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  1. #61  
    I personally think that people would be less likely to abuse the existing system if there was a continuation of certain things. ie, lets face the facts min wage does not begin to cover the basic essentials of raising a family let alone supporting yourself. I would have far less problem with many social programs if they were not stopped just because a person gets a job based on min wage. I have zero problem if a person who has kid (s), goes to work, and continues to receive supplementary income to help with child care, medical and hell putting more then cat food on the table. Kids going to school hungry is just plain wrong. hell kids going hungry in Canada or the US is just plain wrong. If a parent has a choice of feeding the kids or paying the rent or getting medical help and sends the kid to school hungry we have a far bigger problem then paying for a medical system. At least, at min wage they are giving something back. The kids get fed, and get the medical care they need. I do not care if its here in Canada or in any country for that matter. just my two canadian cents worth.
    Life is short, Play hard, and enjoy every moment as if it was your last.
  2. #62  
    Quote Originally Posted by davidra View Post
    Actually, I doubt that based on their employee's perspectives. True, using current dollars the savings are much more. But you can continue to discount that it makes a difference if you want.

    Despite that infections are still occurring today. That was my point.
  3. groovy's Avatar
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    #63  
    Quote Originally Posted by davidra View Post
    Not quite true. There are indeed incentives to improve the quality of care with a single payor system. You only need to look at Medicare reimbursement and the use of DRG's for reimbursing hospitals. Increasing efficiency of care results in a financial incentive for hospitals. More recently, Medicare has refused to pay for hospital-acquired infections and other preventable causes of morbidity. The result? Hospitals now have an incentive to reduce hospital-acquired infections, because they will not be paid for the treatment.
    Or... hospitals have incentive to attempt to pass the cost on to the patient or to misdiagnose and/or completely fail to report HAIs. Either way, the type and number of infections that meet the criteria are so exceedingly few that it's really more bark than bite. In theory, you make a point. But this is no different than private insurers denying coverage for HAIs. The only difference is that private insurers are called goons because of this type of practice.
    Last edited by groovy; 07/10/2010 at 11:10 AM.
  4.    #64  
    Quote Originally Posted by cjgem View Post
    Despite that infections are still occurring today. That was my point.
    Of course they are, and always will, more than likely. The point is that the government program that was developed to decrease the cost of care has resulted in not only a decrease in expenditures, but also higher quality care. You know, that bad wasteful government. Between that and the implementation of DRG's, the government has done way more than any private insurers in decreasing the cost of care.
  5.    #65  
    Quote Originally Posted by groovy View Post
    Or... hospitals have incentive to attempt to pass the cost on to the patient or to misdiagnose and/or completely fail to report HAIs. Either way, the type and number of infections that meet the criteria are so exceedingly few that it's really more bark than bite. In theory, you make a point. But this is no different than private insurers denying coverage for HAIs. The only difference is that private insurers are called goons because of this type of practice.
    Very unlikely that a hospital is going to do that. If a patient is on Medicare, and the hospital accepts assignment, if they are found to pass along costs to the patient, or commit fraud, they will lost their ability to bill Medicare. Given the aging of the population, that just doesn't happen. Unlike the Hospital Corporation of America, that shining light of the health care free market, hospitals are less likely to commit fraud. Things were different ten years ago, when many academic medical centers were nailed for poor documentation. That very rarely happens anymore. We have a staff that ensures accurate documentation for both private and public insurers. To not do that usually ends up losing money and getting significant fines.
  6. groovy's Avatar
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    #66  
    Quote Originally Posted by davidra View Post
    Very unlikely that a hospital is going to do that. If a patient is on Medicare, and the hospital accepts assignment, if they are found to pass along costs to the patient, or commit fraud, they will lost their ability to bill Medicare. Given the aging of the population, that just doesn't happen. Unlike the Hospital Corporation of America, that shining light of the health care free market, hospitals are less likely to commit fraud. Things were different ten years ago, when many academic medical centers were nailed for poor documentation. That very rarely happens anymore. We have a staff that ensures accurate documentation for both private and public insurers. To not do that usually ends up losing money and getting significant fines.
    Is it really fraud? If an upgrade to the billing system means they have greater ability to track and report HAIs, there's less motivation to upgrade. You and I both know how much incentive there is for documenting ADEs.
  7. #67  
    Quote Originally Posted by davidra View Post
    Of course they are, and always will, more than likely. The point is that the government program that was developed to decrease the cost of care has resulted in not only a decrease in expenditures, but also higher quality care. You know, that bad wasteful government. Between that and the implementation of DRG's, the government has done way more than any private insurers in decreasing the cost of care.
    So we are in agreement that no matter how much money Hospitals throw at the problem(ie renovation, mold remediation etc), it will continue as well as treating effected patients with no reimbursement forthcoming.
    Last edited by cjgem; 07/10/2010 at 04:48 PM.
  8.    #68  
    Quote Originally Posted by cjgem View Post
    So we are in agreement that no matter how much money Hospitals throw at the problem(ie renovation, mold remediation etc), it will continue as well as treating effected patients with no reimbursement forthcoming.
    "It will continue..."? Yes, at decreased rates (20% less in the reference I posted). And yes, hospitals will continue to treat patients who are sick who are admitted to the hospital. While hospitals, especially private ones, may turn patients away who are not emergent admissions, they don't send people out who are sick without treating them. At least I've never known of one. Even HCA hospitals. The decrease in mortality and morbidity is pretty signicant...especially for those who are prevented from getting an infection, wouldn't you say? And the money saved is significant as well....wouldn't you say? And it's not things like "mold remediation". It's changing central lines more frequently, enforcing handwashing requirements, laminar flow rooms, strict sterile technique, etc.
  9.    #69  
    Quote Originally Posted by groovy View Post
    Is it really fraud? If an upgrade to the billing system means they have greater ability to track and report HAIs, there's less motivation to upgrade. You and I both know how much incentive there is for documenting ADEs.
    ADE's are a different question, but when you look at the massive reductions in ADE's by using computerized entry systems (which Duke has been doing for decades now), there have been dramatic changes for the best. And that's another reason why Berwick is such a great choice. His primary goal has been to reduce medical errors, including ADE's.
  10. #70  
    Quote Originally Posted by davidra View Post
    "It will continue..."? Yes, at decreased rates (20% less in the reference I posted). And yes, hospitals will continue to treat patients who are sick who are admitted to the hospital. While hospitals, especially private ones, may turn patients away who are not emergent admissions, they don't send people out who are sick without treating them. At least I've never known of one. Even HCA hospitals. The decrease in mortality and morbidity is pretty signicant...especially for those who are prevented from getting an infection, wouldn't you say? And the money saved is significant as well....wouldn't you say? And it's not things like "mold remediation". It's changing central lines more frequently, enforcing handwashing requirements, laminar flow rooms, strict sterile technique, etc.

    I guess staying ahead of the game requires renovation and mold remediation. 80% still a pretty big number to have to eat.
  11. Micael's Avatar
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    #71  
    Quote Originally Posted by windzilla View Post
    All I can say for certain is that I have more to gain from listening to new ideas and differing oppinions, than I do from doggmatically asserting my own.
    I guess that makes sense... if your own opinions are wrong
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  12. groovy's Avatar
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    #72  
    Quote Originally Posted by davidra View Post
    ADE's are a different question, but when you look at the massive reductions in ADE's by using computerized entry systems (which Duke has been doing for decades now), there have been dramatic changes for the best. And that's another reason why Berwick is such a great choice. His primary goal has been to reduce medical errors, including ADE's.
    I think ADEs are very much the same issue. There's only so much withholding reimbursement can do before you make patient care so cumbersome and paperwork-laden that there's no time to actually care for the patient and nobody who will be willing to take the risk. Software is great in enforcing policy but it isn't meant to be a time-saver. In fact, in many cases it takes more time.

    Getting back to my earlier point, the Medicare policy regarding HAIs is mostly powerless, in my opinion. Very few infections fall under the guidelines.
    Last edited by groovy; 07/12/2010 at 10:30 AM.
  13.    #73  
    Quote Originally Posted by groovy View Post
    I think ADEs are very much the same issue. There's only so much withholding reimbursement can do before you make patient care so cumbersome and paperwork-laden that there's no time to actually care for the patient and nobody who will be willing to take the risk. Software is great in enforcing policy but it isn't meant to be a time-saver. In fact, in many cases it takes more time.

    Getting back to my earlier point, the Medicare policy regarding HAIs is mostly powerless, in my opinion. Very few infections fall under the guidelines.
    Not so inconsequential. This is from the New England Journal.



    I think there is more to be done, but to discount this as being trivial is incaccurate. Try asking a hospital administrator how inconsequential this is to them.


    Starting in 2009, Medicare, the US government's health insurance program for elderly and disabled Americans, will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay.

    So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Instead, the bill will be picked up by the hospital itself since the rules don't allow the hospital to charge it to you.

    According to a statement from the Centers for Medicare & Medicaid Services (CMS), the new rule is part of a step to:

    "Improve the accuracy of Medicare's payment under the acute care hospital inpatient prospective payment system (IPPS), while providing additional incentives for hospitals to engage in quality improvement efforts."

    That means Medicare won't be paying for surgery to remove objects accidentally left inside the patient in an operation, and neither will it pay for treating patients who receive the wrong blood type in a transfusion. But the main impact will be in the area of hospital acquired infections.

    Hospital acquired infections kill nearly 100,000 Americans a year, according to the Centers for Disease Control and Prevention (CDC), with 2 million patients needing treatment that costs over 25 billion dollars a year.

    Consumer groups say the changes will give hospitals a strong incentive to prevent such mistakes and thereby increase patients safety from infections and procedural errors.

    Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign welcomed the news:

    "Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors."

    "These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe," she added.

    According to the Consumers Union, at the moment, more than 60 per cent of the total national bill for treating hospital acquired infections is met by Medicare. And many of these infections could be prevented if hospitals followed simple infection control procedures such as making sure hospital staff washed their hands between patients.
  14. groovy's Avatar
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    #74  
    Quote Originally Posted by davidra View Post
    Not so inconsequential. This is from the New England Journal.



    I think there is more to be done, but to discount this as being trivial is incaccurate. Try asking a hospital administrator how inconsequential this is to them.
    Why doesn't this table show "average cost of treating condition"? Because treating a pressure ulcer is considerably cheaper, both in care and legal expenses, than removing a sponge. But consider this: Medicare's Policy Not To Pay For Treating Hospital-Acquired Conditions: The Impact -- McNair et al. 28 (5): 1485 -- Health Affairs

    Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million—equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality.
    EDIT: Sorry davidra, I don't want to get too sidetracked on this as it was my point that private insurers can, and have attempted to do similar things.
    Last edited by groovy; 07/12/2010 at 11:32 AM.
  15.    #75  
    Quote Originally Posted by groovy View Post
    Why doesn't this table show "average cost of treating condition"? Because treating a pressure ulcer is considerably cheaper, both in care and legal expenses, than removing a sponge. But consider this: Medicare's Policy Not To Pay For Treating Hospital-Acquired Conditions: The Impact -- McNair et al. 28 (5): 1485 -- Health Affairs



    EDIT: Sorry davidra, I don't want to get too sidetracked on this as it was my point that private insurers can, and have attempted to do similar things.
    I don't have access to the methods, but without knowing what six conditions they used in their model, and without combining the costs of all the other situations that are not reimbursed, it's hard to generalize their results to a national summary. For example, I can't tell if this article addressed the retained sponges and pressure ulcers (treating pressure ulcers is more expensive than you think). All I can say, from the provider side, is that the three hospitals I am associated with have all instituted significant oversight of infection control methods and have rules regarding changing lines, avoidance of wrong-site surgery, triple sponge-counting....etc. Clearly they think it's worthwhile.
  16. groovy's Avatar
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    #76  
    Quote Originally Posted by davidra View Post
    All I can say, from the provider side, is that the three hospitals I am associated with have all instituted significant oversight of infection control methods and have rules regarding changing lines, avoidance of wrong-site surgery, triple sponge-counting....etc. Clearly they think it's worthwhile.
    Why did they do that?
  17.    #77  
    Quote Originally Posted by groovy View Post
    Why did they do that?
    Well, there's always the possibility that they really care about their patients and want to provide high quality care. And the fact that they might improve their bottom line wouldn't hurt. But far be it from me to explain the thought processes of hospital administrators.
  18. groovy's Avatar
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    #78  
    Quote Originally Posted by davidra View Post
    Well, there's always the possibility that they really care about their patients and want to provide high quality care. And the fact that they might improve their bottom line wouldn't hurt. But far be it from me to explain the thought processes of hospital administrators.
    I understand. But the possibility exists that they would have implemented it even in the absence of the vast fortune they would recoup from Medicare? In fact, isn't it more likely that Medicare's new policy was little more than a footnote in their overall consideration?
  19.    #79  
    Quote Originally Posted by groovy View Post
    I understand. But the possibility exists that they would have implemented it even in the absence of the vast fortune they would recoup from Medicare? In fact, isn't it more likely that Medicare's new policy was little more than a footnote in their overall consideration?
    Yes, it's more likely, because most of the demonstration projects looking at "pay for performance" trials have resulted in an increased quality of care but unclear cost savings. I think that will change, though, because much of the quality measures are preventative care, and it takes some time for that to make a cost difference.
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