Dêáth Panel??

[b2r]

Medicare Plan for Payments Irks Hospitals

WASHINGTON — For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive.

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

Medicare will begin computing performance scores in July, for monetary rewards and penalties that start in October 2012.

www.google.com/url?sa=t&source=web&cd=3&ved=0CDIQFjAC&url=http%3A%2F%2Fwww.nytimes.com%2F2011%2F05%2F31%2Fhealth%2Fpolicy%2F31hospital.html&ei=VvvkTc2yM_LdiAK36KzpCQ&usg=AFQjCNHKJVVBlUH7I9RHq57bidx9ixhysw

[Bluerobin]

Bout time they held hospitals accountable! No, I don't worry about death panels. I have a DNR.

[floridayankee]

May 31, 2011 9:52:54 GMT -5 Bluerobin said:

Bout time they held hospitals accountable! No, I don't worry about death panels. I have a DNR.

I have no problem holding anybody accountable for their actions. But, other than a case of negligence, I don't really think a hospital should be held accountable for the patient's care (or lack thereof) for a full 90 days after they leave the hospital though. Take the example they used in the article:

If, for example, an 83-year-old woman is admitted to a hospital with a broken hip, she might have hip replacement surgery and then be released to a nursing home or a rehabilitation hospital. When she recovers, she might return to her own home, but still visit doctors and physical therapists or receive care from a home health agency. If she develops a serious infection, she might go back to the hospital within 90 days.

[.....assuming they're talking about a serious infection related to the hip surgery and not something unrelated like a hang nail]
Nearly everything medical comes with risks, warnings and/or side effects. If the infection in the above example was caused by, say, some foreign material being left behind by the Dr. during surgery, sure, hold them responsible. But, if the infection occurs because this lady did not properly clean and dress the wound, why should the hospital be held accountable? Even if the surgery went perfect and post op care was perfect, the chance of infection still exists. Shit happens....there is no way to assign accountability every time, all the time, IMHO.

[Bluerobin]

You get warranties on cars and repairs. Why not on health care? Either it is competent or it isn't. Are you afraid the hospitals can't measure up?

[ugonow]

My wife worked in the workers comp side of a large insurance company.They had lists of doctors they were supposed to avoid because of their risk and cost record. I would imagine that is kind of what they are trying to achieve.

[ugonow]

And for the record, the insurance industy prefer to use the term utilization management instead of the term death panels.....

[floridayankee]

May 31, 2011 10:14:07 GMT -5 Bluerobin said:

You get warranties on cars and repairs. Why not on health care? Either it is competent or it isn't. Are you afraid the hospitals can't measure up?

Not at all. I said I have no problem with accountability for something that one should be held accountable for.

But playing off your auto repair warranty....if a mechanic puts in a new radiator and you go and fill it with salt water, do you think he'll honor that warranty when your engine blows? If you have a new transition installed and go the clutch at every stoplight, do you think the mechanic will honor the warranty?

Competency of the hospital has absolutely nothing to do with them if the patient is irresponsible once they leave.

[Bluerobin]

FY, they will work it out. If you have a broken leg and die from a gunshot wound, it should not count.

[EVT1]

Hospitals are worried about losing money because they will have to be proactive in reducing costs, not the norm of billing Medicare at will for everything under the sun. Statistics can take other factors into account and show who is doing what. Why not give it a shot?

[Deleted]

Of course there will be death panels, call it whatever you want. I don't go to MDs, so no one can worry about treating or not treating me. BUT, since I am not productive and paying taxes right now, not sure how much luck I will have getting a new job when I get well due to the economy and my age and the lack of "importance" of the jobs I have worked my butt off doing my entire life-- I'm pretty sure they will just let me die if I get cancer or something. What a way to go, after a life of raising productive children, doing my share for the USA, etc.
Now, my sister-in-law-- same job for many, many years. Has good benies. Last 6 months she has had chemo, is now going through radiation, and is getting a bone marrow transplant in July---- because she has good PRIVATE insurance. If SHE dies it won't be through lack of trying, or someone deciding she has exceeded her future potential vs. cost for treatment. Just think how wonderful and socially just it will be when EVERYBODY gets equal treatment and even people like my sister-in-law are allowed to just die, because everybody will have the same crappy insurance if the "single payer" crowd gets their way. My- how efficient it will be. (Until YOU are the one getting the same treatment as a cab driver like me, then we'll see how you like it all..)

[ugonow]

Krickitt, my wife has been going through that for the last 2 years. We have good insurance through my ex employer and I feel blessed to have it. We still have a stack of medical bills and are inching towards our lifetime max. They are getting picky on what they will pay and will deny anything they can...and I really can't blame them.The costs are absurd. But like I said,I am very grateful to have it.

[Deleted]

ugo-- best wishes to your family, and to all of us as we inch closer and closer to--- God only knows what is coming.

[ugonow]

If SHE dies it won't be through lack of trying, or someone deciding she has exceeded her future potential vs. cost for treatment.

There is a point where insurance will not pay for anymore treatments, only quality of life or hospice costs.Many of the best new treatments are not being covered yet,as they are considered too new. If you care to google, there are tons of cases on record of patients dying because of lack of treatment as insurance companies haggled. Cat scans have been proven to be the most effective screen for lung cancer,but insurance companies will not pay for them as a screen because it is more cost effective numbers wise to treat cancer. Ask to have a chest xray to see if your lungs are ok,and you can not get it.You have to have a problem first. It is a numbers game.

[Colleenz]

are inching towards our lifetime max

I thouight lifetime max did not exist anymore

[ugonow]

thouight lifetime max did not exist anymore

I will believe it when I see it.In the plan summery we recieved in January,it included a lifetime max.

[handyman2]

The emphasis has been in the past to get patients out of the hospital sooner. History has shown that it saves money and people seem to fell better at home. However the hospital and doctor advise the patient that has surgery to follow certain procedures so as not to create complications. However far to few do not adhere to those instructions. They start to feel better and do not protect and incision properly or do things they should not until released by the doctor. I can tell you what will happen if they enforce this rule. The hospitals to protect themselves will keep the patient longer which in turn drive up the cost to the insurance co or patient.
Remember when a hospital would keep a mother and baby in the hospital for a week? Well if this rule is enforced you will see that again in my opinion.

[ugonow]

Valid point. But there are doctors and hospitals that for one reason or another run into more complications resulting from their treatments than others.

[Deleted]

Which is stupid, and yes, costs will go through the roof. Look at ME. I broke my pelvis and my elbow and a rib or 2, have had NO treatment except an ER trip when I got injured, and I'm doing fine. They WANTED to send me to a rehab from the hospital, but didn't because I have no insurance. Do the math on that. I guess if I had had Obamacare the hospital would have sent me straight to rehab to cover their butts, according to what we are talking about here. Since I am a gap person above welfare, but below affording fancy insurance, I would get the free Obamacare, I am sure. I might STILL be in rehab if I had Obamacare right now, and I have recovered fine in my own bed with my own family taking care of me. Do the math. This is going to wipe this country out-- or they are just going to let people die. There is no utopia where everybody can have everything and live this blissful life. I can't believe more of you with private insurance aren't scared to death of what is coming at us.

[ugonow]

Every case is different. My wife trys her best to stay out of hospitals, but seems to go in for 2 week stays every few months.Last time she waited too long and would not go until her lungs were filled with fluid, and had to be put on a resperator in Intensive care for 3 days..

[Deleted]

That sounds horrible, ugo. Does she have cancer or something? God, good luck. My brother has been through the wringer this last year with his wife's cancer. It is actually fortunate he got laid off last year because she is basically an invalid right now, and he is her caretaker. We're just hoping the bone marrow transplant works, because it is the end of the road if it doesn't.
(Off topic, sorry.)

[ugonow]

Yup.lung.My prayers go out to your brother and his wife.It is a hard voyage.

[Deleted]

lung.. Good luck. Is she getting treatment still?
Is your insurance lifetime max for both of you, or is hers coming close, but you still have yours? I haven't had insurance for about 8 years, and never had a crisis, just kid stuff, etc. Can't remember.

[Politically_Incorrect12]

Sounds like the government is trying to cut down on cost by charging hospitals...90 days seems a bit long IMO. I've seen too many people who leave, don't take care of themselves like they should and end up back in the hospital. I guess this is a great way for the government to "tweak" the numbers to say the cost of Medicare is lower than it actually is...

[ugonow]

No, no treatments right now, just a lot of reoccuring complications from both the disease and treatments.It is a per person max. I think she could probably go on some socialist type of healthcare if she loses mine.I doubt we could find anyone else to insure her.

[Politically_Incorrect12]

May 31, 2011 12:31:12 GMT -5 Colleenz said:

are inching towards our lifetime max

I thouight lifetime max did not exist anymore

Lifetime max isn't supposed to exist for insurance companies...for the government it's another story. There isn't a lifetime max so to speak, they'll keep paying as long as they approve it. All the talk about evil insurance companies denying claims was just a bunch of BS by those on the left that know that government will have to do the same thing to control cost.

[ugonow]

I guess this is a great way for the government to "tweak" the numbers to say the cost of Medicare is lower than it actually is...

Or it could be something as simple as some providers have a better record than others. A bad doctor can run up costs signifigantly.

[Politically_Incorrect12]

May 31, 2011 12:43:19 GMT -5 ugonow said:

Valid point. But there are doctors and hospitals that for one reason or another run into more complications resulting from their treatments than others.

And this is a great way to really make hospitals not want to take on high risk patients who most likely already have an issue with finding help as it is now. Next the war cry will be something like "evil hospitals won't help these patients because of money, we need the government to take control so these people can get care."

[Politically_Incorrect12]

May 31, 2011 13:27:44 GMT -5 ugonow said:

I guess this is a great way for the government to "tweak" the numbers to say the cost of Medicare is lower than it actually is...

Or it could be something as simple as some providers have a better record than others. A bad doctor can run up costs signifigantly.

The government has always dictated what it will and won't pay when it comes to hospital and doctor visits, they are just now decreasing the size of the net they will cover (thus reducing cost and putting more liability on the hospitals who will likely start being a little more picky with some of the pt. care they choose to provide).

[ugonow]

All the talk about evil insurance companies denying claims was just a bunch of BS by those on the left that know that government will have to do the same thing to control cost.

Nope, no bs. Insurance will not pay for anything not covered by your particular plan.Neither will the government. But this does not mean they dictate what treatments you may have. It dictates what treatments they will pay for.

[Deleted]

But-- if private insurance runs out, like you say, ugo, she CAN, at THIS time, still get treatment through the state plan. Hopefully. I used to have faith that things would be okay if I ever got sick, but with Obamacare I just don't believe it any more. There will be way too many people ABUSING it, just like people now abuse medicaid, and the ERs. Especially since Obama is gung ho about legalizing the illegals. Not that they don't already use our medical.... if people think insurance companies are bad now-- how can you believe things will be better with millions more on free medical? It's a myth that tons of money will be brought in to pay for it by uninsured people. SOME, maybe, but the majority that don't have insurance now can't AFFORD insurance, and will get it free or VERY cheap on Obamacare. Costs are going to go through the roof. Which is why I don't understand why people don't believe there will be death panels-- call it what you want.