- The Washington Times - Sunday, December 9, 2001

A doctor on call. A patient in need. A life at risk. All because it took the doctor 20 minutes to wade through extraneous documentation on the chart to find out the patient was suffering from a hemorrhaging ulcer.

Twenty minutes.

In a small, 33-bed hospital in Texas, 20 people are employed just to comply with Medicare billing procedures. An Illinois hospital reports that it has more than 100 full-time employees who spend more than 3,200 hours each month navigating the complex web of billing requirements.

Medicare's irrational paperwork requirements and complex regulatory demands are yanking the heart out of our senior's health care system. It forces doctors and nurses to put paperwork before patients.

If you doubt the ridiculous hoops that must be jumped through to "code a claim," just ask your family doctor how much time he spends plowing through piles of paperwork. Believe me, you'll get an earful. Health care providers are fed up, and with good reason.

One congressman spent an afternoon working in a local doctor's office so he could walk a mile in a provider's shoes. His task: complete forms needed to file Medicare claims. He was immediately confronted with several volumes of instructions all the size of phone books. A quick review of these "guides" revealed Medicare jargon that was so unclear it might as well have been written in another language.

The difficulty of just filing a claim to get paid for treating a senior citizen is a glaring example of how broken the Medicare bureaucracy is. Forms don't take your grandmother's blood pressure and they don't perform open-heart surgery. Hospitals should be hiring doctors, not accountants. We need more nurses, not paper pushers. Health care providers serving nearly 40 million seniors on Medicare shouldn't spend valuable time filling out unnecessary forms.

Medicare itself provides no decent roadmap to the intricate maze of billing forms, codes and claims. The General Accounting Office recently tested the accuracy of Medicare contractor responses to providers' questions. The results were alarming. Nearly 85 percent of answers provided by contractor call centers were incomplete or inaccurate. They provided wrong answers to frequently asked questions 32 percent of the time.

Then to add insult to injury, if a doctor submits a claim using the "advice" provided by the government, and it is determined to be wrong, the government can impose a huge fine or just shut down his practice. If the government can't figure out its own billing procedure, how can it hold doctors accountable?

GAO also found that there are fewer than 26 full-time Medicare employees assigned to oversee contractor relations efforts for every provider in America that's nearly the same number of people assigned to fill out forms in that small Texas hospital.

Health care providers are faced with a monstrous government bureaucracy that second guesses their medical decisions with heavy-handed oversight. As one physician from my hometown said, "The system has subjected me to a Star-Chamber proceeding for the crime of serving the elderly." How can anyone provide quality health care under such conditions? If we don't reduce the complexity and paperwork in Medicare, we will drive small health care providers out of business and severely reduce seniors' access to the care they need.

Working together, though, we will stop the madness and restore common sense to the Medicare bureaucracy. The first bill produced under my leadership as chairman of the House Ways and Means Health Subcommittee was the "Medicare Regulatory and Contracting Reform Act of 2001." By focusing on the regulatory hurdles faced by doctors and their patients in every community, I and my colleague, Health Subcommittee ranking member Rep. Pete Stark, California Democrat, generated a bipartisan movement for change.

Our legislation simplifies the regulatory process, provides education and technical assistance to health care providers, protects the rights of providers when audited, and moves us toward a more sensible and collaborative partnership between Medicare and doctors.

It also creates an ombudsman to help providers solve problems they encounter with Medicare and to get seniors the answers they need. Because audits of providers have become so hostile, the bill creates a demonstration program that will provide intense and targeted technical assistance to our smallest providers, who usually serve seniors in poorer rural and urban areas.

This week, the House passed this critical legislation with a broad bipartisan vote. We've provided the momentum, and now we need the Senate to act quickly so we can deliver this bill to the president.

Although Medicare faces other challenges modernizing it with benefits like prescription drugs and shoring up its long-term financial solvency as Baby Boomers retire the first step is to streamline and strengthen the program from within to make sure it prioritizes patients over paperwork. If the Senate doesn't move fast, Medicare's bureaucracy like carbon monoxide will quietly put providers under and out, with tragic consequences for seniors.

Providing quality health care to our seniors trumps filling out needless forms any day of the week. The Medicare bureaucracy doesn't get that. We need the help of the Senate to make sure they do.

Rep. Nancy Johnson is a Republican member of the U.S. House of Representatives from Connecticut and is chairman of the Ways and Means Subcommittee on Health.

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