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Wednesday, May 19, 2010

The Strangling of American Hospitals

We had staff meeting yesterday at the hospital. A topic of discussion was RAC audits and a specific case affecting our hospital.

If you don't know what RAC audits are, do a Google Search on it and read about it for yourself. I betcha most of you have never heard of such a thing.

Anyway, I felt compelled to write my Congresswoman, Marsha Blackburn, and my two Senators, Bob Corker and Lamar Alexander over this issue. I know I'll probably get the standard form reply, but it made me feel better anyway. Here it is:

Dear Senator/Congresswoman:

I feel the need to make you aware of the serious situation created for small hospitals under the RAC (Recovery Audit Contractor) program created by Medicare.

I am a physician at our local hospital. During staff meeting yesterday, we discussed a situation concerning a recent surgical case. A patient had a lesion surgically removed. The doctor’s note read as follows, “an eleven blade scalpel was used to remove the lesion”.

The RAC auditor reviewed this chart and stated that the note should have read, “an eleven blade scalpel was used to EXCISE the lesion”.

Because the word REMOVE was used instead of the word EXCISE, the RAC auditor declared that the hospital should refund Medicare an amount of $11,000. The hospital appealed and pointed out to the auditor that there was essentially no difference in the words EXCISE and REMOVE. To no avail, the auditor stated the hospital owed Medicare $11,000.

Senator/Congresswoman, these RAC audits are an exercise in pure lunacy. I hope you can see the obvious stupidity imposed on hospitals by the intrusion of the United States Government by this example above. I would also hope that you would take steps to relieve us of the burden of these nonsensical RAC audits. If you don’t, many hospitals like ours simply will not survive and will end up closing the doors.

It is my understanding that the bureaucrats involved in the RAC audits are entitled to a third of the funds they recover from hospitals. So out of that $11,000 dollars they are squeezing from our hospital over the definition of a single word, the auditors themselves stand to collect $3666.66 for themselves. Senator/Congresswoman, can you truly believe that hospitals will be treated fairly under such a system? If a private entity conducted itself in a manner similar to the RAC auditors, the people in that entity would be jailed.

Of course if Barack Obama has his way we will end up with single payer health care for all which will no doubt be broke like Social Security and Medicare. More and more hospitals will close. So much for universal health care.

Right now our hospital makes about 46 cents for every dollar billed to Medicare. We make 24 cents for every dollar billed to Tenncare (Tennessee Medicaid). I am told under the proposed Medicare cuts and RAC audits we can see our reimbursement fall to 32 cents for every dollar billed to Medicare. You can see we are slowly but surely being strangled by Uncle Sam. Our doctors, nurses, and other hospital staff work hard to provide health care to some very old and very sick people. We deserve honest payment for our efforts rather than a bunch of shenanigans invented by Medicare designed to avoid payment.

Senator/Congresswoman, I implore you to look into this thing called RAC audits. Talk to your constituents in the health care field. They will tell you the same thing I am telling you. We are being strangled by this government nonsense.

I am looking for a personal and thoughtful reply from you on this matter, not the usual form reply provided by a staffer.


Thomas M. Hamilton MD.

So there you have it. If you are on Medicare or have relatives or friends on Medicare they will sooner or later be affected by this gubment lunacy. I read yesterday on Drudge that more doctors than expected are bailing out of Medicare. This means that fewer and fewer seniors will be able to find doctors or keep their doctors.

I ask you to share this post with your friends personally and in the blogosphere and also with your congressman and senators.


  1. I've sent the link to several friends, who will forward it on to their friends.

    It's almost like loan sharks or the mob. There's nothing fair or right about the auditors getting a percentage and certainly not that big a percentage.

    Semantics: Tomato/Tomato

    Right Truth

  2. I would love to see the Senators' responses. May I have your permission to crosspost this at Monkey in the Middle?

  3. EXCISE or REMOVE caused THAT? "Intrusion of the US government.."? We ain't seen NOTHIN' YET.
    Keep up the good fight.
    I think I will send this around, thanks.

  4. Findalis, you have my permission to do with this as you wish. I told the hospital administrator yesterday that unless the general public becomes aware of the idiocy we're subjected to by the gubment, we will never survive.

    Problem is that I would be willing to bet that none of the politicians I wrote have any idea what is happening out there in the real world. Some of them probably just don't care.

  5. Z, we had a discussion about "better documentation by the doctors". Problem is that if we start using excise instead of remove, the RAC auditors will just come up with something else equally as stupid.

  6. Thanks for posting on Right Truth, Sweetie.

  7. This is still making the email rounds, so you should get some more coverage and comments.

    It's nuts, legalized robbery.

    Right Truth

  8. I am a certified coder and am well aware of the RAC audits...

    This was in the Indianpolis star yesterday...


  9. It'll be interesting to see if you do get a personal reply or the standard form reply.

  10. Thanks, Sue. You know first hand what we are up against. The problem with the Indianapolis story is that it implies that the hospital is evil and did something wrong. How do we know those patients did not need to stay overnight? Who would you trust to make that decision, a medical doctor or a RAC auditor? Ultimately it was a doctor that decided......not the hospital. If the doctor did not keep the patient overnight and that patient had a bad result, then the doctor and the hospital would probably be involved in a malpractice issue. Seems as if we are screwed any way we turn. Problem is that whatever the RAC auditor decides sets the course. Of course the hospital can appeal but that is a crap shoot (we appealed the wording REMOVED vs. EXCISED and lost).

    MK, I'll let yall know if I hear anything back from the legislators......I'm not holding my breath.

  11. This is typical bureaucratic bullsh*t. These people are so concerned about their precious jobs that every "t" and "i" must be crossed and dotted and this alone makes a bureaucracy almost unworkable. We're stuck with more of this for now and under Obamacare it will get worse.

  12. Ron, what is really a travesty is all of the money spent by the gubment trying to implement all their recovery and oversight plans. The bureaucracy has already passed the point of unworkable. It is headed down a sh*thole and trying to take us with it.