Hospitals push age hike for Medicare
- 0Sep 30, '11 by herring_RN Guide[color=#464646]seek to avoid cuts in federal payments
by [color=#444444]tracy jan
washington - as the deficit reduction supercommittee hunts for $1.5 trillion in additional savings, us hospital executives are so worried about having their payments cut that they plan to start lobbying congress next week to shift the burden onto their elderly patients - specifically by raising the age of eligibility for medicare....
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- 0Sep 30, '11 by herring_RN GuideQuote from nurse15dcThank you!Thanks for posting. fyi I had to google to read the article without signing up. Found this direct link -
- 8Sep 30, '11 by Chico David RNJust by way of starting a meaningful discussion:
Contrary to propaganda, the Social Security System actually is not in deep trouble - some rather minor tweaks to the funding mechanism can make SS secure way into the future. Medicare however is a different story. The growth in Medicare spending is at a rate that truly is not sustainable over the long haul. Following the the current growth trends out for a few years leads to a point where the program eats most of the federal budget. This, however is not a problem with Medicare per se. Medicare is the most efficient system we have in this country - the lowest admin expenses in the system itself and the lowest expenses for providers in dealing with it. The problem is how fast the underlying costs of health care are growing. It behooves nurses to take a serious interest in solving the problem because, if we don't, people will look to blame us - as in "Costs are rising so fast because nurses are overpaid."
A bunch of different ideas have been floated to fix the problem. They range from the technocratic to the ideological. It may be that the real answer lies in some mix? Here are some of those approaches and a few thoughts about them:
1. The Republican solution is to shift more of the cost to beneficiaries in one way or another. Raise the eligibility age, increase copays, or the Ryan plan, which stops guaranteeing Medicare as a federal benefit and gives the elderly a voucher to buy private insurance. The value of the vouchers would be capped, so each year the part paid by the beneficiaries would be larger. The non-partisan Congressional Budget office estimates that, even though the cost to the government would go down, the cost to individuals and employers would go up more, so net total cost would increase.
2. Cut payments to providers for any given service: This has been done to various degrees by both parties, but has done about as much as it can do. At some point, you push that as far as it can go and providers stop taking Medicare patients, or they cost shift to other patients, or they go into the red themselves, or some combination of those. What this story is about is hospitals fearing payment cuts so much they are pushing for more of Number 1 above to avoid them.
3. Try to reduce the use of unnecessary services: Various ideas are advanced for this. The "free market" approach is to make people pay more of the cost themselves so they will "shop more wisely" and consume less. The trouble is that the overconsumption of healthcare, where it exists, is not driven mostly by patients. There may be a few unnecessary visits to MD offices and there certainly are ER visits that could be handled in offices a lot cheaper. But the big ticket items are the unneeded tests, surgeries and procedures and it's mainly the docs and the medical culture that is responsible for those, not the patient. If you are lying on a gurney in the ER with chest pain and the doc says you need a heart cath, you aren't going to shop for a better price somewhere else and you aren't going to seriously question the judgement of the doc most of the time. But we do know that your chances of getting that heart cath - or any of a bunch of other procedures - varies widely from hospital to hospital and from region to region. And we know that some of the areas with the lowest cost have the best outcomes - more money spent does not equal better care.
I could write lots more, but I have to get on to other things now, but maybe that's enough for a conversation starter?
- 5Sep 30, '11 by needshaldolChico, I think the biggest problem is paying for unnecessary tests, care, etc. I work in acute care and we have this one doc who will not let patients die. Seriously. These patients are demented, unable to walk, have to be fed, diapered, and are wasting away and what does she do? She talks to the family about feeding tubes. Some of these patients start pulling at their lines, and now we need to restrain them. Then the tests start. She has got to be making $ off medicare for this. This is a good example of where our medicare money goes.
- 1Sep 30, '11 by Chico David RNQuote from needshaldolit's a huge part. Then the question becomes how do you change it? Nobody really wants hard and fast rules about when you stop aggressive treatment - cases vary so much. By me, people in the end stages of chronic illness really don't belong in ICUs they belong in hospice care. But how do you make that happen in practice? Interestingly, as I mentioned in my previous post, there are huge variations in that stuff around the country. And it seems like the biggest variable is what you might call the medical culture of an area. In some places certain things are accepted practice. In other places the accepted practice is different. And we know that in very high cost areas the average annual cost per patient on Medicare is over twice that in low cost areas, with outcomes that are no worse or even better. An interesting problem, and one we do need to solve.Chico, I think the biggest problem is paying for unnecessary tests, care, etc. I work in acute care and we have this one doc who will not let patients die. Seriously. These patients are demented, unable to walk, have to be fed, diapered, and are wasting away and what does she do? She talks to the family about feeding tubes. Some of these patients start pulling at their lines, and now we need to restrain them. Then the tests start. She has got to be making $ off medicare for this. This is a good example of where our medicare money goes.
- 5Sep 30, '11 by kcmylornBefore we dice and chuck the Medicare system- I would first like to see how well and less expensive these hospitals are run by cutting top managment salaries, perks, bonuses and benes. I would like to see the real/true cost of running a healthcare facility with out a $multi million dollar expense of one worker(scratch the word worker- it assumes that person puts some sweat into their job on a daily bases, not due to a hormone problem) Employee!! These CEO's gotta go!!
- 4Sep 30, '11 by needshaldolIt is not just the CEO's and management. I take care of all the medicare issues with my elderly mom and I find so many really dumb people working in medicare. For instance, her primary doc retired and I called to change her primary doc and I was told that it would not go in till November 1. I said "what am I supposed to do for her if she gets ill or needs help before"? The answer was she had to wait. Then after talking to two other people in the "office" he said, "well the supervisor said since it was not your moms fault that he retired, she can see a different doctor if necessary before November 1". Gotta love this stuff.
- 9Sep 30, '11 by nerdtonurse?You wanna fix health care (hospital costs)? make it so that the CEO's total compensation package can't exceed 100x the cost of the lowest paid person (and word it so they can't just contract out the work, either) at the hospital. You wanna pay a CEO 40 million bucks, you pay the cleaning guy 400,000 bucks. WHA? That's too much for a cleaning guy? No, honey, that's too much for a CEO.
Cap malpractice to actual cost of care and loss of income of patient. And then take the doc's freakin' license so he can't skip over the state line and do it to someone else..
If a person comes to the ER for something non-emergency, like an earache or a toothache (never seen dentistry performed in the hospital), take the cost of the visit out of their check. (I'm not talking trauma, I'm talking the person who's tooth has hurt for 3 months and decides at 4 am on a Saturday to go to the ER).
If a person is in the ER more than 1x per month, figure out why and fix it. If it's substance abuse, they either go to rehab or can't come back for "drunk and done fell over." If it's someone with endstage everything, they need to go on hospice and not end up being tortured their last weeks in an ICU when nothing's going to change the outcome.
All of this comes down to giving the patient and families realistic expectations. And since a lot of the docs I work with absolutely stink at end of life / chronic disease issues, this isn't going to get fixed, the system's going to break, more hospitals will close. It's a good thing we're nurses, because we may well be the "healthcare system" for our families...the only one they can afford.
Welcome to the fall of Rome, part 2..