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Why ObamaCare failed

Hawkeye10

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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

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
 
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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

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.
 
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.
 
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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.
 
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.

Except that practice change is for more patients in less time. Lower quality of care.. and cost containment at the cost of patient care.

but carry on.
 
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
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.
 
Except that practice change is for more patients in less time. Lower quality of care..

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.
 
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.

It is complaining that Obama's signature impact on America does not work.
 
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.
 
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.

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.

And quality performance measures are only as good as their validity. And there is little validity in most of today's quality measures.

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 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.

.
 
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.

.

Why not hire more staff?
 
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.

.

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.
 
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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.

YePPers.
 
I was reading an article in one of our newspapers here in Australia explaining your crazy your private health system is, "after world war 11 there were wage controls in America and labour shortages, so employers couldn't compete for the workers by raising wages so they began offering health insurance, in the 1950's the IRS decided the insurance wouldn't be taxed as wage income so private health insurance has become tax expenditure"
We in Australia pay our own private health insurance out of our own pocket, the employer does not pay it, and nothing to do with it, and it is NOT tax deductable, no wonder you cannot afford it
 
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.

In other words, it sucks.
 
THE WAY.. that revenue has been decoupled from the FFS treadmill means that providers are not getting paid for their time.

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.

Tell me.. Does Obamacare require any physical functioning requirements prior to discharge? And post discharge?

The ACA requires reporting and it links reimbursement to performance. It doesn't remove medical decision-making from medical professionals.

Did Medicare require any metrics of physical functioning and independence prior to Obamacare that can be measured?

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.

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.

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.

Meanwhile, HHAs are moving into a world where their own reimbursement is linked to quality and performance.
 
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.

Ok, how are you claiming they are manipulated? Let's go through the process.
On 14-20 August, Census workers went out to, or called approximately 70,000 households, gaining a useful sample of about 60,000. 3/4 of the household had been interviewed in July, 1/8th were new to the survey, and 1/8th were returning after 8 months out of the survey.
The households were asked about work activity for August 7-13 and classified according to set definitions.
The information was sent directly to the Bureau of Labor Statistics in DC, on a server only accessible by members of the Office of Employment and Unemployment Statistics (OEUS). Note that no one in OEUS is a political appointee and workers there were hired in every administration since Reagan.
22-26 August the OEUS people called back to Census with any questions, follow-ups, flagged any odd responses, and began compiling the data.
29 August the OEUS office went on lock-down and no one outside that office is allowed in without escort (doors will only open to properly keyed badges).
Today, the final report, kept in a special safe, will be given to the Office of Publications for print-setting and formatting. This afternoon, the final report will be presented to the BLS Commissioner (the only political appointee in BLS) who will sign off.
Tonight a copy will be sent to the White House Chief Economic advisor who may share it with the President.
Tomorrow at 8:30 am according to the Naval Observatory clock, the jobs situation report will be released to the public.
Census and the Bureau of Economic Analysis have access to the raw data, as do academic researchers who sign a non-disclosure agreement.

So, when and how in that process are the numbers manipulated, and by whom?
 
Why not hire more staff?

Because reimbursement per patient is dropping and has been dropping (before obamacare as well by the way).. the profitability per patient is less.

That means that you have to become more efficient by seeing more patients per care provider. And by lowering the cost of that care provider.. which is why you are more likely to see a PA than the actual doctor.

Its why you are more likely to see an Occupational therapy Assistant.. or Physical Therapy Assistant rather than a Doctor of Physical Therapy.

Its why you are more likely to get your meds dispensed by a "Med Aide".. than by a Bachelor or Masters of Nursing.
 
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.
\

Of course.. because the IDEA of making patients better.. and able to be at home makes sense. The problem is in the implementation of it.

Heck.. when you talk in generalities.. it makes sense to have hospitals be reimbursed better if they can keep their patients home and not have to be readmitted. On the surface that's a great idea. The hospitals provide better care in the hospital.. more aggressive therapies, more coordinated care.. do better discharge planning.. and reduce their length of stays and get patients home in better condition...

Wow.. sounds awesome.

the problem is in the practice. The assumption here is that hospitals that were screwing up before.. that were part of the problem.. suddenly slapped their hands on their foreheads and said "well crap".. "lets start treating these patients better. Lets start spending more money on discharge planners, lets spend more on therapist times and evaluations, lets spend more money on pharmacists, etc.. to provide better and more coordinated care. "

What has happened is that hospitals have NOT improved their care.. but instead are controlling the patient flow downstream to manipulate their reimbursement.

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.

that's right. And out of curiousity.. are Home Healths finding that the complexity of patients has GONE DOWN?

And please show me on the Oasis.. where the potential of the patient is detailed and whether they met that potential or not.

Now.. go to SNF.. and their MDS.

Are SNF"s finding out that their patient case loads are becoming less complex?

And again.. show me where the potential of the patient is recorded and whether they met that potential on discharge.


And honestly.. whats worse about this is that in twenty years of being a medical provider.. I have seen the expectations for these patients begin to drop since 1998.

We know more of how to make them better, more functional.. but over time the reimbursement paradigm is not to help them reach full potential.. but to get them to the cheapest care possible as fast as possible (even though in the long run is much more costly.. way way way.. more costly).

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.

We love to pass the buck in this country.. and we are doing it right now.

these patients that are going home.. sicker. and less functional? Eventually are going to need a lot more care.. a LOT more care as they age.. then they would have if they had been taken care of properly.

Who knows though.. maybe we will again see the day when its acceptable that Grandma spends her "golden years".. in a bed. A wonderful hospital bed.. an expensive pressure relieving bed to be sure. With a home health aid to get her something to drink at a call bell.. in her home.

But still in bed. :(
 
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.
 
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.

NOW THAT IS FUNNY

You really have no clue do you.

I challenge you. Go to all the home healths and snfs in your region. Be especially sure to go to private facilities without affiliation to the hospital. Go ask them about the local hospitals and their referral patterns. See what you find out.

Go ask patients what their choices were upon discharge.. whether they were made aware of ALL the available choices.

I have worked and owned facilities all over this country. If you think hospitals and physicians don;t try to control their referrals for benefit... I have some ocean front property in South Dakota to sell you...

Wow.. how can you be that naïve? Its got to be the ideology.
 
Go ask patients what their choices were upon discharge.. whether they were made aware of ALL the available choices.

They have to be.

42 CFR 482.43 - Condition of participation: Discharge planning
(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.

If what you're suggesting were happening, there'd be quite a bit of legal action in progress.
 
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.

See if the hospital gave them every option of where to do outpatient therapy.. or dialysis.

I challenge you to ask these folks and then compare them to the advertised places in the community. See if they were given EVERY choice. And then find out if there was any pressure to go to one or another.

Sheesh louise you are naïve. Why do you think hospitals have been buying up physician practices and hiring physicians on staff???!?!? You don't think because they get a financial advantage by controlling the referral system and control patient flow? :doh


Tell me... is there a financial incentive in the hospitals keeping patients in their own system (particularly good paying patients) ?

Now.. tell me the mechanism/metric that's used to measure this. Tell me exactly HOW you would know and by what metric.

Now.. tell me.. is there a financial incentive for hospitals to pad their numbers by putting pressure on assisted livings, home health agencies and SNF's? Yes or no.

What mechanism is there in place then.. what metric.. of what a patient COULD have achieved..versus what they achieved?
 
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.

What the hell are you talking about? As you seem to have forgotten the flow of the conversation, I'll remind you: you made the (unsubstantiated) claim that hospital discharges to HHAs and SNFs came with special strings that were designed specifically to harm patients experiencing acute episodes in need of a hospitalization within 30 days of a discharge. Let me refresh you:

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.

We're not talking about MRIs or labs or physician clinics or some broad conversation about referral patterns. We're talking about your allegation that America's hospitals are actively harming their patients by bribing, cajoling, forcing post-acute care providers to somehow intervene in critical situations and prevent a patient from going to a hospital. To, as you say, "avoid the wrath of the original hospital."

Wrath exercised using, of course, a mechanism that does not exist since hospitals are required by law to include any HHAs or SNFs in a patient's discharge plan that wish to be included and must make patients aware of all available options for post-acute care. Special protections written into law and regulation specifically covering the class of provider with which you started the conversation and not the unrelated ones to which you're now desperately attempting to shift the conversation.

This has nothing to do with the financial case for acquisition of a physician practice or whatever other nonsense deflections you want to toss out to try and obscure your obvious unfamiliarity with the regulatory framework and incentives in place with respect to the topic of conversation. You made a dumb claim, you can't support it, and now you're off to the races trying to throw any random thing at the wall in the hope it'll stick. I think we're done here.
 
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