The Current State of Medicare

[B-Large]

Perhaps the best article I have every read on the realities of Medicare, the realities of "Premium Support" or "Voucher" proposed by Rep. Ryan, and the underlying Notion that the Affordable Care Act is one of the key pieces of groundwork to prove that Rep. Ryan's plan can be implemented in a reponsible way for out most vulnerable citizens. Caution: There is no Left or Right Ideology muck slinging, just a evidence based write up that to me, say the Republicans and Democrats are not as radically seperated in their ideas as most of us are led to believe, but rather their ideas inter-twine. I posted the conslusion, but the whole article is fascinating.

 

 

The Conclusion:

 

The U.S. health care system badly needs reform. Our payment system rewards quantity rather than quality. We waste huge sums on administration and at the same time neglect administrative outlays that could lower spending and increase quality. Medicare is part of that system and therefore is infected by many of those problems. But the problems of the U.S. health care system are not confined to or disproportionate in Medicare. Attention should focus on systemic reform. The Affordable Care Act has started us on that effort. That law is not perfect. In the course of its implementation we will learn a lot and encounter unanticipated effects that will cause us to change the law. But the successful implementation of health insurance exchanges is a necessary precondition for serious consideration of a voucher system. To bull ahead with a voucher plan of any stripe, before we have in place health insurance exchanges, an essential element if such a plan is to succeed, would be rash and irresponsible.

 

 

The Link:

 

http://www.brookings.edu/testimony/2012/0427_medicare_aaron.aspx

Edited May 3, 2012 by B-Large

[birdog1960]

Perhaps the best article I have every read on the realities of Medicare, the realities of "Premium Support" or "Voucher" proposed by Rep. Ryan, and the underlying Notion that the Affordable Care Act is one of the key pieces of groundwork to prove that Rep. Ryan's plan can be implemented in a reponsible way for out most vulnerable citizens. Caution: There is no Left or Right Ideology muck slinging, just a evidence based write up that to me, say the Republicans and Democrats are not as radically seperated in their ideas as most of us are led to believe, but rather their ideas inter-twine. I posted the conslusion, but the whole article is fascinating.

 

 

The Conclusion:

 

 

 

 

The Link:

 

http://www.brookings.edu/testimony/2012/0427_medicare_aaron.aspx

i know he's from brookings but this guy quotes keynes...that surprised me as did his choice of quotation itself. many interesting points here especially "currently privately administered (medicare) programs add cost...and premium support is not warranted.

 

there's no question that payment should be outcome rather than volume based. the trick is convincing the public that more is not always better and is sometimes worse. witness the outrage at the evidence based recommendations to decrease mammography screening and the ultimate acquiescence of the medical groups making them. this will be the hardest problem to solve but the most important. i've spent hours counseling patients on why a particular test is ill advised or potentially harmful. they nod their heads, voice their understanding and then say, "yeah, but i want it anyway". will legislators have the balls to back up doctors who appropriately say "no"? unfortunately i don't see either party doing it. the advisory panel was the most benign route to get there but has been soundly vilified to the point where almost everyone refers to it as a death panel. i'm hopeful but not optimistic.

[Doc]

I'll agree to be paid on quality when everyone else does. Namely the politicians.

[birdog1960]

I'll agree to be paid on quality when everyone else does. Namely the politicians.

more than likely, your or my agreement or disagreement will be inconsequential

[Doc]

more than likely, your or my agreement or disagreement will be inconsequential

Maybe. But we'll see how many doctors continue to see Medicare patients when they're not getting paid because "certain quality metrics weren't achieved."

[OCinBuffalo]

The key word is quality. Nothing, NOTHING in the business processes of health care organizations I have encountered addresses quality PROPERLY. The only thing that does is: the people, doing it by hand, rote, default, verbally, etc., while being forced to fill out pointless form after pointless form, paper or software, which in fact impede quality concepts, rather than attend to them.

 

If people are the only chance of doing quality right, then people are also the most likely reason it will be done wrong. This is intolerable to anybody who knows anything about quality assurance, and is also why the entire malpractice menagerie of BS exists.

 

Look, any clown can just make up a 1-5 status, not base it on anything remotely quantifiable, pretend it exists in a vacuum, call it a "quality assurance standard". Not even. That's not even close to how this works.

 

The good news is: quality can be done, and it can be done properly. Most importantly it can be done properly for health care, in that it is possible to adjust proper QA practices to fit the realities of health care. However, F'ing about with care plans, etc. is not the answer. Most of this junk is unrepairable, has horrible design flaws, and therefore needs to go.

 

Btw, after we do quality, can we start on cost? I don't care which one we do first, but if we do quality, managing cost is the next project. That's because: you can't do health care exchanges properly if you don't know quality or cost, either. If we are serious about exchanges, vouchers, etc., then we better be serious about quality and cost. Otherwise, we are better off doing nothing.

 

As I've said 100 times, I should be for Obamacare, because it plays right into my hands professionally. But, I'm not, because stupid is stupid, and "meaningful use", as a standard, is the stupidest thing I have heard since I was in public utilities.

[birdog1960]

Maybe. But we'll see how many doctors continue to see Medicare patients when they're not getting paid because "certain quality metrics weren't achieved."

it's a commonly made threat but is it real? i saw some numbers on the number of practicing physicians that feel financially set to retire. it was surprisingly low. seems the only one making 15% a year on investments in recent times is romney.

[OCinBuffalo]

Maybe. But we'll see how many doctors continue to see Medicare patients when they're not getting paid because "certain quality metrics weren't achieved."

Depends on who is setting the metrics, how, and for whom they are setting the metrics. By all rights, YOU, and your organization, should be setting the metrics for yourself.

 

For example, in another industry, I would never walk into a client meeting and say "well, the rest of the industry is doing it this way, so you have to as well, and we'll measure your performance against that". Not only would the client, rightly, toss me out on my ass, it's simply wrong. So why is this OK for health care?

 

The fact is that quality comes from the organization's internal commitment to it, not some external clown that shows up. Surprise! If we want to measure anything, the first thing we should measure is the commitment to quality. And, that's easy: tell me how many patients are in this facility and who is doing what for them right now.

 

It's simple inquiry, but the average health care outfit does not have that answer. They don't because nobody is looking at this properly. It's by no means the only question, but it is the first one. If we aren't about being able to answer that question, every day, all the time, because we NEED to know the answer, and only want to answer it because the state is here today, then we aren't serious about quality. If the state persists in its quest to determine whether a piece of paper/software form was filled out, instead of getting the answer to Question #1, then they aren't serious about quality either.

Edited May 4, 2012 by OCinBuffalo

[Doc]

Depends on who is setting the metrics, how, and for whom they are setting the metrics. By all rights, YOU, and your organization, should be setting the metrics for yourself.

If only.

[OCinBuffalo]

If only.

This is possible. Perhaps more possible than you think.

[Doc]

This is possible. Perhaps more possible than you think.

I was talking about this current administration and Obamacare. If Romney wins and Obamacare is repealed, it might happen. There is an organization called "Docs 4 patient care (.org)" that is trying to become the replacement for the sell-out AMA, which I've been told has been promised (yeah, I know) to be involved with new health care law.

[OCinBuffalo]

I was talking about this current administration and Obamacare. If Romney wins and Obamacare is repealed, it might happen. There is an organization called "Docs 4 patient care (.org)" that is trying to become the replacement for the sell-out AMA, which I've been told has been promised (yeah, I know) to be involved with new health care law.

 

I am going to check them out.

[Doc]

BTW, I was working with a GI doc the other day, and he was complaining about how he was doing a colonoscopy on a manager of a clinic in our work city (Waterbury, CT, which neither of us live in) that was sending him tons of Medicaid patients for scope procedures, knowing what ****ty rates they pay. He said that when he confronted her on it, she said "do you want me to ruin your day?" We get $149 for an office visit for Medicaid patients (because they're a FQHC) because "no one else will see them." Yeah, if docs were getting $149, EVERYONE would want to see them. That's almost double private insurance rates.

[OCinBuffalo]

BTW, I was working with a GI doc the other day, and he was complaining about how he was doing a colonoscopy on a manager of a clinic in our work city (Waterbury, CT, which neither of us live in) that was sending him tons of Medicaid patients for scope procedures, knowing what ****ty rates they pay. He said that when he confronted her on it, she said "do you want me to ruin your day?" We get $149 for an office visit for Medicaid patients (because they're a FQHC) because "no one else will see them." Yeah, if docs were getting $149, EVERYONE would want to see them. That's almost double private insurance rates.

Section 330. Very important to us. Now move along, nothing to see here.

 

 

I was just gonna say that. But...having "will report direct variable cost" as part of a US code...is just too...hysterically awesome, to let a chance to say it go by.

[B-Large]

i know he's from brookings but this guy quotes keynes...that surprised me as did his choice of quotation itself. many interesting points here especially "currently privately administered (medicare) programs add cost...and premium support is not warranted.

 

there's no question that payment should be outcome rather than volume based. the trick is convincing the public that more is not always better and is sometimes worse. witness the outrage at the evidence based recommendations to decrease mammography screening and the ultimate acquiescence of the medical groups making them. this will be the hardest problem to solve but the most important. i've spent hours counseling patients on why a particular test is ill advised or potentially harmful. they nod their heads, voice their understanding and then say, "yeah, but i want it anyway". will legislators have the balls to back up doctors who appropriately say "no"? unfortunately i don't see either party doing it. the advisory panel was the most benign route to get there but has been soundly vilified to the point where almost everyone refers to it as a death panel. i'm hopeful but not optimistic.

 

I remember last year when those screening guidelines came out.... there were so many women freaking out "but what if you're the one woman who had cancer and we don't screen!!" So you ask them if the benefit of that one diagnosis justifies the radating of 1,000 other women for no evidencial reason, they say "of course!!!"

 

There is new evidence about PSA's out recently, how do we think people will react to that news?

 

People in this country really need to start listening to the the doctors who are doing the research and laying out the evidence based screening guidelines.... doing uneccesary screening in this country is costing them system a fortune- and putting alot of people at increased risk with scanning, etc.

 

People won't listen though- they will be persuded by some talking head that this is tantamount to "death panels and rationing"....