August 22, 2012

Can We Allow Medical Management Care to Continue?

This is one of the more interesting discussions about managed care. Medical management is managed care and needs to be something everyone is aware of how it will affect him or her. This is a large area of contention between doctors, hospitals, and the medical insurance industry including Medicare. Who is right? After reading and researching this on my own, I think there are valid positions on both sides of managed care. I will say that hospitals have the least favorable position in their goal of larger and larger profits. Physicians may have the strongest positions and the insurance industry has made some very serious and deadly mistakes. In addition, the health insurance industry has too often turned away from serious auditing of fraudulent hospital and physician claims.

The author is well qualified for writing about the topic, but as a patient with a chronic disease, I have some experience with managed care (2004 to Dec 2005). I was constantly battling to remain on insulin, as they wanted me on oral medications. My first wife was also under a managed care plan (1998 to 2002) which prevented some cancer treatments. So the first error in the article is that managed care started to disappear in the early 1990's needs to questioned. At least one commenter to the blog agrees with this. Managed care has continued despite this author’s position. It may have decreased in volume of managed care, but has continued to exist.

I can see both sides; however, until Medicare and the medical insurance industry does their due diligence, most managed care efforts will continue to be less than effective or efficient. Hospitals will continue to recode to obtain fees that should never have been allowed for procedures that never happened and make makes patients appear on paper as being sicker that they actually were. Hospitals will continue to do tests on dying patients that are not warranted, but will probably not be questioned once the patient dies. Physicians will continue to perform tests for defensive medicine purposes to prevent lawsuits.

Some of the comments to the blog are interesting and do point out some areas that are abused by all concerned. It does raise questions about the reliability of managed care; however, other issues that managed care has abused in the past are presented as well. Managed care in the past has been equated with excessive use of euthanasia when proper patient care would have added life and even quality of life. This is a reason to oppose managed care. Under the current healthcare law, it appears that managed care may be even more reckless.

I am in favor of proper managed care, but there will need to be changes to the way it is administered and more thought incorporated into the decision making. In my perspective as a patient, I can see the rise of a new class of patient advocates that will be needed to work for the patient to prevent abuse of managed care. I oppose some of those that are operating now as termed “ambulance chasers”; however, the new class of advocates may need to have some legal training and extensive medical knowledge.

The other requirement that may not be wanted is complete transparency by all concerned – hospitals, physicians, and insurance. If managed care is set up as another entity, then they will need to be transparent as well.

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