Hospitals save $100 million in Medicare costs under state experiment

[BlueGin]

And they fine hospitals unfairly. Which btw are usually the hospitals serving the poorest communities .
***************************************

"Dr. Don Goldmann, chief medical and science officer at the Institute for Healthcare Improvement, a Massachusetts nonprofit, cautioned against attributing the drop in readmissions only to the penalties, since the government also has other, less punitive programs underway. “There’s so much at play,” Goldmann said. “I’d be careful about imputing the reduction to any one intervention.”

As the penalties have played out, an increasing number of prominent experts are voicing concerns that the punishments are too harsh and doled out unfairly. For one thing, Medicare lowers payments to hospitals even if they have reduced their readmission rates from the previous year—so long as their rate is still higher than what the government believes is appropriate for that hospital. Medicare uses the national readmission rate to help decide what appropriate rates for each hospital, so to reduce their fines from previous years or avoid them altogether, hospitals must not only reduce their readmission rates but do so better than the industry did overall."

The source you've cited is from October, 2014. Has there been an update?

You mean you don't know?

I mean intelligent people understand that if they want to prove their point, they're able to post current information. Apparently you're unable to do that.

Riiight.

Isn't it ironic that the board moron who posts nothing in the way of information is making this statement.

ROTFLMAO

He can't help it. He has nothing else.

 

[Sun Devil 92]

The source you've cited is from October, 2014. Has there been an update?

You mean you don't know?

I mean intelligent people understand that if they want to prove their point, they're able to post current information. Apparently you're unable to do that.

Riiight.

Isn't it ironic that the board moron who posts nothing in the way of information is making this statement.

ROTFLMAO

He can't help it. He has nothing else.

It's become clear that she's only on here to derail and annoy. I've pretty much stopped looking at her posts. I do see them in the context of a quote.

It's really not worth it.

She clutters up the board with bulls**t.

 

[BlueGin]

You mean you don't know?

I mean intelligent people understand that if they want to prove their point, they're able to post current information. Apparently you're unable to do that.

Riiight.

Isn't it ironic that the board moron who posts nothing in the way of information is making this statement.

ROTFLMAO

He can't help it. He has nothing else.

It's become clear that she's only on here to derail and annoy. I've pretty much stopped looking at her posts. I do see them in the context of a quote.

It's really not worth it.

She clutters up the board with bulls**t.

Yep. Board troll and probably a sock.

 

[Arianrhod]

Evidence you can't hold your own in the discussion: You gossip about "the enemy" in the third person like a bunch of third-grade girls.

Carry on.

 

[Sun Devil 92]

From the article:

The new clinic is one example of innovative strategies Maryland hospitals are employing to improve population health and reduce costs under their state's unique new global budget revenue, or GBR, program. State officials negotiated the program with the CMS Innovation Center and launched it last January, moving the state toward paying healthcare providers based on improving population health rather than on volume of services. Other hospitals are launching similar initiatives to keep their patient populations healthier.

********************************

And so, why were they not doing this before ?

 

[Greenbeard]

From the article:

The new clinic is one example of innovative strategies Maryland hospitals are employing to improve population health and reduce costs under their state's unique new global budget revenue, or GBR, program. State officials negotiated the program with the CMS Innovation Center and launched it last January, moving the state toward paying healthcare providers based on improving population health rather than on volume of services. Other hospitals are launching similar initiatives to keep their patient populations healthier.

********************************

And so, why were they not doing this before ?

Because under the old system hospitals make money by filling beds. Revenue and margin are driven by service volume.

In the past, hospitals had no financial reason to offer lower cost care in settings outside of the hospital to prevent higher downstream (i.e., inpatient) spending. Such interventions might've been better for the patient's/population's health and they may have saved the system as a whole money, but they deprived the hospital itself of that revenue. There was simply no business case for doing what these hospitals have now started doing.

Granted, that's been starting to change around the country in recent years as more and more providers are being paid for outcomes (not just service volume) under the ACA. But no incentives have gone as far as what Maryland started doing in 2014.

Under their new model, the healthier the population and the more cost effective the intervention, the better for the hospital's bottom line. The business model has changed. If an upfront investment in a setting outside the hospital can improve someone's health and avoid a hospital admission, under the old model the revenue from that admission disappears. Savings to the system from better health and more cost-effective interventions would be a net loss for the hospital. Under the new system, the hospital benefits from doing a better job and investing in health outside its walls.

 

[Sun Devil 92]

Still nothing to address the fact that people are paying more for insurance and getting less.

Just looking at hospitals is missing the grand picture.

 

[Greenbeard]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

 

[Sun Devil 92]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

Thank you for being honest.

 

[Sun Devil 92]

This entire article demonstrates the failure of the market with regards to health care.

How is there 100 million in "fat" out there that nobody in the private sector went after ? If there were 100 million in "excess"s sitting on the table in any industry, someone would find a way to get some of it. That requires an explanation by itself.

While not altogether clear, one has to wonder how the government regulators have allowed hospitals to operate so ineffectively.

The answer, in part, I know lies in the barriers to entry into these kinds of activities and the risk associated with providing health care services.

What kind of hospitals are we talking about anyway ?

Is this article saying that the Maryland State Government can go in and set budgets for PRIVATE HOSPITALS ?

If so, they are not private.

And it would appear that the Maryland State Government might be responsible, in part, for all this waste.

 

[Sun Devil 92]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

 

[dblack]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

Not exactly. But it represents a key element of the statist strategy regarding health care - to use the increasing portion of health care paid for by the state as a means of controlling the market. That's the wet dream of single-payer. If government becomes the sole source of health care funding, they will have unmitigated power to set prices - they'll simply tell health care providers how much they're willing to pay and hang up the phone.

 

[Sun Devil 92]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

Not exactly. But it represents a key element of the statist strategy regarding health care - to use the increasing portion of health care paid for by the state as a means of controlling the market. That's the wet dream of single-payer. If government becomes the sole source of health care funding, they will have unmitigated power to set prices - they'll simply tell health care providers what they're willing to pay and hang up the phone.

Does the ACA give power to the states to regulate PRIVATE HOSPITAL budgets ?

To be truthful, I am not sure I understand the different types (if there are any) of hospitals that are out there.

The claim of 100 million saved is also something I have not done the math on.

100 million out of how much ?

 

[dblack]

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

Not exactly. But it represents a key element of the statist strategy regarding health care - to use the increasing portion of health care paid for by the state as a means of controlling the market. That's the wet dream of single-payer. If government becomes the sole source of health care funding, they will have unmitigated power to set prices - they'll simply tell health care providers what they're willing to pay and hang up the phone.

Does the ACA give power to the states to regulate PRIVATE HOSPITAL budgets ?

To be truthful, I am not sure I understand the different types (if there are any) of hospitals that are out there.

No, not directly, but hospitals are increasingly dependent on state funding. So, when the state says 'jump' ...

 

[dblack]

Also re: ACA, it actually impedes this kind of state level action. Maryland ha

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

Not exactly. But it represents a key element of the statist strategy regarding health care - to use the increasing portion of health care paid for by the state as a means of controlling the market. That's the wet dream of single-payer. If government becomes the sole source of health care funding, they will have unmitigated power to set prices - they'll simply tell health care providers what they're willing to pay and hang up the phone.

Does the ACA give power to the states to regulate PRIVATE HOSPITAL budgets ?

Also - to more directly answer you question, ACA doesn't give this power to states, it actually prohibits it. But Maryland has special waivers. Apparently, ACA cedes similar "freedom" to the rest of the states in 2017.

Regardless, this is an abysmal abuse of government power, and not something to be celebrated.

 

[Sun Devil 92]

Also re: ACA, it actually impedes this kind of state level action. Maryland ha

Just looking at hospitals is missing the grand picture.

This isn't a thread about "the grand picture," it's about hospitals. In one state. And how they're re-shaping the way they deliver care in response to one of the most interesting experiments going on anywhere in the country right now.

It's a piece of a larger puzzle, but it's a big deal. And one I personally find fascinating. If you want to complain about insurance plans, there's plenty of other threads in which you can do that.

This forum is about Obamacare.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

If so, this amounts to a full blown takeover by the federal government of our hospital system.

Not exactly. But it represents a key element of the statist strategy regarding health care - to use the increasing portion of health care paid for by the state as a means of controlling the market. That's the wet dream of single-payer. If government becomes the sole source of health care funding, they will have unmitigated power to set prices - they'll simply tell health care providers what they're willing to pay and hang up the phone.

Does the ACA give power to the states to regulate PRIVATE HOSPITAL budgets ?

Also - to more directly answer you question, ACA doesn't give this power to states, it actually prohibits it. But Maryland has special waivers. Apparently, ACA cedes similar "freedom" to the rest of the states in 2017. In either case, it this is an abysmal abuse of government power, and not something to be celebrated.

I am not clear on what you calling an abuse of power.

Also, are you saying the OP statements are not true ?

The first couple of lines say that the ACA grants this power.

Forgive my lack of knowledge.

 

[dblack]

I am not clear on what you calling an abuse of power.

I'm calling the use of welfare benefits to manipulate markets is an abuse of power.

Also, are you saying the OP statements are not true ?

The first couple of lines say that the ACA grants this power.

Forgive my lack of knowledge.

The OP is typical Greenbeard equivocation - the article says the opposite.

 

[Greenbeard]

How is there 100 million in "fat" out there that nobody in the private sector went after ? If there were 100 million in "excess"s sitting on the table in any industry, someone would find a way to get some of it. That requires an explanation by itself.

(1) Sick = services delivered = revenue to the hospital.
(2) Healthy = services avoided = no revenue to the hospital.

There doesn't have to be anything to "go after," nor is anybody doing anything "wrong," when providers are delivering care as a set of episodic, acute care interventions if (1) is true. That's the business model that has to be followed under those circumstances. It just isn't the best strategy when it comes to patient health or system costs.

The question is whether the financial incentive baked into the system is to keep people healthy or to just treat them when they're sick.

The classic example is preventable hospital readmissions. There are many cases where relatively low cost interventions post-discharge could prevent a high-risk patient from ending up in the hospital for the same thing one, or two, or three weeks after they leave. That would keep the patient healthier, let them stay in their community, and avoid the expense associated with a second (or third or fourth...) inpatient stay.

But why would a hospital invest in those interventions? They cost upfront money, and they eliminate the revenue stream associated with the patient coming back for another stay (i.e., the unnecessary "expense" being eliminated is the very revenue the hospital needs to balance its books). Doing the right thing effectively costs them money twice. That's the reality of the old way of doing things.

Is this article saying that the Maryland State Government can go in and set budgets for PRIVATE HOSPITALS ?

Maryland has set prices for hospitals for the past 40 years. Under what they're doing now, they've offered all hospitals in the state the opportunity to enter into voluntary global budget contracts with the state. The goal was to recruit enough hospitals over a five year period that the amount of hospital revenue under these agreements would grow from 0% in 2014 up to 80% by 2018.

In reality, every hospital signed up in the first year and they had 95% of hospital revenue in these agreements in 2014.

Your OP states that the ACA gave authority to the state to set hospital budgets. Does this mean all hospitals ?

The state has always had the ability to control how commercial insurers and Medicaid pay hospitals (and they've exercised it for quite some time). What they don't necessarily have control over is how Medicare pays.

But their experiment won't work if Medicare isn't participating. They wouldn't be global budgets if they didn't include services provided to Medicare beneficiaries. Which is why Maryland needed to exercise an option created by the ACA (an 1115A waiver of the Social Security Act) to launch this demonstration and secure Medicare's participation.

 

[Sun Devil 92]

Maryland has set prices for hospitals for the past 40 years]

If this means all hospitals, I find that amazing.

Of course the statement could be taken one of many ways.

Did they set all prices ? And who set them ? Was it a government agency ?

 

[Sun Devil 92]

But why would a hospital invest in those interventions? They cost upfront money, and they eliminate the revenue stream associated with the patient coming back for another stay (i.e., the unnecessary "expense" being eliminated is the very revenue the hospital needs to balance its books). Doing the right thing effectively costs them money twice. That's the reality of the old way of doing things.

You asked the question...I am sure you know the answer.

In your article it says.....

Maryland hospitals receive an agreed-upon amount of revenue each year regardless of the number of people they treat and the amount of services they deliver, as long as they provide efficient, high-quality care to their communities. Adjustments also can be made to recognize an increase in market share or improved efficiency.

Whose paying that revenue ?

The people in the low income housing district that were calling 911 (and getting away with it) all the time ?

So if I read this right.....

Initially, I am thinking.....the state is paying the hospitals everything up front....regardless.

But that can't be for all services (my guess is that if you want foot surgery...you still pay).

So what is this fixed revenue supposed to cover ? And the "regardless" clause has to have some qualified number of people. Otherwise it makes no sense.