'Overserved?' What a euphemism!

The Government Accountability Office set out to learn whether Medicare beneficiaries were getting access to doctors without undue hassle. GAO found few problems with that. 

But it found regions -- including most of Florida -- where patients were going in and out of doctors' offices and hospitals as though in a revolving door.

The GAO report called these areas "overserved." Let's call them what they are: places where Medicare patients get overtested and overtreated. And where Medicare gets overbilled.

Anyone who understands human nature could have predicted that traditional Medicare, sometimes still referred to as "Fee For Service" to distinguish it from managed care, would generate too many "services." It pays by the unit -- by the visit, the test, or the treatment -- instead of some other way. 

Granted, it's tricky to think of another way to pay doctors. Prepaid managed care raises fears of undertreatment, or at least inattentiveness, while the suggestion of paying doctors on salary makes many in the medical profession apoplectic. Health policy specialists are trying to dream up a way to pay doctors based on outcomes, but then who would treat the dying? Paying doctors for following guidelines -- the right amount of treatment and the right kind -- brings accusations of "cookbook medicine."

So I'm not suggesting that it's easy to figure out. But clearly a system that pays doctors more if they run more tests and do more procedures has several downsides. The GAO report focuses on costs, which is appropriate at a time when we're trying to figure out how to save money in the system.

But there's another downside: Iatrogenic illnesses -- those that occur because of the medical intervention. Sometimes it's an infection, sometimes a medical error. It can be an unforeseeable complication that occurs even when the physician does everything right.  

Every defender of the status quo -- doctors, patients, insurers and public officials -- should read that report. Especially those from Florida.

--Carol Gentry can be reached at 727-410-3266 or at this e-mail.