...aaand welcome to the real world (Obamacare)

[Jhhnn]

To be honest I don't know why you post here since everything is over your head at all times.

Reminds me of Cheney, in way. Confronted with his own words, he claims he never said that. It's a little like Rush, too- when the going gets tough, just label and dismiss, take the proud to be oblivious route.

I wonder sometimes, too. Not because it's over my head but rather because some of the right wing spew is beneath contempt.

 

[Jhhnn]

Richard Mayhew writes some good stuff about ACA issues over at Balloon Juice. He is particularly good at pointing out the pros and cons of various parts of medical and insurance law. He has a post up now that explains facility fees and how hospitals are screwing over patients and Medicare by buying up clinics and designating them as outpatient facilities so they can collect higher fees from the patient and government.

It doesn't matter what laws are written, when it comes to money the greedy will find a way to manipulate the system to their favor. You can write the most bullet-proof law you think you can and still greedy people will find a way to circumvent it in some novel way. Greed will never go away, it just morphs into another form and continues.

All you can do is play whack-a-mole with these greedy assholes every time they pop up.

Indeed. The law needs to evolve to meet such challenges. At the present time, the ACA is in lockdown because Repubs would rather kill it than refine it.

 

[Jhhnn]

I'm not conservative... sigh.

ATOT in a nutshell. You either agree, or you're a Texashiker conservative.

Try an objective measure-

https://www.politicalcompass.org/test

I''m a left libertarian.

 

[zinfamous]

Nearly 48 hours and not one redacted post by OP.

impressive.

 

[Slew Foot]

Saying that they reimburse below the cost of care is often very misleading. They might reimburse below the AVERAGE cost of care, but that is something totally different.

For example, take MRIs. Buying an MRI machine, maintaining it, and staffing people to run it are all basically fixed costs: they are roughly the same if you do 1 MRI per day or 30. Now a hospital's ideal scenario might be all private insurance people paying high prices all day, but that often doesn't happen because there simply aren't enough people on private insurance that need MRIs. Now the hospital has a choice, they can either accept Medicare MRI patients and get lower payments for an MRI or they can get nothing. Since their costs are mostly fixed, taking Medicare patients increases the amount of revenue AND profit they make from that MRI machine.

It could be true that it was a money loser if they only took Medicare patients, but if they are using Medicare patients to soak up slack capacity (like basically all hospitals that take Medicare do), they aren't losing money, they are making more money.

This isn't true for every procedure and every case, but it's true for a lot of them. There's a reason why the vast majority of hospitals accept Medicare, and it's not out of the goodness of their hearts.

Staffing is anything but a fixed cost and is one of the highest running costs in operating a hospital. If you dont have patients that need a service, you can send the staff home early and not pay them. If the staff running the MRI costs $130/hr and your reimbursement is $100 per scan, youre losing money by keeping it open.

 

[fskimospy]

Staffing is anything but a fixed cost and is one of the highest running costs in operating a hospital. If you dont have patients that need a service, you can send the staff home early and not pay them. If the staff running the MRI costs $130/hr and your reimbursement is $100 per scan, youre losing money by keeping it open.

Are you claiming Medicare reimbursement is lower than even staffing costs? Please provide a source.

Edit: unless you can, my point stands. Medicare is better than idle equipment, therefore saying it reimburses at below cost levels is misleading.

 

[werepossum]

You didn't show that at all. You showed some hospitals have financial problems. That's not news. You showed rural hospitals are struggling, though your own article reported that the majority of them were in states that did NOT accept the "Obamacare" Medicaid expansion. (That is the opposite of the point you are trying to make, by the way.)

Regardless, rural hospitals have been struggling -- and closing -- for decades (i.e., long before the ACA) for many reasons. This was also explained in your article. Please explain your theory on how a hospital that's only admitting two patients per day is supposed to thrive. While it is unfortunate for the community when this happens, businesses fail when they lose almost all of their customers.

My own small rural home county's only hospital never closed, but it went through some very hard times because of very poor service. A friend's son had an accident weightlifting and the only doctor on call for the emergency room was a gynecologist. He diagnosed the kid with two badly broken wrists and two badly broken elbows, and put him in casts up to mid-bicep. Poor kid couldn't feed himself. On the follow up two days later he took more xrays and replaced those casts with casts up to his armpits. Now the poor kid couldn't even pee or wipe his own butt. Week later their own doctor came back from vacation, looked at all the xrays, diagnosed the kid with one simple wrist fracture and gave him one cast about six inches long. All that mental trauma because the emergency room physician was a gynecologist who hadn't read an xray since residency. I've delivered parts many times when the entire hospital was vacant and the only person there was the mechanic and a fellow high school student who worked the night shift as an aide. (And she wasn't allowed to open the exterior doors, much less enter the emergency room; all she could do was call someone. She was however hardworking, smart as a whip, and hotter than primordial fire, so I guess it all worked out. Don't know she got much practical nursing experience there though.) Never got better until they contracted with a service to provide competent emergency room physicians, so that people eventually developed some level of confidence that the local hospital might be a better choice than driving an hour to another.

Medicaid reimbursement is certainly one factor driving hospitals into the red, but I'd bet most of those hospitals are rural hospitals with emergency rooms. As such they are obligated to treat most of the people presenting, and clearly some reimbursement is better than none. It's a world easier to adjust one's business model to insufficient income than to no income.

 

[OverVolt]

//

 

[werepossum]

No its not, people on the internet are such unbelievably dense dumbasses with all this link nonsense. Did you know the internet is practically the last place to be in the know? A medium sized hospital costs $50-100 million for EPIC EHR's. I was being a little low so as to be more believable. There is $49 million set aside for the project with financing up to $100 mil available. First hand sauce bro.

Apparently it can go as high as $700 million

See here: http://www.forbes.com/sites/zinamou...ectronic-health-record-might-not-be-worth-it/

You might as well just take a dry erase marker and scribble "I don't know anything about the ACA" on your forehead.



Being required to buy multi-hundred million dollar EHR systems is a funny way to save money huh. If not Epic then its just a different system, like Cerner. Some hospitals outright refuse to use the systems and demand another. But they all more or less suck. Epic is likely the best.

Clearly there are things in Obamacare that are harmful to hospitals, but EHRs have value too, and after the initial cost of acquisition maintenance is much less, perhaps lower than maintaining paper records. And done right, they should save lives.

My biggest objection isn't forcing them on hospitals, it's the way they are being used. My neighbor is an RN with various accreditations and certifications, spent three decades as an emergency room trauma RN. When she couldn't take that anymore she moved on and did a variety of jobs, but encountered the same thing at several hospitals - someone prescribing medications with no physician name and no examination. It's typically things like blood thinners, but not everyone in hospital needs blood thinners. (For instance, I was scheduled for an operation early the next morning and some yahoo I'd never seen prescribed me a blood thinner - although that was on a paper chart he literally had to wander by and pick up.) And in several instances she saw prescriptions that would literally kill people, such as blood thinners every hour at what should be the daily dose, or sleeping aids for all patients regardless of whether they were already on medications which duplicate the effects or have interactions, or who had conditions which made sleeping aids dangerous. Most of these would be administered by young nurses with two year degrees if that, nurses who don't have the knowledge or experience to recognize dangerous doses.

 

[compcons]

Just to be clear, not every hospital (regardless of size) needs to buy Epic. The hospitals without those kinds of funds can certainly buy a less expensive EMR and even have it outsourced 100%.

That argument of $50M is like saying you can't have a job and drive to work because the Mercedes is too expensive.

 

[Slew Foot]

Are you claiming Medicare reimbursement is lower than even staffing costs? Please provide a source.

Edit: unless you can, my point stands. Medicare is better than idle equipment, therefore saying it reimburses at below cost levels is misleading.

Medicare will usually give you a small profit, medi-cal will leave you with a loss. I run a medical group, i know every number that goes in and out.

 

[fskimospy]

Medicare will usually give you a small profit, medi-cal will leave you with a loss. I run a meducal group, i know every number that goes in and out.

A few things:

1. Your personal group is anecdotal evidence, especially when we're talking about hospitals.
2. What procedures?
3. What costs are you counting when determining if medi-cal leaves you with a loss?

Often when people try and calculate these things they use average per-patient cost, which as I already mentioned is a bad idea unless you have no underutilized capacity.

 

[Slew Foot]

A few things:

1. Your personal group is anecdotal evidence, especially when we're talking about hospitals.
2. What procedures?
3. What costs are you counting when determining if medi-cal leaves you with a loss?

Often when people try and calculate these things they use average per-patient cost, which as I already mentioned is a bad idea unless you have no underutilized capacity.

i dont need to prove anything you, youre just some dumb liberal on the internet pushing their adjenda.

 

[OverVolt]

Just to be clear, not every hospital (regardless of size) needs to buy Epic. The hospitals without those kinds of funds can certainly buy a less expensive EMR and even have it outsourced 100%.

That argument of $50M is like saying you can't have a job and drive to work because the Mercedes is too expensive.

Epic is likely a bargain compared to everything taking 1.5x longer.

Anywho I'm done. ATOT is dumb.

 

[First]

Epic is likely a bargain compared to everything taking 1.5x longer.

Anywho I'm done. ATOT is dumb.

Yikes.

And this isn't even ATOT, turd.

 

[ivwshane]

I love comedy threads like this!