It's Official Repubs Are Done Trying to Kill Obamacare

[yorkriver1]

I hate to be positive here, it doesn't seem to be popular, understandable, there's not much good news out there, but there are some hopeful trends, coming out of Medicare to start. CMS has gotten the message that, um, if we really spend on prevention and reimburse according to outcomes, maybe we would spend less.

One chain of clinics has developed a patient centered method for the sickest patients to lower hospitalization rates. They have metrics to show pretty dramatic reduction of rehospitalization rates, compared to averages. Employees are mandated and screened to have positive attitudes, no sullen entitlement, patient scorning there. Kind of like their living depends on customer satisfaction...sound familiar to us?
The clinic founders are invited to meetings with insurance carriers and the government. It comes down to rethinking the profit through selling more expensive treatments/hospital days, which we know is unsustainable.
Striking the Right Balance for Better Patient Outcomes | Real World Health Care

Here, in the next article, CMS is reimbursing based on patient satisfaction. So, that's why my hospital chain operated doc's office is sending out patient surveys, and has added a PA and Nurse Practitioner to offer same day urgent care visits.
Reimbursements Now Tied to Patient Satisfaction « SMS Healthcare EVS Blog

 

[nylife11023]

I expect we will get single-payor. Medicare for all. Agents will do OK selling supplements, unless of course the system is changed so that there will be no gaps. I don't sell health insurance, but I read the news and no matter how badly Obamacare fails (which it will) the country will not go back to the system we came from before Obamacare was passed. I hope fellow Republicans and conservatives look to the future and work on a system that will 'work' and not just be an obstruction.

 

[Norwayguy]

I expect we will get single-payor. Medicare for all. Agents will do OK selling supplements, unless of course the system is changed so that there will be no gaps. I don't sell health insurance, but I read the news and no matter how badly Obamacare fails (which it will) the country will not go back to the system we came from before Obamacare was passed. I hope fellow Republicans and conservatives look to the future and work on a system that will 'work' and not just be an obstruction.

I agree can not think of a time that a government program failed and we went back to the way it was before they just changed to something else.

 

[somarco]

if we really spend on prevention and reimburse according to outcomes, maybe we would spend less.

There is no evidence that essentially paying for performance produces improved results. In fact it can have the opposite effect with more limited access to quality care.

 

[yorkriver1]

There is no evidence that essentially paying for performance produces improved results. In fact it can have the opposite effect with more limited access to quality care.

The Medicare Advantage HMO specialty providers who are working on high cost populations like diabetics and chronic heart condition patients do have stats on costs for hospitalization/re-hospitalization rates that are dramatically lower than average.

They get higher capitation rates for chronic care patients, so their model helps them make money while saving money for the Medicare system.

There is a new health club in our area that has a dietitian on staff. They will get reimbursements for being part of a treatment program for Type 2 diabetics.

What remains to be seen in the overall picture for the under 65 population is how to make this work without everyone covered.

I don't like the de-emphasis on using agents to help people. Here locally, some church based groups realize how much we can help and have invited us in to open workshops for those who want to apply.

Carriers have "gone direct" in multi-channel offerings for some time now, so it's not just the government that appears to be looking to throw us under the bus...

 

[Crabcake Johnny]

If the Republicans are smart, they will do nothing. They were setting themselves up to take the blame and about to give the Dems the chance to say "it would have worked out just fine if the Republicans wouldn't have defunded it."

Let it be. Then come '16 all they have to say is "hey, you voted for this."

 

[houcoogster]

The Medicare Advantage HMO specialty providers who are working on high cost populations like diabetics and chronic heart condition patients do have stats on costs for hospitalization/re-hospitalization rates that are dramatically lower than average.

They get higher capitation rates for chronic care patients, so their model helps them make money while saving money for the Medicare system.

There is a new health club in our area that has a dietitian on staff. They will get reimbursements for being part of a treatment program for Type 2 diabetics.

What remains to be seen in the overall picture for the under 65 population is how to make this work without everyone covered.

I don't like the de-emphasis on using agents to help people. Here locally, some church based groups realize how much we can help and have invited us in to open workshops for those who want to apply.

Carriers have "gone direct" in multi-channel offerings for some time now, so it's not just the government that appears to be looking to throw us under the bus...

I can vouch for this one personally. I represent an MA that will call them day and night to go get a test done or some other check up until they go. They stay on top of their chronic cases like Tater stays on top of his collections!

 

[houcoogster]

This should be very interesting.

Kristol Reveals GOP Alternative for Obamacare to be Released Tomorrow | National Review Online

 

[somarco]

So what happens when providers refuse to accept patients with a low probability of being cured?

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Locally, we have hospitals that have closed OB departments and ER because they are not profitable. Same will happen if pay for performance is instituted across the board.

 

[cadylou]

So what happens when providers refuse to accept patients with a low probability of being cured?


Somarco, this is already a problem in the world of skilled nursing & home healthcare being approved by insurance. With some patients, they will never be "cured", or even show what some may deem to be "improvement" - but nursing services are required to maintain quality of life and prevent further degeneration. Measurements around improvement jeopardize some in a profound way if payments are based on this. Cases such as these have always been cited in areas where programs like Medicaid become privatized - typically private companies who take over those safety net programs try to control costs this way & Medicaid tends to have many who will never improve since it provides for a lot of nursing home and long term care health services. It's a problem.