The Conservative Case for Obamacare

[Quantum Windbag]

Nothing prevents the hospital from discharging a patient. What the provision does is prevent hospitals from pushing patients out the door as quickly as possible, then racking up money on readmissions. It instead creates an incentive to completely treat the illness the first time.

Exactly my point. If the patient wants to go home, and the doctor sees no problem with it, but they both understand that the illness will require a readmission, they are fucked.

But that doesn't make any sense. Why would the patient want to be discharged, then turn around and come back to the hospital in a few days for the same condition?

Why would a patient want to go home and be surrounded by loved ones instead of staying in a hospital? Seriously? Have you ever stayed in a hospital?

 

[Not2BSubjugated]

Nothing prevents the hospital from discharging a patient. What the provision does is prevent hospitals from pushing patients out the door as quickly as possible, then racking up money on readmissions. It instead creates an incentive to completely treat the illness the first time.

Exactly my point. If the patient wants to go home, and the doctor sees no problem with it, but they both understand that the illness will require a readmission, they are fucked.

But that doesn't make any sense. Why would the patient want to be discharged, then turn around and come back to the hospital in a few days for the same condition?

The intended purpose of this portion of the bill cannot, by itself, justify the value of said portion.

The fact of the matter is that fining a hospital for readmission of a patient incentivizes them to do what they can not to readmit patients. On the front end, this is mostly good: it's encouragement to get their shit straight the first time.

On the back end, however, this is a horrible, horrible idea. Regardless of why a patient was wrongly discharged, it should -never ever ever- be in a hospitals best financial interest to keep them from being readmitted if they need it.

Like the rest of us, doctors are human beings and prone to occasional mistakes. Fining them for readmission won't eliminate mistakes: you can't legislate the human condition to perfection. So when mistakes happen, you're actually encouraging hospitals to do what they can to pretend there was no mistake and keep that patient from coming back for a proper diagnosis/procedure.

At best this is a very poorly thought out method of achieving more legal accountability for the people doing the initial diagnosis.

 

[Polk]

It creates that incentive on the front end, but the back end incentive you point to doesn't really exist due to other mechanisms (such as the ability to sue if they're harmed). The penalties will not eliminate mistakes, but it will surely reduce them.

 

[Polk]

Exactly my point. If the patient wants to go home, and the doctor sees no problem with it, but they both understand that the illness will require a readmission, they are fucked.

But that doesn't make any sense. Why would the patient want to be discharged, then turn around and come back to the hospital in a few days for the same condition?

Why would a patient want to go home and be surrounded by loved ones instead of staying in a hospital? Seriously? Have you ever stayed in a hospital?

You're leaving out the key part that "go[ing] home" under the circumstances results in the person become more ill.

 

[Murf76]

Once again, that's not a determination on if the patient can be readmitted. It's about what the community will pay for.

By telling the hospital it cannot discharge a patient for any reason and later readmit him you are interfering in the doctor client relationship. Doesn't it make more sense to send a patient home, if possible, in order to save money, than to force them to stay in the hospital?

Nothing prevents the hospital from discharging a patient. What the provision does is prevent hospitals from pushing patients out the door as quickly as possible, then racking up money on readmissions. It instead creates an incentive to completely treat the illness the first time.

Again.... hospitals have no financial incentive to push patients out before they're ready to go. It is INSURANCE companies which pay the bills, MEDICARE chief among them, who have a vested financial interest.

This is a disgusting bid by Democrats to RATION hospitalization to seniors. And while you're busy arguing that there's some sort of vested community interest which outweighs the rights of INDIVIDUALS, bear this in mind.... we INDIVIDUALS don't get a choice about whether we'll have our pockets picked to support Medicare. So, we PAY for it. The money is forcibly TAKEN from individual citizens. Further, when government is a player on the field rather than the referee, there's no one left to arbitrate disputes over what gets covered and what doesn't. If your private insurance company kicks you out of the hospital, you can sue them. You can replace them with a better company. When Medicare kicks you out, good luck finding somebody to take that up with. And now, you'll be discouraged from being readmitted if that decision was premature or if your situation worsens.

 

[Greenbeard]

First, you are mistaken. It wasn't and isn't market mechanisms in either case, it is government mandated mechanisms.

Ah, but indeed it is a market mechanism. As Kleinke so succinctly put it: "free up buyers and sellers, standardize the products, add pricing transparency, and watch what happens. Market Economics 101."

Robust competition on a level playing field, customers responding to clear price and quality indicators, sellers rewarded for responding to those signals. That's generally what's known as a "market."

 

[dblack]

First, you are mistaken. It wasn't and isn't market mechanisms in either case, it is government mandated mechanisms.

Ah, but indeed it is a market mechanism. As Kleinke so succinctly put it: "free up buyers and sellers, standardize the products, add pricing transparency, and watch what happens. Market Economics 101."

Robust competition on a level playing field, customers responding to clear price and quality indicators, sellers rewarded for responding to those signals. That's generally what's known as a "market."

Just not a 'free' one.

 

[Quantum Windbag]

First, you are mistaken. It wasn't and isn't market mechanisms in either case, it is government mandated mechanisms.

Ah, but indeed it is a market mechanism. As Kleinke so succinctly put it: "free up buyers and sellers, standardize the products, add pricing transparency, and watch what happens. Market Economics 101."

Robust competition on a level playing field, customers responding to clear price and quality indicators, sellers rewarded for responding to those signals. That's generally what's known as a "market."

Can you explain how forcing people to buy insurance coverage they neither want, or need, is freeing them up? After you do that you can explain how forcing everyone to sell exactly the same thing is freeing up sellers.

 

[syrenn]

Nothing prevents the hospital from discharging a patient. What the provision does is prevent hospitals from pushing patients out the door as quickly as possible, then racking up money on readmissions. It instead creates an incentive to completely treat the illness the first time.

Exactly my point. If the patient wants to go home, and the doctor sees no problem with it, but they both understand that the illness will require a readmission, they are fucked.

But that doesn't make any sense. Why would the patient want to be discharged, then turn around and come back to the hospital in a few days for the same condition?

you are joking right?

Have you ever been in the hospital? I know for myself.... all i wanted was to go HOME....knowing that there was a very real possibility of needing to be readmitted in a few days.... for the same thing.

 

[Quantum Windbag]

But that doesn't make any sense. Why would the patient want to be discharged, then turn around and come back to the hospital in a few days for the same condition?

Why would a patient want to go home and be surrounded by loved ones instead of staying in a hospital? Seriously? Have you ever stayed in a hospital?

You're leaving out the key part that "go[ing] home" under the circumstances results in the person become more ill.

Like being seriously sick and insisting on going to a family reunion?

By the way, the law doesn't say that hospitals need to prevent people from getting sicker, it penalizes every readmission regardless of the cause. Every health care wonk hates it because of the potential negative impact on safety net hospitals and at risk communities, yet you are stuck in knee jerk mode to defend it simply because the government passed it.

Get over yourself and start thinking.

 

[Greenbeard]

By the way, the law doesn't say that hospitals need to prevent people from getting sicker, it penalizes every readmission regardless of the cause.

No, it doesn't penalize every readmission. There's a whole thread dedicated to this topic below this one, take this crap there.

 

[dblack]

By the way, the law doesn't say that hospitals need to prevent people from getting sicker, it penalizes every readmission regardless of the cause.

No, it doesn't penalize every readmission. There's a whole thread dedicated to this topic below this one, take this crap there.

Don't sling that equivocation here too. It penalizes all re-admissions above the dictated maximum regardless of the cause. Every readmission, no matter how righteous the reasons for the discharge, contributes to the total that will eventually result in a fine. Keep ignoring that.

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results, it's about following orders. It's about centralized authority telling us how to live.

 

[Greenbeard]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

 

[Polk]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

Exactly. The idea that holding people to account for their actions is "never being held accountable" is kinda humorous.

 

[dblack]

Accountability for results is precisely what this is.

Only if the "results" are constrained to the goal of being under a predetermined number of readmissions. This may, or may not, have anything at all to do with whether the discharges that led to the readmissions were a good idea or not. This is being 'held accountable' for failing to satisfy an arbitrary statistic - not for causing harm. It's blind "accountability" that is sure to sweep up quality care with harmful care and treat them the same.

Exactly. The idea that holding people to account for their actions is "never being held accountable" is kinda humorous.

But this isn't holding them accountable for their actions. Unless you really believe discharging a patient is somehow inherently bad. The question is whether they are discharging them without proper concern for their well-being. This regulation neglects making that judgement on a case by case basis and instead rests on the assumption that any hospital with a re-admission rate above a predetermined maximum is making bad calls.

 

[Oddball]

First, you are mistaken. It wasn't and isn't market mechanisms in either case, it is government mandated mechanisms.

Ah, but indeed it is a market mechanism. As Kleinke so succinctly put it: "free up buyers and sellers, standardize the products, add pricing transparency, and watch what happens. Market Economics 101."

Robust competition on a level playing field, customers responding to clear price and quality indicators, sellers rewarded for responding to those signals. That's generally what's known as a "market."

Forcing people into the same marketplaces to seek uniformity is Communism 101, comrade.

 

[Murf76]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

No it's not. There's no practical difference in a patient spending 3 days in the hospital this month and 3 days next month as opposed to 6 days in a row. What this administration is trying to accomplish is to force the elderly into palliative care, where life-sustaining treatments are no longer available to them. This is Obama giving Granny "a pill" instead of a pacemaker.

 

[Quantum Windbag]

By the way, the law doesn't say that hospitals need to prevent people from getting sicker, it penalizes every readmission regardless of the cause.

No, it doesn't penalize every readmission. There's a whole thread dedicated to this topic below this one, take this crap there.

Why?

 

[Quantum Windbag]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

Tell me something, why do policy wonks that actually understand the issues think that this will, potentially, devastate safety net hospitals and at risk populations? You usually have the answers, are they wrong?

 

[Quantum Windbag]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

Exactly. The idea that holding people to account for their actions is "never being held accountable" is kinda humorous.

Yet, for some reason, you are refusing to address the concerns about this policy coming from the left side. Cold that be because you are a hack?