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Author: OrmontUS Big gold star, 5000 posts Feste Award Nominee! Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 464875  
Subject: Open letter to Yoda on Healthcare Date: 12/18/2012 6:15 PM
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Yoda,

I just got back from a board of trustees meeting at “the hospital”. There were a number of Powerpoint presentations by various officers showing how well we are doing. One of the poorer scores is that of “days stay” where we are at about 6 and the goal set by the government (what is affectionately called “Obamacare”, otherwise officially known as the Patient Protection and Affordability Act) is a little over 4. In addition, (we have an elderly population around the hospital and work with a number of nursing homes) we seem to have too many “return customers” within the first 30 days after a patient is released.

One of the ways this is being dealt with is to incentivize the doctors by paying them a “bonus” (forget the technical word used) if they manage to get a patient out quicker and keep them from going back to the hospital within a month by administering care at their offices.

Another is by making an alliance with a California based managed care group who has just moved into the neighborhood and who apparently aggressively manages their Medicare Advantage program.

There are a few interesting statistics which were mentioned: It seems that, on average, 40% of all care costs are spent in the final few months of life. It also seems that hospital acquired infections rank fourth in cause of death in the US.

The word “and” in Patient Protection and Affordability Act seems to be important. Patient Protection seems to be important for as long as a patient is in the hospital, but Affordability takes at least an equal footing (and an increasing one as the patient gets older and/or sicker).

Jeff
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Author: PosFCF Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 411677 of 464875
Subject: Re: Open letter to Yoda on Healthcare Date: 12/18/2012 6:52 PM
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One of the poorer scores is that of “days stay” where we are at about 6 and the goal set by the government (what is affectionately called “Obamacare”, otherwise officially known as the Patient Protection and Affordability Act) is a little over 4.

Jeff

The experience the hospital is having with patients covered by "Obamacare" might change after October 1, 2013. The current (emergency, if you will) PCIP was added onto the ACA so that those with pre-existing conditions could get coverage right away instead of having to wait until the more open enrollment which starts in October. Thus, your hospital's experience might be due to the sicker patients getting coverage earlier. However, as the population of covereds gets younger, those who need hospitalization may bring that 6 days down just because of the volume of covereds.

Just a thought

Poz

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Author: OrmontUS Big gold star, 5000 posts Feste Award Nominee! Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 411681 of 464875
Subject: Re: Open letter to Yoda on Healthcare Date: 12/18/2012 7:23 PM
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We have a person dedicated to reducing the "warranty repairs" within the first month. The hospital is rewarded (currently - I think it goes up later in the program) with an amount in six figures while giving up incremental revenue in seven figures.

From a business standpoint, this is just nuts.

Most of the hospital's patients are Medicare (not Obamacare), but the rules of reimbursement have shifted to the new rules.

The government seems hell bent on encouraging a managed care model where the insurance company gets paid a flat fee per patient and only spends what it has to in health care.

While the term "DP" is politically incorrect, it is true that gatekeepers have the company's interests in mind when they decide on what coverage to give.

Jeff

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Author: yodaorange Big red star, 1000 posts Feste Award Nominee! Feste Award Winner! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 411684 of 464875
Subject: Re: Open letter to Yoda on Healthcare Date: 12/18/2012 8:24 PM
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Ormont said: One of the poorer scores is that of “days stay” where we are at about 6

Jeff, thanks for this update. It perfectly fits with what happened to my deceased friend. He was in the hospital I think for 6 days before being discharged to go home. In less than 24 hours, he was literally turning blue due to a lack of oxygen. While I am sure the hospital does not want to see customers decease, kicking them out early might not be the best option.

I wonder if the hospital tracks: "Number of patients that likely deceased because we released them too soon?"

As if on que, the headline of the New York Times business section right now is:

Hospitals Fear They’ll Bear Brunt of Medicare Cuts

With growing pressure to reach an agreement on deficit reduction by the end of the year, some consensus is building around the idea that the largest Medicare savings should come from hospitals and other institutional providers of care.

“Hospitals will be in the cross hairs for more cuts,” said Lisa Goldstein, an analyst with Moody’s Investors Service, which follows nonprofit hospitals that issue bonds. While hospital executives fiercely defend the payments their own institutions receive, many acknowledge that Medicare is spending too much and growing too fast.

Those executives point out, however, that they have already agreed to $155 billion in cuts over a decade as part of the Affordable Care Act and they face billions more in additional cuts as part of the current negotiations. They argue that such large cuts to hospitals will ultimately affect beneficiaries.

“There is no such thing as a cut to a provider that isn’t a cut to a beneficiary,” said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx.


In my friends case as in many cases, it would be hard to 100% prove he deceased because he was released early. I sure would not want to be the discharging doctor. There are plenty of lawyers that would attempt a malpractice case in these circumstances. Increasingly doctors are refusing to see Medicare patients. It is pretty understandable. . .

Thanks for the update,

Yoda

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