Thursday, February 26, 2009

Okay, this is scary....

In reading about Obama's new $634 billion health fund, I came across this:

The budget figures also represent significant shifts in how the United States will pay for medical care.

For example, experts have identified hospital readmissions -- especially for elderly patients -- as a sign of poor care and unnecessary expense. About 18 percent of Medicare patients are readmitted to the hospital within 30 days of an original visit. The new approach would establish flat fees for the first hospitalization and 30 days of follow-up, sometimes done by separate facilities. Hospitals or clinics with high readmission rates could be paid less.


I am not sure what the details are but just from reading the above, how is punishing hospitals or clinics who re-admit sick patients by paying them less going to provide good care? It's like the insurance programs that dock doctor's pay the more patients they see--and reward them for seeing fewer. Many just see fewer, regardless of whether the patient is better or not. But maybe I am naive and good care isn't the point. Maybe the point is to make a certain portion of the American population including the president feel good that all Americans have insurance, even if patients are left sitting outside the hospital door.

Perhaps I have this wrong, maybe there is more to this "new approach" than I have heard about. Maybe....

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42 Comments:

Blogger HMT said...

From what I understand Dr's get minimal payment from Medicare patients. This creates an economic incentive for them to spend very little time doing a history workup and understanding why the patient is really there. "Head hurts? Here's a handful of Advil samples (maybe something stronger if the pharma rep came today) C-ya!"

Of course the same patient is back in a day or two, with the same or related problem. If the Dr is lucky its a different hospital so not their problem anymore. Most likely it's now an ER visit (much more expensive)

I'm guessing this is an attempt to change the economic drivers for patient interaction; producing overall lower costs. Something that our medical system is in dire need of. I won't comment on how effective this will be as I haven't taken a close look at how its constructed. I do know that one simple change won't fix the economic disincentive Drs have to providing quality day-2-day patient care.

10:49 AM, February 26, 2009  
Blogger TMink said...

I think this is also a first step to letting the elderly die without so much palliative care in the last of their life. It would apply to the chronically ill as well.

They will get less medical care and their death rate will go up.

Next will be the children born with problems. They are very expensive in terms of medical utilization.

I abhor this, but it is coming.

Trey

11:00 AM, February 26, 2009  
Blogger Melissa said...

Maybe hospitals won't be in such a hurry to throw people (old, young, and in-between) out so quickly.

11:22 AM, February 26, 2009  
Blogger yukio ngaby said...

The British have had similar problems in their health care system. When Parliament found out that some people languished in the emergency room for days before seeing a doctor, they passed a law guaranteeing that a doctor would see a patient within X hours of being admitted to the emergency room. The result was some patients not being off-loaded from ambulances and a numbers of walk-ins being refused admittance. Simply instituting a policy does not solve the problem. Macro-management of doctors and health officials has proven to be both foolish and ineffective.

1:26 PM, February 26, 2009  
Blogger Roci said...

...death rate will go up

More than 100%? That IS bad.

1:35 PM, February 26, 2009  
Blogger DADvocate said...

readmissions -- especially for elderly patients -- as a sign of poor care

This is probably a gross overgeneralization. During the last year of his life, my father had fallen and hit his head causing bleeding on his brain. Because one of my sisters is an attorney who is an expert in healthcare related issues and another sister is a social work professor who is also an expert in medical social work, I can guarantee that he got excellent care. But, he was still in and out of hosptitals and rehab facilities at least a half dozen times during his last year.

I have seen pictures of the problem yukio describes. Hospital mortality rates are measured every year by various government agencies. The result is that hospitals often try to discharge to nursing homes patients they think are on the edge of death. When I did admissions for a nursing home this was a big problem. Sometimes the patient would die before they were admitted and they would have to be sent back to the hospital to be "officially" declared of having died there.

We have a pretty durn good healthcare system. Minor tweeks would be helpful but an overhaul would be harmful if not dangerous.

1:48 PM, February 26, 2009  
Blogger pdwalker said...

Remember, all these bright new shiny plans are about rewarding failure.

2:05 PM, February 26, 2009  
Blogger Larry J said...

The words may say one thing but the end result will certainly be reduced care. Government managed health care often starts with good intentions but very quickly puts cost control ahead of health care quality. That's just the nature of the beast.

2:57 PM, February 26, 2009  
Blogger TMink said...

Good one Roci. 8)

Trey

3:43 PM, February 26, 2009  
Blogger nathan said...

I am not rushing to badmouth this at this early state. In fact, the implication is that many patients not properly treated quickly return for further help...and the time set in the article says "within 30 days."

I would be more nearly impressed that the approach is sound or unsound with statistics etc rather than anecdotal remarks.

4:01 PM, February 26, 2009  
Blogger br549 said...

Hey, give those with anecdotal remarks a chance, will ya? They've only been at it since the facts about "the plan" have been leaking out.

4:49 PM, February 26, 2009  
Blogger uncle ken said...

Removing direct patient costs for medical care will drive utilization through the roof. FedGovCo will have to find ways to ration care. In Canada they did it by closing hospitals, and capping how much each MD could earn. Good luck if you get sick in December. In the UK, always more Orwellian, such niceties as repairs of fractured hips are denied past a certain age, whne the patient is no longer considered of use to society.

If you enjoy going to the Post Office, and riding Amtrak you're in for a real treat next time you try to visit the doctor.

5:03 PM, February 26, 2009  
Blogger max's skunk works said...

Keep in mind that reducing the length of hospitalization has been a longstanding goal of medicare/aid policies. This has been enforced through the structure of payments and other 'incentives'. And the effect has been salutary in many cases by motivating innovations in surgical techniques and technologies, and also a better quality and variety of outpatient services. But it's also likely that a significant portion of readmissions would not have occurred if these patients had been able to stay in-hospital longer.

I can't comment on this new policy, without having read the specifics. But if it doesn't provide fees that accommodate longer hospitalization where necessary, then I fear that it will constitute a perverse incentive to neglect patients.

5:18 PM, February 26, 2009  
Blogger Ronald said...

One of the beautiful things that medicare does is their readmission for certain core measures. If you are admitted for say, congestive heart failure, are successfully treated and discharged and come back for readmission in 30 days, the government stiffs the hospital for the entire second stay, regardless of the quality of care. Doesn't really give the hospital much incentive to successfully treat the patient.

6:04 PM, February 26, 2009  
Blogger TMink said...

nathan wrote: "I would be more nearly impressed that the approach is sound or unsound with statistics etc rather than anecdotal remarks."

Nathan, my take on you is that you are an appologist for president Obama and are not open to critical thought concerning him. I do not think I am the only one who has formed this impression and sees you as someone who lacks an open mind. You could ask here if you wished to see if I was wrong. 8)

Trey

6:40 PM, February 26, 2009  
Blogger J. Bowen said...

For example, experts have identified hospital readmissions -- especially for elderly patients -- as a sign of poor care and unnecessary expense.

I wonder how those so-called experts determine what is and is not poor care or unnecessary. For instance, my grandmother, during her last two years, was in and out of hospitals for various reasons. Almost every instance was a result of her underlying condition for which there was no cure. The doctors alleviated her pain, but eventually she was back in the hospital for a new problem or for the same, albeit intensified, problem. The care that she received wasn't poor-quality or unnecessary, but it was expensive (had she not had secondary insurance to the tune of +$6000 she would have been bankrupted). At least she died before the government could screw up the system any more than it already has.

9:40 PM, February 26, 2009  
Blogger uncle ken said...

"I wonder how those so-called experts determine what is and is not poor care or unnecessary. For instance, my grandmother..."

Well there is the crux of the dilemma. The faceless remote bureaucracy is simply not capable of determining, years in advance and thousands of miles away, what medical care is or was in the best interests of your grandmother.

Central economic control does not work, as the USSR found out. Apparently this will not stop the ideological zealots of the collectivist cadres now controlling our country from applying the same failed principles to medical care.

3:42 AM, February 27, 2009  
Blogger JG said...

Here is one of the major problems of the US medical system:

In continental Europe, physicians are paid quite a bit more than other highly educated professionals. They are only regarded as demi-Gods.

In the United States, most people (for whatever reason) regard physicians as Gods. They are also paid like that. The only problem is that they are not Gods, not demi-Gods and, if you consider that the incidence of real malpractice is probably at a very, very high multiple of the actual number of malpractice suits that are brought, not even necessarily competent professionals.

Why not just pay them like demi-Gods instead of Gods?

Now if you add the salaries of the hordes of "administrators" in health care plans and the like to the outrageously ballooned salaries of physicians, you come to a good chunk of change.

And that's a major reason why health care insurance costs $600 per month for a guy in his 40s in the United States, but health insurance plus dental plus nursing care insurance only costs around EUR 200 per month in Germany.

As a side note, a different system should be introduced that uncovers medical malpractice to a greater degree - people aren't aware of the extent to which it occurs and the degree to which it is covered up. A physician who is actually making people worse, and who is pulling down huge sums of money in the process, is beyond disgusting for me. The system has to change.

4:25 AM, February 27, 2009  
Blogger uncle ken said...

"Why not just pay them like demi-Gods instead of Gods?"

Oh why not! Let's have some committee determine what everyone is worth while we are at it. Should a haircutter be paid $50 or $14, are nails worth more than hair? Why should my grocery checker get less than the quarterback of the Dallas Cowboys? Would you play offensive line on the Steelers for $20 an hour? Me neither. Would you go to Medical School for 13 years after high school, emerging broke and exhausted at 30, having sacrificed the sweet days of youth just to be a doctor, just so some #$%^&*( clerk in DC could tell you what you were worth? Nobody else worth a crap will either. You will still have doctors, but anyone with any brains will be doing hair and nails - so much easier for the same money.

Having destroyed education (ask any recent graduate to spell "cat" without spotting them the 'c' and the 'a') and pretty much eliminated stable family life in African-American society FedGovCo now turns it's attention to medical care. Stop the Merry-Go-Round, I want off.

4:51 AM, February 27, 2009  
Blogger JG said...

Uncle Ken:

I'm talking about more of an attitude adjustment than a committee deciding who is worth what (for the record: I also find the latter to be disgusting).

Ya know, in one year some girl warbeling out a song is worth $100 million, the next year that same girl warbeling out the same kind of song is worth nothing (fashion / trends). In one year the Hula-Hoop has record sales, in another year no one wants it. GM and bank executives are paid millions and millions every year to do exactly what a five-year-old girl could do: Bankrupt the company.

My point is that in continental Europe, people (in my opinion) have a more realistic view of physicians.

And please don't go on with the "... exhausted at 30" crap. Others here may also have some schooling, they just don't wear it on their sleeve (like you).

6:01 AM, February 27, 2009  
Blogger JG said...

"... having sacrificed the sweet days of youth just to be a doctor ..."

------

Oh ... my ... gosh. Actually, being in school is a lot more fun than working. The guy who sacrificed the sweet days of youth is the guy who started at a company at age 20 and worked his way up with 10-12 hour days to being a company officer in his 40s. Not people like us, who twittered around and had a good time in school.

Time for the violins.

6:04 AM, February 27, 2009  
Blogger JG said...

And while I'm at it:

The information I have seen suggests that a collaborative approach to patient care produces far better results than an authoritative approach.

I think this should be explained to people (potential patients) so they realize that putting up with a gas-bag, massive ego physician is not in their best interests. Collaborative physicians are actually BETTER physicians.

That's another angle to this God / Demi-God thing that I'm trying to get across.

6:19 AM, February 27, 2009  
Blogger Trust said...

Here's a frightening documentary for you...

Imagine the media reaction if that clip was published when George W. Bush was president.

8:13 AM, February 27, 2009  
Blogger Dr, Ellen said...

We interrupt this rant to ask a question. How come I get a "clickjacking attempt" every time I use a cursor key on these comments, instead of the mouse and the scroll bars? (I'm using Firefox with NoScript.)/question

As for the new medical rules, simply remember. Who do the dead vote for, then?

9:11 AM, February 27, 2009  
Blogger johnbono said...

Ugh, what a lousy idea. The reason why people, especially elderly are readmitted is because they, you know, are sick(as evidenced by the first admission). And being elderly or chronically ill(cancer), recovery is longer and can involve return visits because of the ups/downs of recovery. This plan would punish cardiac, oncology, and other specialties that deal with the gravely ill. "Sorry, but we can't allow Bone Marrow recipients back into the hospital until their 32 day break-in period is complete."

A perfect example of the health care system run by the same folks who gave us the Department of Motor Vehicles.

12:25 PM, February 27, 2009  
Blogger Melissa said...

JG said: "Oh ... my ... gosh. Actually, being in school is a lot more fun than working."

No, being in school when you don't learn anything useful and or actually have to compete is a lot more fun than working. Getting a liberal arts degree is a blast.

Going to medical school (or law school, or engineering school), and making sure that you acheive the way you need to, putting in hours of studies every night, is HARD WORK.

3:09 PM, February 27, 2009  
Blogger JohnAnnArbor said...

My grandfather worked in accounting. He noted something interesting during his hospital stays. On weekends, several doctors would visit, ask a few questions, then leave. He'd never seen them before, and never did again afterwards. Curious, he looked at his hospital bill. The doctors were getting "consulting" fees, charged to Medicare of course. That the system allows such obvious fraud is one reason it's so outrageously expensive. That there's no energy spent on rooting out the fraud is disgusting.

3:54 PM, February 27, 2009  
Blogger JG said...

This comment has been removed by the author.

5:37 PM, February 27, 2009  
Blogger br549 said...

My life has been prolonged, saved, by three separate and incredible surgeons. They all are specialists in their fields of endeavor, and I was lucky to have them. But....I can vouch for the for the doctors out of nowhere waltzing in for a couple minutes and getting consulting fees - that my insurance would not pay for. So they have billed me directly. However, I won't pay the bills either.

My daughter is in her 7th year at university pursuing a PhD in bio-chemistry and bio engineering. She works her ass off. She works around the clock, around the calendar.

I suppose any of the above individuals could have quit school in 8th grade and sponged off their parents a few years until they got a union job dropping batteries in cars on an assembly line for 80 K a year.

6:35 AM, February 28, 2009  
Blogger Sissy Willis said...

Democrat "compassion" was never about the have-nots, however defined. It's always been all about 'feeling good about themselves:

Part of my leftism was a sales pitch

5:17 PM, February 28, 2009  
Blogger FrederickJohnson said...

What you all need to get Big Insurance and Big Pharma to butt out is SINGLE PAYER HEALTHCARE. No more bureaucratic red tape and no, it's not "socialized" medicine before you people get it wrong. Get your butts off the couch and push for HR 676 or quit complaining.

7:22 PM, February 28, 2009  
Blogger Joe said...

How is single payer healthcare not socialized medicine? All health insurance companies have limits in their policies, so would a single payer system and since that single payer is the government it is, by definition, socialized medicine.

As for "no more bureaucratic red tape", are you out of your fucking mind? You have never seen red tape until you've experienced single payer healthcare. The difference is that now you have recourse. You can sue or just be a pain in the ass. With the government being your insurance, you won't get anywhere and if some bureaucrat messes up and, say, your child dies because they didn't receive an established life saving procedure, you won't be able to sue. In the long run, the only question will be: where do we Americans now go to get quality health care because it sure as hell won't be in the US.

1:14 PM, March 01, 2009  
Blogger FrederickJohnson said...

LOL ! Joe, you say you want tort reform on the one hand and then you say you don't. You can't sue government the way you can sue the corporations so single payer is actually the real road to tort reform. There's already plenty of bureaucratic red tape with corporatized care. With single payer healthcare, all those trial lawyers and sleazy insurance companies won't be choking the patients or doctors. Ole' Dubya forgot to realize that if he wanted tort reform, he should have pushed for HR 676. Besides, you people who preach "personal responsibility" are ditching it by going against single payer healthcare and that alone gives me a lot of laughs at you suckers. LOL !

2:51 PM, March 01, 2009  
Blogger Cham said...

For those of you interested in the abuse of the healthcare system, here is an interesting article about doctors and the usage of scans.

8:51 AM, March 02, 2009  
Blogger Greg Toombs said...

In the next 30 years (or in other words, near the end of an optimistic life expectancy for me) we can expect to hear: 'Sorry. time's up. We're over our budget, too bad, so sad.'

Of course there won't be any alternatives since they will be deemed selfish and unnecessary.

Not that death is a great gig, anyway, but you'll be hearing it from your government as they snap the checkbook shut - as already happens in Canada, the UK and France.

The government will also control the statistics and any information about healthcare effectiveness.

But the bureacracy will have some very nice pensions and special healthcare set-asides of their own.

So we have that going for us. Which is nice.

12:39 PM, March 02, 2009  
Blogger JG said...

Greg Toombs:

I think, unfortunately, that you're right.

But here's something else to think about: The government can take unlimited amounts of YOUR money away from you without firing a shot (for you tax evaders out there). How? Via inflation and running a money press.

If the government wanted to, it could pay for anything it wants by drastically increasing the money supply.

Inflation will take away your money just as surely as taxes. It doesn't matter if the government takes half your money in the form of taxes, or it drives inflation up to the point where your money is exactly equal to that post-tax amount.

5:01 PM, March 02, 2009  
Blogger JG said...

Anyone who was *sentient* under the presidency of Jimmy Carter will probably understand what I mean.

5:07 PM, March 02, 2009  
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9:00 AM, May 05, 2009  
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4:07 AM, June 08, 2009  

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