Here are some examples of the influence of government in medicine.  Debra Lienhardt, JD in the June edition of “Outpatient Surgery,” explains in great detail why it is illegal for a surgery center to provide transportation to or from the surgery center for a Medicare patient that is unable to drive or get a ride.  Seriously.  Failure to adhere to her advice could draw the scrutiny of the Office of the Inspector General and felony charges of “an intent to induce” Medicare referrals.  ”Don’t touch my Medicare” cries are drowning out the “Can I get a ride” requests, I guess.

Jerry Sokol, JD and Amanda Jester, JD write in the May edition of the same magazine that one of the reasons that so many physician-owned surgery centers are selling or joint venturing with large hospital systems is that..”….this option aims to exploit Medicare’s substantially higher reimbursements for hospital outpatient surgery.”  You mean hospitals are paid more by Medicare than physician-owned outpatient surgery centers for the very same procedures?  How did this come about?  A health staffer in D.C. told me last month that the Medicare payment to one of the “not show a profit” hospitals here in Oklahoma City for any of the procedures listed on our website (this guy had done his homework before he met with me…he had read all of my blogs, as well!) was twice what we had listed on our site.  He asked me if I thought saving one half of the total money spent on Medicare patients’ outpatient surgery just here in Oklahoma City was a significant number with some sarcasm, as we discussed Medicare’s looming bankruptcy. He also asked me if I would sign a contract right then and there to provide all of the Medicare outpatient surgery in Oklahoma City at our website rates.  I told him “no” and he laughed and said he already knew what I would say.

In our local paper, officials at the state “Health Care Authority” are touting their success at lowering the rates of Cesarean sections for child birth amongst the Medicaid population.  How did they do it?  They decided to pay the obstetrician less for doing a Cesarean delivery than they do for a vaginal delivery.  What they neglect to say in the article is why obstetricians have historically done more C-sections in this population:  they were paid more to do them and they ducked the lottery-type lawsuits stemming from birth trauma resulting from difficult vaginal births.   The government to the rescue!  Guess what will happen now?  If you guessed that women needing C-sections won’t get them and more babies will be born with brain damage or upper extremity trauma and more obstetricians will be sued you go to the head of the class.  Bureaucrats sure know how to solve these problems don’t they?

G. Keith Smith, M.D.