One More Way ObamaCare May Increase Costs
The health reform law encourages doctors to work for hospitals. But once they become employees, doctors are encouraged to admit more patients so the hospitals can bill Medicare for more money. This is happening everywhere, but here is an example from The New York Times:
Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors. Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.
“intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.”
Technically this is still a business. Regardless of what they sell
yes, but the corruption involved is the real issue
I wouldn’t say its corruption, I think the government is embarrassed by the inability to price set in healthcare and is upset that hospitals are now taking advantage of it.
advantage to the tune of 500 million dollar fines to even be noticed. That’s both insane and alarming.
Medicare reimbursement rates are price setting.
It is not health care.
This is corruption and a poor reflection of morals…
“The practice of medicine is moving more rapidly than ever from decision-making by individual doctors toward control by corporate interests.”
But how do we stop this
The government has to stop making stupid decisions on insurance and actually figure out how to fix healthcare
“It’s not a doctor in there watching those statistics — it’s the finance people,”
returning healthcare back to the people will be difficult
They’re the real ones running our healthcare industry.
That is not exactly what you want to hear about as we are in the middle of a health care overhaul.
In this case, patients stop being people and start becoming statistics.
“Mr. Newsome joined H.M.A. in September 2008 from a high-ranking post at Community Health. He left H.M.A. last summer to head a religious mission in Uruguay. His compensation in the three years before his departure totaled $22 million.”
Well its settled, I’m staking my place in the healthcare industry.
It’s as if all of the scumbag bankers have moved over to healthcare.
“In Georgia, a baby whose temperature was 98.7 degrees was admitted to the hospital with “fever,””
These hospitals are able to maneuver around so many obstacles since there is no set price in healthcare. The ability to make money is endless
Using a baby as the commodity though is just embarrassing.
Can’t say its not genius though. What parent will deny their child care?
Especially if a “trained professional” says so.
The baby was also probably given overpriced infant Tylenol and sent home. “Easy money” for a hospital.
Greedy hospitals, mediocre legislation, expensive insurance… No wonder the healthcare system in America is failing.
John, You really should have a disclaimer here that states this practice has resulted in eight False Claims Act law suits in – I think – 6 different states! I agree with the general premise of your introduction that driving doctors into hospitals could increase costs, but the scheme detailed here is allegedly illegal.
The picture is more complex than this post suggests.
First of all, it is a rhetorical stretch to blame increased admissions on the ACA.
The pressure for increased admissions has been part of US health care for 40 years.
The HMO wars of the 1990’s were focused on this issue among others.
And psychiatric hospitals were brutally guilty of pumping in patients.
Secondly, Medicare at the same time is discouraging the formal overnite admissions of seniors, because a three day stay in the hospital means that Medicare must often pay for 28 days of rehab in a nursing home.
Hospitals are very complex places. Watching them earn money is like watching sausage be made (or legislation).
The systemic problem here is the payment model – fee for service / DRG / case rate. The longer term fix is to move toward capitation / global budgets to serve a specific population. Of course, that could create other pernicious effects including an incentive to skimp on necessary care. Presumably, carefully monitoring and attempting to measure care quality should mitigate that risk.
There is also a role here for the recovery audit contractors (RAC’s) to do post admission audits. To the extent that they can show that patients were admitted when they didn’t need to be, payment for that care can be clawed back and should be. The contractors have up to three years from the date of service to do these audits and, I’m told, they earn a 9% commission on any money they recover.