Home Forums Hunting & Shooting Hunter's Campfire THIS is how Death Panels will REALLY come to be...

A thread started by eyeball this morning, based on the news story that the Feds are going to start fining hospitals for patients that are readmitted within 30 days of discharge. This scheme of fines may well be the straw that breaks the camel's back of Medicare, and healthcare in general. This news is far worse than it appears on the surface.

I was reading about this last week in the trade papers, and have been discussing it with other docs and healthcare folks. This is a Medicare ruling, primarily, but it will affect all hospital patients.

The Feds are claiming that this will improve post-admission outcomes. What they ignore is that, as eyeball says, the Feds are already forcing hospitals to discharge patients sooner by denying payment for patient stays if the Medicare account managers say the length of stay was "unnecessary". And believe me, like the IRS, Federal Medicare/Medicaid bean-counters can always find ways and means of denying claims. Doctors are no longer allowed to make the decision as to when a patient can go home; even if your clinical judgment says a patient needs 2-3 more days of inpatient care, if you don't follow the Medicare rules and discharge today, you and the hospital will be denied ALL payment for the entire stay.

So you send the patient home, and he gets sick again. Let's say his first admission was for pneumonia. But he was weak because he went home sooner than you wanted him to, and he fell down a week after discharge and broke his hip. NOW Medicare is going fine the hospital! Between the length-of-stay restrictions and the new fines, hospitals are getting caught like a base runner in the hot box between 3rd and Home.

What the Feds and the hospitals aren't talking about is what these moves are going to do to hospital care access for ALL Americans.

Here's the deal: about 1/3 of hospitals in America (probably more, but that's the number mostly agreed upon) are too remote, too small, located in economically poor areas, or too something-or-other to make it on their own with the fees they charge their patients. The reasons for that are varied, but let's just simplify it and say that the costs of running a hospital continue to escalate (along with the number and complexity of Federal regulations!!!) every year, but reimbursement hasn't been keeping up. These hospitals are staying afloat only because they have access to govt funds as Critical Access hospitals, or through other grant programs.

Here's the Catch-22: hospitals can only get these funds if they accept Medicare and Medicaid patients.

Now, take these small and relatively inefficient hospitals (which are critical to their mostly rural constituents) and now start squeezing them on both ends of the Medicare/Medicaid fee scale. The Feds (and States, too, in the case of Medicaid) reduce payments on the one hand, and tack on new fines and sundry "fees" on the other.

As the Medicare crisis deepens through idiot plans like this readmission rule, hospitals will no longer be able to stay in the hot box. Declining revenues plus fines will make it impossible to meet Federal benchmarks, and they'll lose their Critical Access funding. Bankruptcy will follow swiftly and surely. Most American hospitals are not-for-profit and operate on margins of less than 3%. It won't take much of a hit from the Feds to turn that margin into a loss.

If that happened in my town, for example, folks would have to drive 70 miles farther to the nearest ER/hospital. For people west of us, that could mean having to drive 150 miles to the nearest hospital. I know of places more remote than this where closure of the local hospital would be even more of a problem. But all of these small hospitals are currently endangered species, and it's gonna get worse as Obamacare's hidden provisions start to take effect in the near future.

I am certain that this is what the Feds want to happen. They can close 35-40% of America's hospitals in the next 4 years without doing anything overt, giving them plausible deniability. This will allow them to "cut costs" and make Medicare look like less of a burden on the taxpayer.

In the same stroke, they'll increase the burden of Medicare/Medicaid patients on the remaining hospitals, which will increase wait times and decrease timely access to services. Inevitably, people are going to die. People are going to get a lot sicker before they can access the care they need. And best of all, from the Obamocrats' perspective, it will all be the fault of the hospitals for not managing their money wisely.

Death Panels?? They won't need no steenkeen Death Panels!! The shrinking healthcare economy is going to be the Great Death Panel of them all, and this move by the Feds is just gasoline being tossed on smouldering coals.

Anyone remember a few months ago where the UN scientists were sayingvwe need to kill a third of the worlds population to make the earth sustainable. Can we put two and two together?

How will this effect those of us with supplemental insurance to our Medicare?

DD, read it again... if this measure closes 30% of America's hospitals--hell, if it even closes 15% OF them--it's going to affect EVERYBODY...

Hey doc. You forgot to mention the section that forbids hospitals from expanding.

gitem...

Hell, if I put in EVERYthing they've got in store for us that we know about--never mind all the stuff that's not even on the horizon yet--I'd use up all of RickBin's bandwidth and totally destroy the joy here on the 'Fire!!!

So it doesn't matter if we have insurance or not there won't be any hospitals to go to. In other words, our health care is going back to the early 1900's maybe even back to the 1800's.

Our government seems woefully ignorant of economics. I doubt that they could have intelligently put together such a devious plan. But the effect is the same.

In the end the market always wins. Governments fight that principle in vain. It may take a long time, but the market does eventually win. Governments that think they are smarter, or stronger, or have more staying power than the market always lose in the end, but they never seem to learn from it.

May heaven help Mr. Romney in November.

This may sound like I am in left field or have lost it. But what if theybreally are tryingvto limit the amount of health workers available IF there is an armed revolt to take back our country. I'm not proposing a conspiracy here . I just don't trust Obama.

Sounds like Doctors need to take a pay cut. If we grow the healthcare economy any more half of America will be playing doctor on the other half.

Do... That's another thing. Under obamacare all doctos will be paid the same no matter whether you are a family physician or a Neuro surgeon.

Tell me about it!!!

I fled the collapse of the Canadian healthcare system almost 20 years ago, which was brought on almost entirely by government mismanagement and stupid laws. First, the Federal government outlawed private healthcare with their Canada Health Act in the late 80's, which put an intolerable squeeze on the system; then they reduced the size and number of Canadian medical schools based on the Barer-Stoddard Report, a bureaucratic White Paper that pronounced that the way to reduce health care costs was to reduce the number of doctors practicing medicine.

The result of these and other Canadian healthcare fiascos from Ottawa is that Canadians endure significantly more difficult access to healthcare for elective procedures such as joint replacements and gall bladder surgeries, and their system has no capacitance to deal with true emergencies such as epidemics. (This was really evident in the last big flu epidemic about 8 years ago, where people were dying in their cars in the ER driveway in Calgary and Edmonton because there was literally no floor space in the hospitals for people to lie on. It didn't make the papers, but I was there and saw it with my own eyes.)

Governments have an Animal Farm mentality when it comes to economics: four legs good, two legs bad. It has to be literally that stupid for bureaucracies to grasp any concept and apply it.

Um, I think you might be misinformed there... that might be a goal of the Obamacrats, but I haven't read anything about it.

Yet.

It's not doctors' fees that are driving the cost of healthcare. And doctors have been swallowing cuts in reimbursement for years, for your information. Since most doctors and clinics are not government offices, we find ways to cut costs, boost production, etc, to maintain a reasonable income.

It's government regulations, the hostile medicolegal environment, and bureaucracy that make up the bulk of our healthcare costs. Doctors were far wealthier in the 1960's than they are now, and the inflation-adjusted costs of the healthcare system were a fraction of what they are now. The things that have changed since then all rest squarely in the hands of government: medicare, medicaid, and "managed care".

Don't get me started on "managed care". This is nothing more than a swindle that allows insurance companies (and Medicare and Medicaid) to regulate themselves at the expense of doctors and hospitals, and take a second bite (and a third, and a fourth) out of each healthcare apple.

But don't worry, doctors will swallow the bitter pill, because that's what we do. But don't count on seeing a doctor so easily 5 years from now. Many of us are planning to retire, quit, shift into less stressful jobs, and so forth. In 10 years you won't be able to see a MD or DO until you've been screened by a nurse practitioner or physician assistant.

Doc, great post...very spot on...pretty soon your healthcare will be determined by the social worker who flips open her Govt issued ICD tome ( volume that deems what medicare will pay for ) its about 4 inches thick and contains what constitutes acceptable admission critera- have a case worker over my shoulder every day constantly telling me we cant admit pt X, they dont meet criteria- in the past and to a certain extent now we just put the individual in the hospital when we deem necessary- the screws are tightening though and its getting harder to do what you feel medically necessary when it does not jive with the "book"... its going to get ugly

Yesterday i went to a seminar held by a lady that basically owns a firm specializing in supplement/atvantage medicare plans. This was an information type seminar given what i do for a living.
Also topical because my wife in on medicare, and i go there in december.
There were directions given, opinion only, by the person holding the seminar as to the direction of medicare over the next five years. I am happy that my wife had her surgery last week, rather than carrying it forward.
Some thoughts gathered:
One, atvantage plans rather than being on the way out are gaining strength. Low monthly cost, but in total because of the yearly max copay about the same costwise on someone living to 85 to the "f" plan supplement, which over 40% of people have. The "f" plan is the one under attack. The government figures because of the low personal cost of copay, too many people are repeatedly going to the doctor. The solution is to raise the copay requirement. That puts the camel's nose under the tent.
Then you can start raising the copay. Average cost is about 150 a month for the F plan, one guy in attendence was paying double that because he is already means tested. Translated you make more than say a certain amount per year, you have a bigger premium. That can really be expanded.
two
most likely raising the age to 67 to get medicare.
Three a one percent increase in the medicare premium withheld from W2 income, half point increase to employer, half point increase to employee.
This is without getting into the area of medicare reembursement to a health care professional.
My personal quack gave up private practice about a year ago due to the coming computerization and cost of same, and reembursement. He went to work for a health care chain. Office visits use to be around 90bucks, they are now 190 bucks if you don't have insurance, medicare, or are part of the atvantage plan including the health care chain. They, the government, in my opinion, are going to nickel and dime it to death.
A lot of people don't realize it, but part A of medicare everybody gets, you pay from social security deduction about 100bucks a month for part B, but that is a optional program, same as part D for drugs. There are govt programs that will assist in paying that B if you meet certain guidelines, like you are broke. As to A, if you have to go to the hospital and don't have the supplements to cover copays, each trip is 1056 bucks if i remember right you are responsible for. Unless you are an illegal alien, where everything is okay. Now how is the hospital going to collect that 1056 bucks?
We are friggin doomed. I had one client that needed a hip replacement this year, and got it with the doctor of her choice.
the doctor told her she was lucky to schedule it when she did, as 30 days later he could not afford to continue taking medicare reassignment, and was going to refuse to treat in that situation.

One thing also i didn't know, is there are special programs for people like me, which description fits 2/3rds of older people, that is, two preexisting health conditions. In my case that is diabetes/hypertension. They have "special" health care plans for people like me where a "case manager" is assigned. Makes me feel real good about that "case manager". Screw them.
Luckily for those of us living along the border, we have access to prescription drugs in a lot of cases in mexico, where the cost of those medications is about 30 to 40% less than the stuff here.
What nobody wants to talk about is you can't continue to expand these programs for everyone, where everyone isn't paying into the system and expect it to work, it isn't. You go into any hospital in arizona, and you see the illegal presence. I am sure they are paying for that service.

That is so much crock:
YOU spent all those years in school, YOU incur a 500k debt to get the degrees and licences, YOU go into debt to start a practice(very expensive, even in the 70's when i was making medical loans to doctors to set up practice), YOU deal with the malpractice insurance, YOU deal with the limited reembursement from wherever for a office visit by a patient, YOU deal with the hours, and then tell me they are overpaid.
My wife's surgery was done last week partially because we wanted someone qualified, had done a LOT of those type of surgeries, and wasn't practicing AT medicine to do it. A GOOD doctor deserves every penney.

Doctors spend a huge amount of time, energy, and money getting ready to practice medicine, and then they have to spend their whole work day with sick people. The market says that to have an adequate supply of physicians, the profession has to pay well. Trying to regulate the market into submission is a fool's errand.

But if you want cheaper health care, the path ahead is more physicians, not fewer. As supply increases, prices decline. Commanding the market to give us more at lower prices with fewer incentives for suppliers is ignorance in action, and doomed to failure.

As this plays out, I'm glad that my son is licensed to practice. He's a real handy kid to have around sometimes. In a pinch, I can get primary care there.

doc:
a few years ago i was being seen by a mayo trained doctor, he was getting out of practice then having seen what was coming, he bought a hotel, believe it or not.

You've heard the story of the guy who calls a plumber, who fixes his problem in about half an hour, and gives the guy a bill for $200? The guy is aghast, and says, "My doctor doesn't charge that much for half an hour!" The plumber replies, "Yeah, I know. I used to be a doctor."