Quoted from McKnight News December 7, 2016:

The U.S. Department of Health and Human Services has until Dec. 31, 2020 to eliminate the backlog of pending Medicare reimbursement appeals, a federal court ordered on Monday.

The order from the U.S. District Court for the District of Columbia follows a timeline proposed by the American Hospital Association, which brought the suit against HHS over its “highly backlogged administrative process.” Judge James E. Boasberg, who authored Monday’s opinion, had stated in an earlier ruling that ordering the agency to resolve the backlog by the prescribed dates was “extremely wishful thinking,” but he changed course after briefs were filed by both parties.

HHS must first achieve a 30% reduction of the current backlog of more than 700,000 pending cases by Dec. 31, 2017, followed by 60% and 90% reductions by the end of 2018 and 2019, respectively. A total elimination of claims pending at the Administrative Law Judge level must be reached by the end of 2020.

Blogger Comment:

HHS and CMS continue to ignore court orders in an attempt to balance a budget that will never be balanced since it isn’t based on a feasible valuation (price) for the services in relation to the actual cost per outcome.  Economically, health care continues to avoid costing its services and relating it to a patient outcome.  They have no idea of the cost nor the outcome.  Until that happens we are living in a bad dream world where the Government wants us to think they are in control when no one is accountable for results.  Ultimately, the day will come when all 700,000 denials will be found to be determined illegally and written off.

Then and only then will we be able to confront the real world of health care. Physicians, hospitals, nursing homes, assisted living units, home care, hospice care will need cost accounting systems for episodes of care crossing the continuum from illness defined by problem to recovery to restoration of function to rehabilitation of body and mind for return to the community or permanent placement in long term care.  This process is a journey not a treatment or a pill … it’s a coordination of services defined by standardized care plans customized to each patient episode.  Reimbursement or payment will have to be based on the models that include a length of time for each level of service and the expected levels of attainment … patient centered yes, outcome based yes, value based yes, accountable at each level yes, affordable yes.

For details read my books  “Restore Eder Pride”, iUniverse, “America in the Red Zone”, iUniverse, “The Boomers Are Coming” Xlibris, “Failing Government Taketh Away”, Xlibris, “Never Too Old to Live”, Xlibris.  These are a series of Self-Health books designed to define the health care paradigm SHIFT to bring forth discussions of how to pay for better care.

I have made my pitch to the Trump transition team regarding Obama Care and the VA debacle.  It is obvious that a move away from an inductive institutional model to a deductive Enterprise model is needed before we know how to fund this monster.  A new look and approach is certainly needed but regardless needs to be privatized, systematized and economized.  Big bad government is making it far too complicated by making it administratively simple for controlling everything and accomplishing nothing.   It’s far more than deregulation … it’s at square one for setting it up like a business, that it is, not as an institutional bureaucracy would have it.