NHS Reform: Great Opportunity or Fraud

Phew! What a few days!

BBC: 'Great opportunity'

Private sector have huge NHS opportunity - minister

By Nick Triggle  7 September 2011 Health correspondent, BBC News

Lord Howe: To be honest I don't think it should matter one jot whether a patient is looked after by a hospital or a medical professional from the public, private or charitable sector”

"The NHS isn't a place to earn a fast buck. There are some outstanding performers in the NHS and they will not give up their patients easily."

He said that the changes being made presented "huge opportunities" to private groups who could provide high quality care.

And he added: "In the coming months and years, the NHS is going to evolve and grow into a very different animal."

What can I say?

Winter’s Tale/Tristram Kenton Guardian

Hermione: "You pay a great deal too dear for what's given freely". -

(Act I, Scene I). The Winter’s Tale.

In the current push for applying market principles, the NHS is in serious danger of paying dearly for unnecessary treatment and worse, fraudulent claims by the new “suppliers” in the market place.

I have highlighted the problems in the US before. Fraud is seen as more profitable than drug dealing.

The US Medicare and Medicaid systems are in a way very similar to what the new market style NHS will be like. Tax-payers pay for them! The much hyped saving, if there is going to be any, will be swallowed up by paying for unnecessary treatment and fraud.

History of Medicare fraud:

New York Times

2008:

Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.

2009:

Arrests in three separate cases in Brooklyn, Detroit and Miami included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so he could bill for twice-daily nurse visits.       Also>>>

But hospitals too:

CNN:

>>>How about My bill from ….. for a $540 tongue depressor. Or one for a $270 2oz. cup of liquid Motrin?

>>>While she was in the hospital a few days old, we were charged for 11 pacifiers at a cost of $121.00 each.

>>>My 70 year old father was hospitalized with Legionnaires Disease. His hospital bill included a bill for a pap smear! His first name was Faye – the hospital must have assumed he was a woman and could scam the insurance company for the charge.

By how much? In the US:

WASTE IN THE U.S. HEALTHCARE SYSTEM PEGGED AT $700 BILLION IN REPORT FROM THOMSON REUTERS

26 OCT 2009

REUTERS PDF

The U.S. healthcare system wastes between $600 billion and $850 billion annually, according to a white paper published by Thomson Reuters.

The report identifies the most significant drivers of wasteful spending - including administrative inefficiency, unnecessary treatment, medical errors, and fraud - and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.

UNNECESSARY CARE (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending.

FRAUD (19% of healthcare waste): Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.

“The Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public

and private healthcare programs are 3-10 percent of total health spending, or $75–$250

billion in fiscal year 2009.”

“Fraud and abuse” occupies the extreme end of the continuum of appropriateness of use and potential waste. While arguments can be made about the appropriateness of some of the care described in the previous section, and, therefore, its classification as waste, no reasonable argument can be made for the contribution of fraud and abuse to quality of care or outcomes. They are cases of intentional misrepresentation resulting in excess payment, including billing for services never rendered and the knowing provision of unnecessary care. Most fraudulent and abusive practices simply add cost with no value, but others actually expose patients to the risk associated with unnecessary procedures.

Practices leading to waste include:

• The intentional provision of unnecessary or inappropriate services

• Billing for services never provided, often with patients’ participation in the fraud, often for

deceased patients

• Misrepresentation of the cost of care by insurers to group plan sponsors

• Kickbacks for referrals for unnecessary services

• Misbranding of a drug by a pharmaceutical company

• Abuse of the healthcare system by patients to receive harmful services, such as Medicaid  recipients with drug addictions enrolling in multiple states.

ADMINISTRATIVE INEFFICIENCY (17% of healthcare waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.

HEALTHCARE PROVIDER ERRORS (12% of healthcare waste): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.

PREVENTABLE CONDITIONS (6% of healthcare waste): Approximately $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.

LACK OF CARE COORDINATION (6% of healthcare waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.

Full Report: Reuters

Not just the US though:

UK Dental Fraud: 2007, 2008, 2010, 2011

The Cockroach Catcher: Winter's Tale: Hansard & The NHS.

Barracuda & NHS: Privatised? No! No! No!

Many of us who continue to love the NHS-Original watched the Panorama programme with intense interest. We saw Harley Street offering better and cheaper cardiac care. We saw Circle’s  Ali Parsadoust in an altruistic posture proclaiming that Circle is the only one that can save the NHS.

Then we saw the unholy gaming by one Hospital on one PCT/GP practice. Or did they?

I have always warned that if those clever people can collapse a complete banking system and they now come and “game” the NHS, what chance do we have.

As private companies offer free shares for GPs in the new market based healthcare system that will soon replace the current NHS, it is amazing that there remain doctors that will continue to point out the dark forces driving the current change.

The Cockroach Catcher has retired from the NHS, but there are other doctors who still work in it, and I respect how verbal some of them are against the initiatives that are currently underway to turn the NHS into an essentially private system without the safeguards of the new US system.

But hang on, no, the NHS will never be totally privatised.

The inspiration came from the natural world: good parasites do not kill their hard working hosts!!! Nor do predators kill the whole species. Keep some alive!!! Milk them forever!!!

Giant Barracuda (Sphyraena barracuda) ©2003 Am Ang Zhang 

As the US insurers found out, Government money is the best money to make and that is really tax payer’s money. The new NHS will be the private sector’s main source of income, as only 90,000 in the UK are covered by private insurance and often they are offered cash incentives to use the NHS.

It is therefore essential for the private health care companies that the NHS is around, at least in name, so that they can make money by providing a “better value and more competitive” service to the NHS!

Some parts of the NHS will have to remain too, as it is necessary for the private sector to dump the un-profitable patients: the chronic and the long term mentally ill, for example. (Right now, 25% of NHS psychiatric patients are treated by the private sector.  But why? Even in psychiatry, there are cherries to be picked.)

Finally, in order to keep the mortality figures low at competing private hospitals, they need to be able to rush some of their patients off to NHS hospitals at the critical moments!

In any case, they do not do dialysis and intensive care, do they?

Wine & Tea: NHS ---- Will it die?

NHS Reform & Panorama: Two Sides!!!

Is it beginning to dawn on some people?

                                                   ©Am Ang Zhang 2011

Panorma: Gerry & the GPs    

Gerry Robinson:

Businessman Sir Gerry Robinson fears 'end of the NHS'

Some PCTs have already began to close.

As the coalition government plans the biggest shake up in the 63-year history of the NHS, businessman and corporate troubleshooter Sir Gerry Robinson offers his viewpoint after spending six months taking the NHS's pulse.

Are the government's health reforms a step forward - or a step towards the eventual dismantling of the NHS?

Two sides of a story:

The changes are better for patients and better for NHS finances according to Dr Kosta Manis, a GP in Bexley. And key to that is the central reform - giving GPs substantial control over budgets instead of the current PCTs.

And that means control over how much they pay for services from the NHS and how much they buy in from the private sector.

In the past, Dr Manis referred patients with heart complaints to a local hospital where consultants usually ordered an often painful and expensive angiogram, using a catheter to probe inside the coronary arteries.

Dr Manis has found a more effective and cheaper alternative, which makes invasive angiograms unnecessary.

Patients at Dr Manis's surgery are examined on the spot to decide whether tests are needed by a top cardiologist, Dr David Brennand-Roper, brought in from a London teaching hospital.

If Dr Manis's patients require further tests, they are sent to a private Harley Street clinic equipped with a high-tech CT scan. They showed a healthy looking lady having the procedure.

This is an example where NHS money is being spent on a private provider - simply because they have got better kit.

I agree with saving the money where possible, but I really do wonder why we cannot have similar facilities to that Harley Street clinic within the NHS - especially if it presents cost savings.

Surprise! Surprise!

But wait: from the Mayo website

If blockages are found with a traditional coronary angiogram, the doctor can perform a procedure called angioplasty to open the blockages straight away.

However, because no catheter is used with the CT angiogram, if a blockage in one’s heart's arteries is found, a separate procedure (a traditional coronary angiogram) is needed.

So it may not be as straight forward as it first appeared.

Oh and the young healthy looking Angela has a normal CT angiogram! But the decision was made by a top cardiologist. The PCT had to pay for that “normal” CT angiogram. Panorama did not raise any question there.

Dr Manis was also concerned that angiograms were often routinely ordered at the local hospital because they were a source of income for the NHS hospital, not because they were absolutely necessary. Wow!

Remember Mayo again?

Mayo Clinic: Disincentive system that works.

Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. One surgeon refers to this tradition as a ‘‘disincentive system that works.’’ Adds another surgeon: “By not having our economics tied to our cases, we are free to do what comes naturally, and that is to help one another out. .  .. Our system removes a set of perverse incentives and permits us to make all clinical decisions on the basis of what is best for the patient.”

That was how it used to be in our NHS!!!

It may be simpler to do away with Internal Market and incentive system.

I quoted Prof Waxman in an earlier post:

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

……..Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

Panorama again:

Andrew Lansley Knew:

The health secretary agreed that the current system can encourage waste.

"It happens because of the way the payment system in the NHS works at the moment - because it pays for activity. So of course if you incentivise somebody just to do more work, they will do more work," Mr Lansley said.

This naturally provides great potential for waste if hospitals are not vigorous in weeding out unnecessary procedures.

I also have concerns that GP reforms would affect other elements of the NHS, possibly even leading to hospital closures if hospital incomes are significantly reduced as money is spent instead on private health care.

Gerry Robinson again:

Still, I am left with serious doubts about key elements of the plans as they stand.

I think the stakes here are huge. Who is going to be managing that big picture?

Unless somebody really does grab this thing at the centre and has the courage to make unpopular but right decisions then I fear this could spell the end of the NHS.


You can catch Margaret McCartney on the show!

Coca-Cola Classic & NHS Classic: Could it happen???

Some politicians have an instinct to survive and dare we say even achieve greatness; others struggle and barely manage to stay afloat. Which do you think Dave & Nick are???


Would it be a Baroness that achieve that greatness? We want NHS Classic!!!

History showed us that some can turn what seem like a catastrophic disaster around and even prosper from it. Coca-Cola’s now famous attempt to change the taste to New Coca-Cola was met with such a consumer backlash that the management swiftly return to the Classic formula and eventually New Coca-Cola was dropped. Or did they!!! In fact the Diet Coke’s flavour is that of the New Coca-Cola that never was. In the States, the Classic Coca-Cola is not all that classic either as it uses HFCS instead of cane sugar. In Mexico & Europe and the Far East, they still use sugar. There you have it!!!

No we want the old NHS!!! NHS Classic!!!

Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings and perhaps if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

Because, reading between the lines, that is what it is. If Andrew Lansley can have his way the ordinary citizens who cannot afford health care insurance will get inferior care in a society hat needs to ration its skilled medical professionals. It is no good trying to pretend it is any other way.

Just like the Coca-Cola in Mexico.

As a doctor it is amusing to find that when given the choice of sugar or HFCS, sugar now looks like the new health food.

Allyson Pollock

Our generation had the best of the NHS.  We had the best of the welfare state including free education, free health care and above all freedom from fear of health care bills.  Now it is up to your generation to fight for what we are in danger of destroying. The BMA are considering taking a legal challenge against the government, you should add your voices. Ultimately the battle for the NHS is a political battle and unless you make your voices heard then the NHS will be lost. Not one citizen in England can afford to lose their NHS; the scale of the public health casualties will be too great if the Bill is passed.  The abolition of the NHS should not be our legacy to your generation for how can you care properly in the knowledge that so many will go uncared for.  Its your NHS but only for so long as you care enough to fight for it.

Independent: David Owen: Our NHS is heading for a train crash

Suddenly all that changed and, surprisingly, the Liberal Democrats too abandoned the evolutionary reforms of the past 30 years of an internal market, and instead embraced Andrew Lansley's external one – a market of price competition, with the EU's competition policy progressively poking its nose into every nook and cranny of our NHS. Furthermore, the proven democratic control of a rationed health service that maintained record levels of satisfaction among the public was to blame.

The Plot Against the NHS

NHS Reform: Shirley Williams, South Africa & Shadow Elite

Shirley Williams: Why this flawed bill threatens the very future of the NHS

Mr Lansley is right to want greater freedom for doctors to work with their patients and to restrain political interference in the NHS. But to throw out accountability in order to tackle petty interference is to undermine democracy itself.

…….Why have so many of our politicians, Labour and Conservative, sought to introduce a market into health? I am not against a private element in the NHS, which may bring innovation and good practice, provided it is within the framework of a public service – complementary but not wrecking. But why have they been bewitched by a flawed US system? I worked in the US for a decade between the 1980s and 1990s and saw the misery of people who could not afford even to insure themselves against the catastrophe of serious ill health.

The Guardian:

One of the emails released by the department shows that officials at the private sector firm McKinsey, which advises ministers, were in active discussion about bringing in overseas firms to take over up to 20 hospitals in return for contracts running into hundreds of millions of pounds. An email to Ian Dalton, head of provider development at the Department of Health, who is heavily involved in the reform programme, in November last year talks about "interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints".

The emails show that McKinsey is acting as a broker between the department and "international players" that are bidding to run the NHS. The documents even lay out some of the conditions required by "international hospital provider groups" for running NHS hospitals. "International players can do an initiative if 500 million revenue [is] on the table." They also need to have "a free hand on staff management". The NHS would be allowed to "keep real estate and pensions".

Overseas Firm?

It would not be from South Africa, would it?

Kruger National Park ©Am Ang Zhang 2011

The one involved in the Kidney Scandal?

Here is what healthcare group Netcare wants you to believe: 109 kidney transplants were performed at the St Augustine's Hospital in Durban, racking up bills of about R21-million, and senior management wasn't paying any attention. 

It couldn't have been expected to notice that 109 well-off, Hebrew-speaking Israelis had passed through the doors in quick succession, accompanied by 109 poor people, most of them Portuguese-speaking Brazilians. Neither could it be expected to question the affidavits signed by all 218 stating that they were relatives. 

                                                                             Fake and kidneys

Or ISTC

The worst performer was the Greater Manchester Surgical Centre, run by South African group Netcare. There, only 56 per cent of contracted procedures were carried out. Netcare received nearly £38m for “phantom” operations.                        

BBC & Internal Market:

John Birt brought in McKinsey and set about introducing hard-headed business principles to what was a creative but flabby organisation. ……But some initiatives never quite worked. One was an "internal market". Some programme editors found as a result that it was cheaper to buy a CD from a megastore than borrow one from the BBC library.

McKinsey has since repaid the favour to Lord Birt by hiring him as a part-time consultant on overseas media issues.

Oooops, McKinsey in reverse.

Enron:

 "Enron has built a reputation as one of the world's most innovative companies by attacking and atomising traditional industry structures," McKinsey gushed in a report published a few months before Enron's collapse.

It's also worth remembering that Jeff Skilling, the former chief executive of Enron, is a member of the McKinsey.

Dr Sarah Wollaston

“It is not Greeks that could destroy the NHS, but if Monitor, the new economic regulator, is filled with competition economists with a zeal for imposing competition at every opportunity, then the NHS could be changed beyond recognition.

It is no use "liberating" the NHS from top down political control only to shackle it to an unelected economic regulator.”

David Bennett is now Chairman of Monitor and he was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

Remember the Shadow Elite!!!

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.         

The Independent: The might of the McKinsey mob 

McKinsey: Galleon, Railtrack & The NHS

NHS & McKinsey: Barracuda & Nye Bevan Curse

Quantum & M: Penny & Monitor

Scary or Depressing: Barrucuda or NHS Reform

                                                                                           Great Barracuda waiting / ©2009 Am Ang Zhang

Dr Grumble's reader has been in touch with him to find out why he has not been posting recently. The answer is that he has been worn down. The progressive changes that have been taking place to the NHS are approaching their zenith. Always inexorable they are now unstoppable. The faux listening exercise and the apparent response has silenced the dissent. For Grumble it is very sad. The service that he has devoted his working life to is on the verge of destruction. The NHS the public loves will be no more. Not, anyway, in its present form. 

Mrs Grumble has noticed the depths of Grumble's depression over the reforms.............................

                                         Read all about it here>>>>>

Dr Grumble was puzzled: 

What puzzles Dr Grumble most about major governmental decisions is just how wrong they can be. You just would not think that any committee of sensible people could get things so utterly wrong. Committees do make mistakes but not on the scale the government does. There must be a reason for this. 

Could this be the reason?  ( From an earlier post)

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care.

So we are going to but in a peculiar manner as the NHS used to be state run and free. Reform is needed!!! Enter GP commissioning. If it is your GP doing the rationing it is no longer the State's problem.

Some very clever people indeed are working for the government. 

Is it Conspiracy or Cock-up? You decide.

But strangely they thought there is still money to be made.

That is why many GPs in the consortia have links with private providers.

It is a sure way of directing patients to secondary care.

The AQPs are already there and many specialists are working for them. It really does not need a genius to work out that Foudation Hospitals if they fail will be bought up by private firms.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of hips or knees. 

Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed. The notion that one should “let them eat cake” does not apply here.

More like: “Let them not see a Consultant!” And if you do, we will make money.

Reform will not save any money but it will make a few City people very rich, very rich indeed.

David Cameron, it is not too late. We will believe you if you legislate against private involvement. Yes, legislate and we would hopefully not have another Southern Cross.

Dr No: Services and the Split

Jobbing Doctor: Can't listen? Won't listen!

The Witch Doctor: Hazards of the Fourth Healthcare Market

A Better NHS: A letter to your MP about the Health Bill

The Cockroach Catcher: NHS 2011: Conspiracy or Cockup?