I work in a critical access hospital and the amount of hoops we have to jump through for even traditional Medicare to pay for even some lab tests that a physician has ordered is ridiculous. They deny a doctor’s order because it isn’t “medically necessary” but most of the time these physicians order these tests to rule out other causes. And don’t even get me started on more expensive testing and commercial insurances. Patients with sleep apnea get denied bipap machines because Medicare believes most can make do with cpap (no, this is not across the board, just a majority example from my small hospital). Once we jump through hoops and appeal 2 or 3 times, it might get paid for then, but rarely does that happen. And no, doctors cannot get kickbacks from ordering these tests. They know their patients better than the government does.
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Dedi. Please see my post “ Increase the number of Private Practice Physicians, Increase Provider Autonomy , Decrease Regs”. Some of your issues could be remedied by my post and possible further regulations. My executive order addresses some of your concerns.
Scott