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  • Hospitals' Skepticism of New Obamacare Medicare Payment Scheme Grows

    A frequent accusation against conservative Medicare reform proposals is that they would “end Medicare as we know it.” But the reality is that Obamacare has already accomplished this. One example is a new program that will, for the first time, attempt to pay for quality by penalizing hospitals that fail to meet bureaucratically created standards for quality and efficiency.

    Achieving better value in Medicare should be a goal of any serious reform plan, but the new law’s solution is unlikely to succeed. Instead, it will negatively impact patients and the hospitals that serve them.

    Obamacare sets up “value-based purchasing” for hospital payments under Medicare. Starting in October 2012, hospitals and other providers will see payments redistributed based on performance scores calculated according to the methodology chosen by the Obama Administration. Payments will be reduced across the board to a new, lower “base” payment, after which hospitals could receive “bonuses” for performing well on the quality measures.

    This “pay-for-performance” scheme is arbitrary at best, and physicians and experts in the field have identified several ways in which it could create perverse incentives that harm patient care. In a recent article, New York Times reporter Robert Pear highlights one: Under the new program, hospitals will be graded on the cost-per-beneficiary of hospital care. Pear reports: “Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.”

    If patients receive care from other providers within 90 days of a hospital stay, a hospital could get a lower score—and subsequent lower payment—based on care they did not provide or even know about. Hospitals thus risk receiving punitive payments that do not accurately reflect the quality of care they provided based on factors beyond their control.

    Teaching hospitals have even more reason for concern, since Medicare payments based on cost-per-beneficiary calculations will put providers that treat sicker, more costly patients at a severe disadvantage. This will create the incentive for providers to avoid taking high-risk patients in order to obtain higher scores and higher payments.

    According to Pear, “Medicare officials tried to allay this concern, saying they would adjust the data to take account of patients’ age and the severity of their illnesses, as well as geographic differences in hospital wages.” But no matter how bureaucrats tweak the program to micromanage seniors’ care, it will not accurately and fairly reward providers for high quality care, since individuals identify value differently based on countless factors that no one-size-fits-all approach can fully consider. Heritage research explains:

    Evidence-based medicine is at its best when it informs a clinical decision rather than dictating it. Physicians know that treatments that prove effective for the vast majority of the population studied may not be the best for those who are two or three standard deviations from the mean. Statistical outliers are patients, too. Patient treatment should ultimately be determined by the physician’s decisions based upon what is best and most effective for that individual patient and not for a statistical population of patients. Preserving physicians’ professional independence is absolutely critical to good patient care.

    Successful reform will allow patients, not bureaucrats, to discern and reward value in the health care system. Transforming Medicare to directly engage consumers in health care decisions would drive providers to respond to patients’ demands and expectations. To learn more about Heritage’s plan to do this, visit http://savingthedream.org.

    Posted in Obamacare [slideshow_deploy]

    11 Responses to Hospitals' Skepticism of New Obamacare Medicare Payment Scheme Grows

    1. West Texan says:

      Good analysis about Obamacare's negative impact on Medicare payments. This is the reality of today's intrusive federal overreach. It's a total mess to say the least. On a personal note, the feds need to look at the eventual phasing out of all nationalized entitlement programs.

      Texas became a part of the United States (US) as its own republican form of government. This was for the benefit of a common defense which allowed Texas to focus on its own commercial and resident needs [promoting the general welfare]. Social progressive demagogues from Woodrow to Obama have attempted to undermine states' sovereignty turning the US into one Big State (BS). Yep! That's exactly what we're expected to accept.

    2. Jeanne Stotler,Woodb says:

      We already have DRG's (diagnostic related goals) instigated by Ins. cos. caring more about profit tha the welfare of the patient. These are causing discharge of patients unable to care for themselves at home, early discharge also means taking care of post op sites, regulation of meds etc, is being carried out by family members or friends who have no idea what complications to watch for. Then what happens? the pat. is readmitted and more surgery can evolve, a stay in ICU, or maybe even death. I've seen radical Mastectomy pats. discharged the next day,complications can develop if not on the lookout for swelling an lymph node infection. Tonsils and adnoids are done out patient, ignoring the chance of hemorraging, c-section patients sent home in 3 days without pain meds. This is only going to get worse with the Feds in control. All the standards that Obama is setting up are beng proposed by NON medical personel. Don't believe me, then get he book "WHY OBAMA CARE IS BAD FOR AMERCA'

    3. Herschel Copeland Ne says:

      Most of us who read the gargantuan Obama (Don't care bill) saw this coming as did Sara Palin,and while death panels are not specifically identified as such, someone will get the short end of the stick, either the hospital or the patient. The monkey seems to sit squarely on the physicians back through the paper work, and the life of a living person is balanced on the wire totally dependent upon how the physician does the paperwork. It is time for health institutions to rebel against the harmful mandates set up by the Obama administration that seems hell-bent on destroying health care in America.

    4. Bobbie says:

      Pay for performance? No kidding this will be harmful to the patients! My God, our lives are in these people's hands!! … being paid according to government standards??? Talk about controlled crisis at government's will!!!??…

      We'd rather be respected to pay the hospital who's ethics are in sincere regard to our health, without forced regard to the imposition of government rules and mandates infringing on our health and ethics of the hospital and care providers.

      Please get the government out! The President informs us by actions and policies, he rejects personal freedom, liberties, America and the value of human life and personal responsibilities thereof.

    5. Mike, Wichita Falls says:

      Congressman Dingell spoke of Obamacare as a way to control the people. He, other lawmakers, Obama and his bureaucracies do not view us as 300+ million individual citizens to be left alone but as subjects to be controlled and managed by them from afar.

      My job includes looking for patterns and exploiting them to the advantage of my boss and his business but never at the expense of people. Obamacare will look for patterns and exploit them at the expense of people…be it their life, liberty and pursuit of happiness.

    6. Jeanne Stotler,Woodb says:

      PS, It's called thje "Practice of Medicine" first, it's not an exact science, second, We are individuals and it's not one treatment or medicine fits all. To let anyone who has not gone to medical school decide the fate of us all is WRONG, WRONG, WRONG.

    7. Harry Snyder Tempera says:

      This frightens me; I am 82 and was in hospital recently. If Obamacare is not abolished, if I become ill after its advent, I may not receive the care I require, in order to follow the regulations set in place by "the Secretary" or some nameless bureaucrat or bureaucrats, with no recourse.
      Medicare patients need to be wary of this scheme, and to let their Congressmen (and women) of their fears—before it's too late.

    8. Tim Az says:

      Reward the Doctors for following a treatment plan designed by a group of unelected and unaccountable beaurocrats. When these untouchables treatment plans fail, then blame the doctor and with hold partial payment to the hospitals. No body wins. Everybody loses. That's how socialism works everyone has the worst outcome, but they will tell you it's fair. Had enough yet?

    9. George Colgrove, VA says:

      We had a plan that worked years ago – before the federal workforce got involved.

      It included cost control measures, service monitoring, access to the poor and it in general kept costs low.

      The plan was called Private Sector COMPETITION and the governing body was the CUSTOMERS.

      It works every time it's tried!

    10. Renny, Maryland says:

      It's been decalired "Unconstitutional!!!!!!" Why are we screwing with it?????

      Just "STOP" and wait. You know the big "o" is hiring more government employees at our expense??

    11. Esther S says:

      I was recently in the hospital and after my primary doctor and my cariologist had discharged me. The hospital said I had to stay another day and take a drug not prescribed by either doctor and to which I was alergic accordiing to medicare (part of obmacare new rules) I created a fuss and they called my doctor and found I was right!! How many people will they kill or injure with these "cookbook" rules??

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