Unbelievable Medicare Changes!!!!!!!!!!!!!!

[Guest guest]

barbhenshaw@... wrote:

> And....the new rules spell out - in no uncertain terms - that

> hospitals can not pass on these " mistake bills " to the patient! This

> is a good thing. I'll bet, in short order, private insurance will

> pass these new rules too.

>

> With love, Barb in Texas

> Son Ken (32) UC 91 PSC 99 Tx 6/21 & 6/30/07

>

>

>

Barb,

Thanks for giving us the rest of the story. My concern was that the

patients would end up being forced to foot the bill. And those on

medicaid aren't usually in an income bracket that affords attorneys to

fight the charges. With this added piece of info, I think we can rest

(and even feel good about changes that will hopefully result from the

new rules).

[Guest guest]

prweller....

>> I still wonder if hospitals are going to say " oops, it was our

>> fault, we won't bill you. What will patients have to do to prove

>> that the equipment was " dirty. " ?

Right now, I'm thinking..... it won't be much of a problem for

patients. Medicare has tons of power (anyone holding the purse

usually does.) They watch the bills like hungry sharks. Plus, whenever

Medicare denies payment, they aren't shy about saying why. If

Medicare refuses to pay because they believe it was the hospitals

fault, I promise patients won't pay either and will have the Federal

government behind them saying you don't have to.

Guess we'll have to wait and see how this plays out, but I'm betting

hospitals will really watch their ps & qs.

Barb

[Guest guest]

Not paying for complication is a great news sound bite but the

reality is that it cuts funding.

The unintended consequences of this would be for hospitals to shun

risk. If hospitals face financial risk for complications they will

be less enthusiastic about accepting difficult cases. Missed sponges

are very rare but more likely the more complicated the surgury. Bed

sores and infections are more common in patients that are sicker and

weaker. Falls in the hospital occur in those who are more frail. If

hospitals screen out higher risk patients they would protect their

pocket book.

This will decrease money into transplant programs as they will be

paying for complications out of the general budget. I can't see

Medicare raising the compensation for a proceedure to compensate for

the hospital taking more risk.

Less funding means that the transplant nurses and coordinators have

their hours cut, it becomes more difficult to attract the best

doctors, and overall the program becomes more stressed.

There should be financial compensation for preventing complications

but it won't be helpful until it factors in the complexity of the

patients served.

I practice internal medicine and there is a lot of talk about pay for

performance. One of the performance measures is diabetic control

which is measure by a blood test (HbA1c). The easiest way for me to

lower my practice's HbA1c average is to turn away the most difficult

diabetic patients that have high scores so that they go to a differnt

physician.

Anyway that's my opinion.

Von

[Guest guest]

Von,

My gut tells me that you are right. Hospitals have to protect their assets,

and while it would be nice for hospitals & health care workers to do more to

prevent mistakes and infections I suspect that sometimes these things are

part of doing medicine. If hospitals suddenly find themselves losing a lot

of money because of hospital infections, while they will hopefully take

measures to reduce those infections, they may conclude that the best way is

to not accept the sickest patients, or the most immuno suppressed patients.

-Marie

>

>Reply-To:

>To:

>Subject: Re: Unbelievable Medicare Changes!!!!!!!!!!!!!!

>Date: Wed, 22 Aug 2007 04:27:29 -0000

>

>Not paying for complication is a great news sound bite but the

>reality is that it cuts funding.

>

>The unintended consequences of this would be for hospitals to shun

>risk. If hospitals face financial risk for complications they will

>be less enthusiastic about accepting difficult cases. Missed sponges

>are very rare but more likely the more complicated the surgury. Bed

>sores and infections are more common in patients that are sicker and

>weaker. Falls in the hospital occur in those who are more frail. If

>hospitals screen out higher risk patients they would protect their

>pocket book.

>

>This will decrease money into transplant programs as they will be

>paying for complications out of the general budget. I can't see

>Medicare raising the compensation for a proceedure to compensate for

>the hospital taking more risk.

>

>Less funding means that the transplant nurses and coordinators have

>their hours cut, it becomes more difficult to attract the best

>doctors, and overall the program becomes more stressed.

>

>There should be financial compensation for preventing complications

>but it won't be helpful until it factors in the complexity of the

>patients served.

>

>I practice internal medicine and there is a lot of talk about pay for

>performance. One of the performance measures is diabetic control

>which is measure by a blood test (HbA1c). The easiest way for me to

>lower my practice's HbA1c average is to turn away the most difficult

>diabetic patients that have high scores so that they go to a differnt

>physician.

>

>Anyway that's my opinion.

>Von

>

_________________________________________________________________

Learn.Laugh.Share. Reallivemoms is right place!

http://www.reallivemoms.com?ocid=TXT_TAGHM & loc=us

[Guest guest]

Yep Von, I think you're right. I can easily see Hospitals saying -

" let's not take the high risk, complicated cases - especially if we

might not get paid " . Conceptually, it seems this is a case were the

government supposedly suspects that hospitals have an incentive to

do a poor job, because Medicare will pay for treatment of

complications resulting from medical mistakes. Therefore, the

solution would be to remove the incentive by not paying for mistakes.

Personally, I think hospitals are already concerned about these

mistakes and don't see them as profitable. Mistakes leave them very

vulnerable to costly lawsuits, and the hospitals have probably

already taken measures to reduce their exposure (by order of their

legal dept.). It seems more likely this is a PR stunt by the

administration to make it look like they are doing something on

healthcare. The hospitals will probably now has an other incentive

to just not wade into the thick weeds of complicated medical cases

like ours.

My 2 cents!

Washington, DC

>

>

>

> Von,

>

> My gut tells me that you are right. Hospitals have to protect

their assets,

> and while it would be nice for hospitals & health care workers to

do more to

> prevent mistakes and infections I suspect that sometimes these

things are

> part of doing medicine. If hospitals suddenly find themselves

losing a lot

> of money because of hospital infections, while they will hopefully

take

> measures to reduce those infections, they may conclude that the

best way is

> to not accept the sickest patients, or the most immuno suppressed

patients.

>

> -Marie

>

>

>

> >

> >Reply-To:

> >To:

> >Subject: Re: Unbelievable Medicare

Changes!!!!!!!!!!!!!!

> >Date: Wed, 22 Aug 2007 04:27:29 -0000

> >

> >Not paying for complication is a great news sound bite but the

> >reality is that it cuts funding.

> >

> >The unintended consequences of this would be for hospitals to shun

> >risk. If hospitals face financial risk for complications they

will

> >be less enthusiastic about accepting difficult cases. Missed

sponges

> >are very rare but more likely the more complicated the surgury.

Bed

> >sores and infections are more common in patients that are sicker

and

> >weaker. Falls in the hospital occur in those who are more

frail. If

> >hospitals screen out higher risk patients they would protect their

> >pocket book.

> >

> >This will decrease money into transplant programs as they will be

> >paying for complications out of the general budget. I can't see

> >Medicare raising the compensation for a proceedure to compensate

for

> >the hospital taking more risk.

> >

> >Less funding means that the transplant nurses and coordinators

have

> >their hours cut, it becomes more difficult to attract the best

> >doctors, and overall the program becomes more stressed.

> >

> >There should be financial compensation for preventing

complications

> >but it won't be helpful until it factors in the complexity of the

> >patients served.

> >

> >I practice internal medicine and there is a lot of talk about pay

for

> >performance. One of the performance measures is diabetic control

> >which is measure by a blood test (HbA1c). The easiest way for me

to

> >lower my practice's HbA1c average is to turn away the most

difficult

> >diabetic patients that have high scores so that they go to a

differnt

> >physician.

> >

> >Anyway that's my opinion.

> >Von

> >

>

> _________________________________________________________________

> Learn.Laugh.Share. Reallivemoms is right place!

> http://www.reallivemoms.com?ocid=TXT_TAGHM & loc=us

>

[Guest guest]

I want to thank you all for your comments! I know that, if you look

at raw numbers, some hospitals have better survival rates for some

illnesses than others. That may not be the whole picture, however

since some take the most seriously injured or ill and will naturally

have lower survival rates. I think that Von's response with regard to

doctors is thought-provoking at the least.

In my case, the infection was seeded in one hospital and I was treated

for its deadly consequences in another hospital. Imagine the

paperwork on that with the new rules!

Penny

>