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The left has two ideas to overcome the adverse selection death spiral and create self-sustaining exchanges. Reinhardt's suggestion is to embrace the Swiss model, which involves imposing very stiff penalties on insurance scofflaws and then enforcing them harshly by garnishing wages. The other idea is creating a public option or a non-profit government-run insurance plan that would compete with the private underwriters on the exchanges and bring down prices.
These ideas are draconian. They are also politically unfeasible —
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ObamaCare tried to remake a sector that constitutes one-eighth of the economy from the ground up. But it made a mess that it just doesn't know how to fix. That will be President Obama's legacy. He should be worried. Very worried
ObamaCare tried to remake a sector that constitutes one-eighth of the economy from the ground up. But it made a mess that it just doesn't know how to fix. That will be President Obama's legacy. He should be worried. Very worried
Anyone who thinks the fully insured individual insurance market constitutes "one-eighth of the economy" doesn't know anything about American health care.
Exchanges and everything you hear about them are a drop in a much larger bucket. That's part of the problem they've run into.
Obamacare changed a lot more about how healthcare is delivered and funded than just what those on the exchanges see.
Indeed, and the parts affecting the actual financing and delivery of health care aren't "failing." They're driving practice change, quality improvement, and cost containment.
This article is just hand-wringing about exchange enrollment.
The millions of Americans who didn't lose health care insurance due to pre existing conditions probably have a different take on the success or failure of Obamacare.Shikha Dalmia is a senior policy analyst at Reason Foundation, a nonprofit think tank advancing free minds and free markets
Why ObamaCare failed
The one thing THE PROFESSOR did, what he was doing when he should have been working on the economy, is a disaster that made the real healthcare problems worse, problems which Obama has never indicated that he ever understood. Obama made an even bigger crisis than we started with at a time when our plate is overloaded with major problems which need solutions pronto because they have been long ignored.
What a mess for the DC ELITE, both the R and the D divisions, a job they are clearly not up to accomplishing.
And still these clowns still cant figure out why Trump is here!
I do believe that this act has bout worn out the welcome.
:stooges
Except that practice change is for more patients in less time. Lower quality of care..
Indeed, and the parts affecting the actual financing and delivery of health care aren't "failing." They're driving practice change, quality improvement, and cost containment.
This article is just hand-wringing about exchange enrollment.
No, it isn't. When you convert a practice to an advanced primary care model, (1) expanded access is part of the deal, and (2) part of the payment is decoupled from x-minute interval FFS billing. And another part of that payment is linked to quality performance.
Yes it is. That expanded access means more patients. and when you decouple from "x minute interval FFS billing", it means that you are not getting paid for your time.
And quality performance measures are only as good as their validity. And there is little validity in most of today's quality measures.
Expanded access means more hours and personnel for the patients you have. It's a necessary feature of any advanced primary care model.
Decoupling revenue from the FFS treadmill you're decrying is exactly what PCPs have asked for and it's what's starting to happen. It's absurd to say PCPs aren't being paid for their time when even Medicare (along with many private payers and even Medicaid programs) now pays for non-face-to-face care management services that previously went unpaid because they didn't fit into the 15-30 minute in-person visit billing paradigm.
Ah, yes. Quality is going down, except by any metric one could use to measure it.
Why try and measure quality when you can instead listen to the bold pronouncements of low-performers who just know everyone's quality is declining except their own?
Expanded access means more patients..
THE WAY.. that revenue has been decoupled from the FFS treadmill means that providers are not getting paid for their time. And by the way.. paying for non face to face time.. when you are reducing overall reimbursement pushes patients away from face to face time.
Ah.. yes quality is going down and its not being measured by any valid metric,
Tell me.. Does Obamacare require any physical functioning requirements prior to discharge? And post discharge?
Did Medicare require any metrics of physical functioning and independence prior to Obamacare that can be measured?
Oooops..no.
So patients are being sent home from the hospital.. and to avoid readmissions.. (which ARE being monitored)... hospitals are sending patients home just as sick or even sicker.. but are telling home health agencies that if they send them back to the hospital.. they are not going to get referrals. So home health agencies are keeping patients that are not doing well at home.. and if they have to transfer them.. they are sending them to OTHER hospitals to avoid getting dinged by the original hospital. Because the hospital is keeping a "score card".. on them.
They are doing the same thing with SNF's and even assisted livings.
They are telling SNF's.. that regardless of the patients needs and potential.. they need to be "discharged on this date". and too bad if the patient has the potential to improve past that level. And if you go over that date.. then you face hurting your "scorecard" and not getting transfers from the hospital.
That's if they are even sending the patient to a snf. I just had a patient enter my office who had a stroke.. who instead of going to rehab.. the hospital sent him to an assisted living where he languished there for 2 months.. with no OT. No SLP and PT once a week on average.
He only left that assisted living and got to us where he was admitted to a rehab because his family had a PT in it that understood what he needed and what against what the home health and assisted living wanted. And I had to personally intervene because it was the right thing to do.. even though financially it was going to hit us.
So.. yeah.. why bother to measure quality with valid measures... when you can listen to folks that have no clue of the actual provision of healthcare and what is actually going on spout off on ideology.?
If you are asking if the quality of our services are going down? YES.. YES THEY ARE. I treat more patients per day.. than I have before. I spend less patient time and more documentation time. Our facilities see more patients with less qualified staff. Our rehabs and home healths are being pressured by outside hospitals to provide what fits THEIR profit margin regardless of whats best for the patient.
I hope to god that you never have a family member have to suffer needlessly because of this system. Of course.. you won';t probably know... because you have no clue what SHOULD have occurred. And of course you don't want to know.
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Expanded access means more patients..
THE WAY.. that revenue has been decoupled from the FFS treadmill means that providers are not getting paid for their time. And by the way.. paying for non face to face time.. when you are reducing overall reimbursement pushes patients away from face to face time.
Ah.. yes quality is going down and its not being measured by any valid metric,
Tell me.. Does Obamacare require any physical functioning requirements prior to discharge? And post discharge?
Did Medicare require any metrics of physical functioning and independence prior to Obamacare that can be measured?
Oooops..no.
So patients are being sent home from the hospital.. and to avoid readmissions.. (which ARE being monitored)... hospitals are sending patients home just as sick or even sicker.. but are telling home health agencies that if they send them back to the hospital.. they are not going to get referrals. So home health agencies are keeping patients that are not doing well at home.. and if they have to transfer them.. they are sending them to OTHER hospitals to avoid getting dinged by the original hospital. Because the hospital is keeping a "score card".. on them.
They are doing the same thing with SNF's and even assisted livings.
They are telling SNF's.. that regardless of the patients needs and potential.. they need to be "discharged on this date". and too bad if the patient has the potential to improve past that level. And if you go over that date.. then you face hurting your "scorecard" and not getting transfers from the hospital.
That's if they are even sending the patient to a snf. I just had a patient enter my office who had a stroke.. who instead of going to rehab.. the hospital sent him to an assisted living where he languished there for 2 months.. with no OT. No SLP and PT once a week on average.
He only left that assisted living and got to us where he was admitted to a rehab because his family had a PT in it that understood what he needed and what against what the home health and assisted living wanted. And I had to personally intervene because it was the right thing to do.. even though financially it was going to hit us.
So.. yeah.. why bother to measure quality with valid measures... when you can listen to folks that have no clue of the actual provision of healthcare and what is actually going on spout off on ideology.?
If you are asking if the quality of our services are going down? YES.. YES THEY ARE. I treat more patients per day.. than I have before. I spend less patient time and more documentation time. Our facilities see more patients with less qualified staff. Our rehabs and home healths are being pressured by outside hospitals to provide what fits THEIR profit margin regardless of whats best for the patient.
I hope to god that you never have a family member have to suffer needlessly because of this system. Of course.. you won';t probably know... because you have no clue what SHOULD have occurred. And of course you don't want to know.
.
yes it is. That expanded access means more patients. And when you decouple from "x minute interval ffs billing", it means that you are not getting paid for your time.
And quality performance measures are only as good as their validity. And there is little validity in most of today's quality measures.
No, it isn't. When you convert a practice to an advanced primary care model, (1) expanded access is part of the deal, and (2) part of the payment is decoupled from x-minute interval FFS billing. And another part of that payment is linked to quality performance.
THE WAY.. that revenue has been decoupled from the FFS treadmill means that providers are not getting paid for their time.
Tell me.. Does Obamacare require any physical functioning requirements prior to discharge? And post discharge?
Did Medicare require any metrics of physical functioning and independence prior to Obamacare that can be measured?
So patients are being sent home from the hospital.. and to avoid readmissions.. (which ARE being monitored)... hospitals are sending patients home just as sick or even sicker.. but are telling home health agencies that if they send them back to the hospital.. they are not going to get referrals. So home health agencies are keeping patients that are not doing well at home.. and if they have to transfer them.. they are sending them to OTHER hospitals to avoid getting dinged by the original hospital. Because the hospital is keeping a "score card".. on them.
This is right in line with how schools manipulate graduation rates. And police manipulate crime rates. And the government manipulates unemployment rates. and so on and so on. Numbers are great if they are reliable, but put in a financial or political incentive to manipulate the numbers and you can be sure that they will be manipulated.
Why not hire more staff?
\AAFP, AOA, AAP, and ACP have all endorsed the medical home model. These are practice patterns they've been asking for financial support to implement in primary care for several years.
Home health agencies submit data directly to CMS on functional status and independence/dependence scores. They have to report it when they receive a patient, every 60 days from then on, and at discharge. That's part of OASIS, it's been in place for years. And it'll play a significant role in the home health value-based purchasing program.
A hospital purposefully sending home sicker patients and patients unready for discharge will incur higher readmissions, even if that patient ends up going elsewhere. Doesn't matter under the readmissions reduction program if the patient shows up in a different hospital, the readmission counts against the hospital that discharged him. So any hospital doing what you're describing will lose money in the long run for poor quality performance. As it should.
Well it won't... and that's because the pressure that it puts on the home healths and SNF's and assistive livings to NOT transfer these patients OR to not transfer them to the hospital.. overall will artificially improve their reimbursements. ..
The SNF's and Home Healths are transferring these patients when they feel that HAVE to.. to other hospitals in an attempt to avoid the wrath of the original hospital... not to help that hospital financially.
Hospitals have no choice, they have to list in discharge plans all HHAs and SNFs in the service area who want to be included. They're legally prohibited from specifying or limiting the PAC providers available to a patient.
You can spin all the conspiracy theories you want, you've offered no evidence or metric to suggest that care quality is declining.
Go ask patients what their choices were upon discharge.. whether they were made aware of ALL the available choices.
(6) The hospital must include in the discharge plan a list of HHAs or SNFs that are available to the patient, that are participating in the Medicare program, and that serve the geographic area (as defined by the HHA) in which the patient resides, or in the case of a SNF, in the geographic area requested by the patient. [...]
(7) The hospital, as part of the discharge planning process, must inform the patient or the patient's family of their freedom to choose among participating Medicare providers of posthospital care services and must, when possible, respect patient and family preferences when they are expressed. The hospital must not specify or otherwise limit the qualified providers that are available to the patient.
They have to be.
42 CFR 482.43 - Condition of participation: Discharge planning
If what you're suggesting were happening, there'd be quite a bit of legal action in progress.
no there won't be.
LIKE I SAID.... go ask patients if they were aware of ALL the choices of referral. Go see if a physicians clinic gives them ALL the options of where to have their MRI.. or LABS.. or Respiratory tests done.
So patients are being sent home from the hospital.. and to avoid readmissions.. (which ARE being monitored)... hospitals are sending patients home just as sick or even sicker.. but are telling home health agencies that if they send them back to the hospital.. they are not going to get referrals.
They are doing the same thing with SNF's and even assisted livings.
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