SECRETARY'S ADVISORY COMMITTEE ON REGULATORY REFORM, DENVER, MAY 15, 2002

RE: PATIENT-PROVIDER RELATIONSHIPS

I am speaking on behalf of one of our past presidents, Lawrence Huntoon, M.D., Ph.D., a neurologist practicing in Jamestown, NY, who intended to come to the public hearing in Pittsburgh. Unfortunately, he was unable to do so, being tethered to the hospital every other day and night.

Incidentally, like many hospitals in rural areas and small towns, this hospital faces serious financial difficulties due in large part to the unfunded mandate imposed by EMTALA rules. The hospital probably provides much more uncompensated care than actually required because of the ruinous consequences of an accusation of an EMTALA violation, even if the accusation proves to be unfounded.

Dr. Huntoon planned to bring an exhibit pertaining to the announced topic of this hearing, even though he would have had to rent a larger car. "Little Frank," his collection of correspondence with HCFA/CMS in banker's boxes, now stands more than 6 feet high.

These files contain innumerable instances of error, unresponsiveness, arrogance, and intransigence in letters from carrier and HCFA/CMS officials. Communications from Medicare to the physician's patients are generally obscure, confusing, and illegible, often being written in microprint code with a printer in urgent need of a new ribbon. Worse, these communications routinely destroy patient-physician relationships by accusing the physician of a criminal act-such as a "limiting charge violation"-before the carrier has made the slightest effort to determine the facts. When proven wrong, the carrier refuses to retract its earlier defamatory statements-so that the patient will understand that his doctor is not a crook-or to apologize for the disruption and financial losses incurred in trying to get Medicare to correct its error.

When Medicare denies payment, the communication to the beneficiary should state that the service is not covered in general or that it is not covered because it does not meet Medicare's criteria. Patients should not be told that the service was "unreasonable" or "unnecessary," as this determination is made by a person who is not medically trained and/or has not personally evaluated the patient. It is not a legitimate function of Medicare to sow discord and suspicion between patients and physicians in order to deflect blame from the system's failures or gaps in coverage.

Physicians are held to an impossibly high standard of accuracy in communicating claims to Medicare, with huge penalties for errors. There should be no double standard for physicians and Medicare officials, who routinely send blatantly erroneous messages with impunity.

Presented by Jane M. Orient, M.D., Executive Director