And so it begins.

[Matt1970]

Yes, when hospitals face a financial penalty for having excessive hospital acquired infections, they tend to work to lessen those, which saves money because we don't have to treat those hospital acquired infections.

This is econ 101. Guess you skipped that class, huh.

I will remember next time you complain about government spending that you were against even attempting to give hospitals an incentive to cut down on waste. Like I said, it's the Hated Obamacare so you have to be against it. It's a culture war thing.

A lot of hospitals don't have the funding to treat the patients properly to begin with. I gots to take me that econ 101 class that teaches financially penalizing them helps the problem. And we all know damn well if Obama came out and said he was going to increase funding to hospitals with hospital-acquired infection problems you would be singing those praises till the cows came home. No you made me come in here and debate you one more time when I said I wouldn't. See what you done made me do?

 

[Hayabusa Rider]

Do you think the govt paying more money to hospitals that offer poor performance is a good policy?

Cutting funding by 1% to hospitals is the same as docking someone's salary for doing a piss-poor job.

Hospitals know how to improve care: have adequate nurses. If they want more money, they need to spend more money to provide adequate care. If they don't want to spend the money to provide adequate care, they shouldn't be given the same amount of money as a hospital that does want to spend money to provide adequate care.

This is much like "Blacks in poverty just are lazy because all they need to do is make more money". So to "inspire" them we kick them off all social services because they should just get a job. Problem solved. Well no.

"having more nurses". You just cut their funding so they have less money and with less money you are going to have more nurses? Those lazy nurses. They just need to work longer shifts and bootstrap themselves into prosperity and great health care.

Makes no sense.

Instead do something which does. There are reviews and accreditations by organizations which exist for that purpose. Where there systemic institutional problems, like hospital acquired infections which are demonstrated controllable, yes use the stick. If on the other hand there isn't enough staffing to do the job in a particular setting then don't have people make bricks without straw, give INCREASED funding for that purpose and monitor the results, then evaluate and modify as needed.

 

[Hayabusa Rider]

Yes, when hospitals face a financial penalty for having excessive hospital acquired infections, they tend to work to lessen those, which saves money because we don't have to treat those hospital acquired infections.

This is econ 101. Guess you skipped that class, huh.

I will remember next time you complain about government spending that you were against even attempting to give hospitals an incentive to cut down on waste. Like I said, it's the Hated Obamacare so you have to be against it. It's a culture war thing.

I think that since government hasn't brought the middle class back to its recent historical point we should pay less in taxes. Since highways aren't being maintained, we cut taxes. Since people are still in poverty let's send less money for the programs. Why? Econ 101. Things will get better if we don't give the tools for the job. Somehow I think not.

 

[Matt1970]

Uhm, guys, Fern never "advocated" for giving poor hospitals more money. He simply brought up the idea of cutting the funding to a poorly rated hospital may not help them be better. He is saying that if that is the only mechanic behind trying to get better healthcare (to withhold funds from poor performers) then we may be making the problem worse. He never said to give poor performers more money and he even said he hasn't given it enough thought to formulate an answer to the problem. He's only throwing it out there as a possible issue. No need to jump on him or make this out to be some conservative hypocrisy.

I'd think a good way to tackle the problem is to have a group that comes in and does a healthcare audit on the hospital. Give the poor performer a huge list of ways to improve and help them get out of the hole they are in. Require that the money from the penalty go into fixing the problem found in the audit. Seems likes a good start.

This just the blatant hypocrisy. They almost always advocate more money to fix every problem except here because, well, we all know there is no wrong in Obama or his policies.

 

[fskimospy]

A lot of hospitals don't have the funding to treat the patients properly to begin with. I gots to take me that econ 101 class that teaches financially penalizing them helps the problem. And we all know damn well if Obama came out and said he was going to increase funding to hospitals with hospital-acquired infection problems you would be singing those praises till the cows came home. No you made me come in here and debate you one more time when I said I wouldn't. See what you done made me do?

A lot of hospitals don't have sufficient funding to prevent hospital acquired infections??? Are you kidding me? Do you know how you can get rid of a lot of these infections? Washing your hands more often. Are they out of soap and water?

You should take an Econ 101 class. Maybe you'll even read a case study about how this has already been tried on the state level and led to major decreases in hospital acquired infections. Maybe they were rich enough to afford soap though.

Just because you're a hypocrite here doesn't mean the rest of us have to be.

 

[fskimospy]

I think that since government hasn't brought the middle class back to its recent historical point we should pay less in taxes. Since highways aren't being maintained, we cut taxes. Since people are still in poverty let's send less money for the programs. Why? Econ 101. Things will get better if we don't give the tools for the job. Somehow I think not.

None of your examples make any sense.

Government budgeting doesn't operate on the same principles as government spending is not constrained by revenue.

The goal of programs for the poor is to alleviate the negative parts of poverty, they are at best hoping for positive poverty outcomes as a second order effect.

For hospital acquired infections not only are many preventable with simple and cheap procedures, efforts to reward and penalize hospitals for them have already been shown to be effective in the real world.

 

[Matt1970]

A lot of hospitals don't have sufficient funding to prevent hospital acquired infections??? Are you kidding me? Do you know how you can get rid of a lot of these infections? Washing your hands more often. Are they out of soap and water?

You should take an Econ 101 class. Maybe you'll even read a case study about how this has already been tried on the state level and led to major decreases in hospital acquired infections. Maybe they were rich enough to afford soap though.

Just because you're a hypocrite here doesn't mean the rest of us have to be.

LOL, so we just aren't washing our hands enough. That should fix the problem.

 

[fskimospy]

LOL, so we just aren't washing our hands enough. That should fix the problem.

I'm not sure why you're laughing, except out of ignorance. The source of a good portion of hospital acquired infections is insufficiently rigorous hand washing and similar sanitation protocols.

 

[Hayabusa Rider]

None of your examples make any sense.

Government budgeting doesn't operate on the same principles as government spending is not constrained by revenue.

The goal of programs for the poor is to alleviate the negative parts of poverty, they are at best hoping for positive poverty outcomes as a second order effect.

For hospital acquired infections not only are many preventable with simple and cheap procedures, efforts to reward and penalize hospitals for them have already been shown to be effective in the real world.

You mean if we cut staffing when staffing is a concern it will make things better? I surely can find things that are done improperly in hospitals which adversely affect outcomes which could be corrected. I take it these restrictions will be solely restricted to such cases? Adverse outcomes from insufficient staff or places which serve in poverty stricken areas where increase in deaths occurs due to conditions outside an ERs control will be not be considered reasons to cut funding? I am serious BTW. Precisely who and who does not get smacked and how is that determination made so it reflects the reality of the institution and it's surroundings? Does it rely on mere aggregate statistics or is there a considered review of circumstance and actually help? Just how is this done? Senior care facilities have a higher incidence of deaths. If funding is insufficient in a particular setting how is that handled? Cut funding again? One size fits all?

 

[WHAMPOM]

Conservatives still butt hurt over President Obama enacting the Conservatives' own proposed alternative to Hilary Care. Plus he's Black and from Kenya.

 

[OverVolt]

..

 

[Matt1970]

I'm not sure why you're laughing, except out of ignorance. The source of a good portion of hospital acquired infections is insufficiently rigorous hand washing and similar sanitation protocols.

The ignorance is your reply to sufficient funds to just use soap and water. Ignore all that crap they have to do like changing gloves with each patient, extra steps to detect diseases, masks, patient isolation, surgical tool cleaning, operating room recirculating air systems, etc, etc. Screw all that. $1.99 bar of anti-bacterial soap is all you need.

 

[fskimospy]

You mean if we cut staffing when staffing is a concern it will make things better? I surely can find things that are done improperly in hospitals which adversely affect outcomes which could be corrected. I take it these restrictions will be solely restricted to such cases? Adverse outcomes from insufficient staff or places which serve in poverty stricken areas where increase in deaths occurs due to conditions outside an ERs control will be not be considered reasons to cut funding? I am serious BTW. Precisely who and who does not get smacked and how is that determination made so it reflects the reality of the institution and it's surroundings? Does it rely on mere aggregate statistics or is there a considered review of circumstance and actually help? Just how is this done? Senior care facilities have a higher incidence of deaths. If funding is insufficient in a particular setting how is that handled? Cut funding again? One size fits all?

uhmm, it is risk adjusted.

Again, this has proven to be effective in the real world. It is literally the lowest hanging fruit we could possibly find in terms of eliminating wasteful spending. It's a no-brainer.

 

[Matt1970]

Short staffed nurses often forget to wash their hands in a rush, or to properly sanitize equipment. IE bleach for C diff equipment or handwashing for C diff since alcohol is ineffective. But if you're patient ratios are too high because the hospital is too poor and you're 11 hours into a 12 hour shift, yea its gonna lead to worse care.

Alot of the poorer performing hospitals just happen to be the ones in poorer neighborhoods with less rich doners, sicker patients, and more medicare payers. Not much different than schools in bad neighborhoods. There is one city hospital I know of that is practically covered in MRSA because of all the homeless population who visit there who are MRSA carriers and its not really their fault. I think they are going to go out of business I already got a new job at a different hospital. Its that bad. So then who is going to serve that community huh? Increase access to care? What? Are the democrats joking? All because their population they serve is sicker doesn't mean they didn't provide good care. Its actually known as a good hospital. But they are now on shaky financial footing much to their detriment.

Sounds like they need their funding cut. That should get them in line.

 

[fskimospy]

The ignorance is your reply to sufficient funds to just use soap and water. Ignore all that crap they have to do like changing gloves with each patient, extra steps to detect diseases, masks, patient isolation, surgical tool cleaning, operating room recirculating air systems, etc, etc. Screw all that. $1.99 bar of anti-bacterial soap is all you need.

Are you just arguing for the sake of arguing now? I am telling you that failure to follow established hand sanitation protocols is a leading cause of hospital acquired infections. It is not a lack of funding that causes people not to follow those procedures, it is a lack of institutional controls.

I have noticed by the way that nobody seems to have an answer to the fact that such payment based schemes have already been successful when implemented. You would think that an evidence based accountability measure would be the dream of conservatives. Guess that's only the case when it's not part of the Hated Obamacare.

 

[OverVolt]

Anyway more:

http://kaiserhealthnews.org/news/value-based-purchasing-medicare/

Most winners from last year stayed winners and losers stayed losers.

How A Hospital Is Rated

Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.

The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations. Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.

 

[Darwin333]

Or to put it another way: Do you think the govt paying less to hospitals that need to improve is a good thing?

I agree with some sort of penalty for poor performers, but recognize that cutting funding is no way to get the improvement we seek. And the latter is the real objective here.

The rule and its application seem terribly simplistic to me. Perhaps it's only that the article mistakenly gives that impression.

Fern

Hmm, thats a good point that I didn't think of. A hospital performs poorly so you reduce their funding making it even harder for them to increase performance.

We DO need a way to get poor performing hospitals to perform better. Getting injured or infected in a hospital when its "easily" avoidable is simply unacceptable, so how do we get them to reduce these avoidable injuries and infections? The other "punishment" mechanism is fines which is virtually the same thing.

In my workplace when I get frustrated getting compliance from my guys (proper use of PPEs and such) I start hitting them directly in their pockets and it works wonders. We also give out safety bonuses at the end of the year equal to 10% of the companies profit that year. Every single accident or safety violation comes directly out of that pool of money so they are highly motivated to "police" each other.

No way the .gov could implement that on their own but perhaps they can "persuade" hospitals that have failing scores to implement a similar program? Nothing gets people to do something better than money going into or coming out of their own pockets. They tend to care a lot less when its money out of the pockets of someone else (like the hospitals).

 

[fskimospy]

In case anyone is interested in one example:

https://innovations.ahrq.gov/profil...ificantly-reduce-hospital-acquired-conditions

 

[Hayabusa Rider]

uhmm, it is risk adjusted.

Again, this has proven to be effective in the real world. It is literally the lowest hanging fruit we could possibly find in terms of eliminating wasteful spending. It's a no-brainer.

Define "risk adjusted". Are underfunded hospitals with inadequate staffing treated equally with those who are well to do?

 

[Subyman]

Are you just arguing for the sake of arguing now? I am telling you that failure to follow established hand sanitation protocols is a leading cause of hospital acquired infections. It is not a lack of funding that causes people not to follow those procedures, it is a lack of institutional controls.

Perhaps, but its not the only issue. You are hung up on this one procedural issue, but that isn't the only issue affecting poor performing hospitals. You are hand waving away the entire discussion by trivializing the problems hospitals face to only hand washing and basic sanitation.

 

[theeedude]

Same conservatives who are bashing Obamacare for cutting 1% from under-performing hospitals have no problems cutting funding much more to under-performing schools, and tell us at every opportunity that increasing funding will not improve education or pretty much any public services outside of Obamacare.
GOP is ready to abandon any pretense of consistency to bash Obamacare.

 

[Hayabusa Rider]

Same conservatives who are bashing Obamacare for cutting 1% from under-performing hospitals have no problems cutting funding much more to under-performing schools, and tell us at every opportunity that increasing funding will not improve education or pretty much any public services outside of Obamacare.
GOP is ready to abandon any pretense of consistency to bash Obamacare.

Your equal and opposite side. You want to not think beyond cutting for Obamacare here and the Republicans want to not think beyond cutting for schools.

Both seem simplistic solutions for complex problems. There are times when it might be appropriate to financially act against both in some circumstances, but that depends on circumstance and not just stupid aggregate statistics.

 

[theeedude]

Your equal and opposite side. You want to not think beyond cutting for Obamacare here and the Republicans want to not think beyond cutting for schools.

Both seem simplistic solutions for complex problems. There are times when it might be appropriate to financially act against both in some circumstances, but that depends on circumstance and not just stupid aggregate statistics.

So first Obamacare was too complex, now it's too simplistic. Tomorrow this BS complaint will fall by the wayside as previous ones have, and it will be too complex again. And on and on.

 

[Matt1970]

Perhaps, but its not the only issue. You are hung up on this one procedural issue, but that isn't the only issue affecting poor performing hospitals. You are hand waving away the entire discussion by trivializing the problems hospitals face to only hand washing and basic sanitation.

Of course it isn't the only issue, and he knows that, but as long as he has one issue that probably wouldn't be effected by financial penalties, it's a good plan. Never mind a hospital may no have funding to upgrade a ventilation system or build a new wing so they have enough beds to isolate a patient, as long as they can continue to buy soap then there shouldn't be a problem.

 

[Matt1970]

So first Obamacare was too complex, now it's too simplistic. Tomorrow this BS complaint will fall by the wayside as previous ones have, and it will be too complex again. And on and on.

We wouldn't expect you to even find a single fault in Obamacare, hell I think you were giving it credit for the economy recovering. And god forbid something did go catastrophically wrong with one of it's policy changes you would just resort back to calling it a republican plan.