, these phrases are more sound bite than sound reasoning and political machinations than a protection of the people.
Medical services, items and treatments are by their very nature individualized- prescribed by a physician and dispensed by health professionals for a specific health need. Whether it is a DME/HME supply, orthotics and prosthetics, breast prosthetics or a major surgery, the decision for that treatment should be a conversation between an individual and their physician. And those directed to provide those services should not be singled out for absurd scrutiny or held "guilty" until they prove that they are not part of a "health care fraud scheme."
What does all of this have to do with the price of tea?
Overzealous regulations and witch-hunt like tactics in an attempt to "find the money", cripple Medicare; contrary to current political claims for "quality health care for all." Time, resources and dollars are spent in sole accommodation of a new and ever changing regulatory environment. Time resources and dollars that practitioners would prefer to spend on care for individuals.
Already in 2009, with the implementation of BIPPA 1997 et al, including Accreditation and required Surety Bonds, 20% of current small women-owned businesses, establish post mastectomy providers, have closed their doors or terminated from the Medicare program. These are not fraudulent providers but businesswomen, forced to close by government policy. This is a 20% reduction nationwide, of providers of a critical health service to women and men who have survived breast cancer and can only be interpreted as a reduction in quality of care and access to care.
Forcing providers out of business, the loss of jobs, city and state revenue is not a way to save taxpayer money or justify bad legislation. Lukily good legislation has been introduced to limit or stop surety bonds, competitive bidding and other issues related to over regulation. As well as provide positive ways to ensure provider quality, and quality of care.
For more information, please visit www.aabcp.org
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