I’d like to start today’s Friday rumination with a small mental exercise for the reader. To begin, stand up in your cubicle, open your office door or look out the nearest window. Now look at the people sitting and working, the humans walking by your office door, or all of the people on the street either walking or driving their cars.
Now that you have done that, internalize this fact; every single person you have just laid eyes on has an uncorrected personality trait. It could be as minor as an irresistible need to wash one’s hands, or as major as having a family of immigrants imprisoned in their basement making opium pipes for export, but every single person has at least one. The reasons for this could be many, but I’ll leave it to Robyn Hitchcock to best describe how they got there in perfect three-part harmony.
My uncorrected personality trait is an inability to forgive. If I have made your acquaintance, even for as little as 30 seconds, and I enjoyed the interaction, you are basically my friend for life. However, if you do me wrong just once, I’ll carry it into the afterlife and do my level best to beat your eternal soul into the celestial ether with the nearest harp.
Since this is a place for healthcare musings, let’s focus on the uncorrected personality trait of the Centers for Medicare and Medicaid Services. As we learned from the Supreme Court this week, CMS has a predilection for never having to pay for mistakes to which it owns up.
This past Tuesday, in an unanimous decision (how often does that happen?), the Supreme Court ruled that provider appeal timelines for reimbursement issues cannot be extended beyond those already established. The case in question, Sebelius vs. Auburn Regional Medical Center, involved 18 disproportionate share hospitals who were found to have been underpaid to the tune of millions of dollars from 1987 to 1994. This mass underpayment was discovered as part of another lawsuit filed in 2006 regarding CMS’ process flaws in determining the number of low-income patients treated by hospitals.
The hospitals argued that because CMS failed to disclose the calculation error, the usual appeal timelines of 180 days or 3 years for good cause should be lifted. CMS countered that appeal timelines could not be extended, and the Supreme Court upheld CMS’ decision.
So to summarize, CMS failed to reimburse hospitals properly over a seven-year period, found out about it 12 years later, declined to rectify the error when it was found and the hospitals affected are now legally required to be stuck holding the bag for patients who had no ability to pay at the time of service.
Some of us have facial tics, some of us are slaves to ritual and some, like me, have an inability to forgive. Compared to CMS being one of the few entities in this world legally allowed to be a financial deadbeat based strictly on the calendar, all of our uncorrected personality traits combined pale in comparison.
Someday, in the lands far beyond, perhaps we’ll all discover how the employees of CMS who are responsible for Medicare payment rules feel about the blunt side of a harp.