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Critics question doctors making millions for 'denying' healthcare

(MGN)

Doctors who streamline healthcare and in the process, save on costs, are getting a portion of that savings from the government as an incentive.

CBS12 Investigates found one group of doctors in Palm Beach County is getting tens of millions of dollars a year.

Critics call it an unintended consequence of the Affordable Care Act.

GETTING RICH

So, how are doctors getting rich by working less?

The program is called the Accountable Care Organization or A.C.O.

An ACO is a group of doctors working together to provide coordinated care for their Medicare patients to improve care and cut costs.

This coordinated care is supposed to save taxpayer dollars and help patients recover faster. But at what cost?

“Doctors are being paid to deny care to patients who need it. That in my estimation is just horrible,” malpractice attorney Ted Babbitt said.

Babbitt represents families like George Matsouka who lost his mother, Aspacia, two years ago.

“It was difficult in the end,” Matsouka said.

On her 96th birthday, Aspasia fell and broke her hip. Matsouka said even though she was unable to walk or use the bathroom, her doctor would not admit her to the hospital.

“That was unfathomable to me,” he said.

LOCAL A.C.O.

Dr. Richard Weisberg is the C.E.O. of the Palm Beach ACO, the largest in the state.

“We are keeping our patients healthier, and keeping them out of the hospitals, and the E.R. where the main costs are,” Dr. Weisberg said.

He said they are not denying any patients care.

With more than 160 doctors and hospitals, they saved Medicare about $300 million in just one year and in return, Medicare paid them $36 million.

That money goes directly to the doctors involved in the A.C.O., according to Weisberg.

“Any incentives we get are to compensate us with the work we are putting in,” he said.

Weisberg points out that coordinating care avoids situations where patients go from one specialist to another and greatly improves outcomes for patients.

A recent report by Health and Human Services confirms this and concludes A.C.O.s have improved the quality of care for patients.

WHAT PATIENTS CAN DO

But Babbitt sees it differently.

“The patient has no idea they are being denied care,” he said. “It is impossible for a patient to know that they need that care until they get sick.”

Matsouka agrees.

“You’re in Catch-22 situation," he said. "It is very frustrating. You want the best care, and you can’t do it.”

That's why today, Matsouka is a patient advocate.

“You need to know and question the doctors on everything,” he said.

Here's what to do if you are denied care:

  1. Ask for it in writing.
  2. Ask how your doctor is paid. Medicare recipients are entitled to see the details of any incentive to withhold treatment.
  3. Get a second opinion.

Criticism of medical billing isn't new.

There are other ways the medical community tries to control costs, including fee-for-service agreements or flat-fee programs.

Critics say both can make doctors extra money with either excessive unnecessary care or too little care.

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