re: Obamacare Rollout Hampered By Operating Rules Lag
this appears to be another symptom caused by the politics of ACA. while the cause appears to be government agency incompetence, it seems to me that the root cause of this problem is the hope by certain decision makers that the ACA would somehow be delayed or repealed. This notion has feed numerous actions on the part of providers and insurance industry ecxecutives delaying their actions in the misplaced desire that implementation of ACA would be delayed. Included in this type of problem is compliance with HIPPA, the failure of industry to implement backend transmission rules, the lackluster acceptance of ICD-10 and the foot-dragging of CMS itself. those actions by CMS to accomodate industry tardiness makes CMS look poorly prepared for ACA. CMS has also a poor understanding of Republican strategy so they also did not execute their efforts to address their tasks to implement ACA. While this article is brilliant in idetifying this abuse of the ACA it is but one more symptom of an industry and agency lingering on a past that cannot be sustained and they are all in various stages of denial over ACA.
The law of the land is and has been clear. Unfortunately both the industry and CMS must accept and act on the law of the land or the law is violated. Both bureaucracies have to accept ACA as real. Today, and likely for some time to come, bureaucracies have wonderful hindsight and very little foresight.
Public Healthcare Policy is flawed because the data supporting objective decisions is so corrupted that it is useless for policy analysis and formulation. Helath Care policy in the U.S. today and for a reasonable future will remain the opinion of a few leaders in the legislative and executive branches of the federal government. In order for this to be corrected CMS must focus on waste, fraud, and abuse of public healthcre programs AND pay the bills on claims on a sound accounting basis.
Congress must take notice:
--CMS does not know how much fraud there is.
--CMS does not have a definition of the concept of abuse.
--CMS has only an understanding of Waste as an exception to policy but no way to discern it in the payment record.
--Congress must listen to the testimoney to them, and read the reports commissioned by them. The IG, OMB, FBI and CMS all have testimoney ON-THE-RECORD that Waste, Fraud and Abuse, by criminals, not only providers, amounts to 40%-60% of the $1.8 Trillion spent by CMS for public healthcare.