So, I'm sure a lot of you know Medicare's new idea about how to cut cost -- I mean enhance patient safety and quality of care.
To decide that once you have been admitted to the hospital for CHF that you shouldn't be seen back in a hospital for 30 days for any reason, even if said-reason-for-return-visit has NOTHING to do with CHF, Medicare just won't pay. Brilliant. So when granny has a fall and hip fracture 28 days after a 3 day hospitalization for CHF, Medicare calls foul and refuses to pay? The brazen ignorance is breathtaking.
Of course, I'd like to think that it isn't my problem if my hospital isn't getting paid for these things. I'm supposed to be immune to collections. Except in a healthcare system that has never valued primary care physicians, it suddenly finds itself without a way to get adequate follow up for our CHF discharges. I ask for a 1-2 week follow up with the PCP and they can't get them in for a month? Well damn. The solution must be to make the hospitalists do it. We'll call it something fancy ... like "bridging" clinics. It's like putting a band-aid on a spurting radial artery.
How many of you are being threatened with this?
This honestly makes me want to look into practicing medicine in New Zealand or Australia. Or to get out altogether. We have a healthcare system that has ensured (by virtue of its insuling primary care reimbursement) such a shortage of PCPs, that when we need them most, we don't have them. So let's make our hospitalists assume duties that make their job look more and more like the career they shunned. Then let the financial penalties roll downhill. If the hospital isn't getting paid, let's punish the hospitalists for their inability to make up for our shortsightedness.
Keep it up, CMS. When you punish our hospitals like this, they make our lives hell. Because they have shareholders to answer to. Less and less of us are going to put up with this abuse. As if you don't have enough doctors opting out of your insulting reimbursements... can you really afford to continue to piss us off?
Wednesday, October 28, 2009
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4 comments:
I agree wholeheartedly with the spirit of your post- it is a tragedy that we put so little value on Primary Care. As a medical student, primary care looks like a suicide option.
I guess I just wonder why doctors have abdicated power in almost every arena, including the political one. I've been told that the strongest health lobbies are Insurance, Pharma and Hospitals. I joined the AMA, but geez, what a terrible way to get business done.
Do you have any thoughts for building a power base?
It's too soon to move to New Zealand.
I hadn't heard about the "no-pay in 30 days" proposal. I'll worry about it when it seriously looks like it's going to happen.
Medicare's proposal indeed sounds ridiculous. And people want to give even MORE power to government beaurocrats?
Before you complain about medicare and/or "government beaurocrats", do this simple exercise:
1) Find a private, individual policy that offers better coverage and less bureaucracy.
2) Note the price of that policy.
Quote)
1) Find a private, individual policy that offers better coverage and less bureaucracy.
2) Note the price of that policy."
And then go back and figure (1) what the real cost of the government plan is with all the taxpayer subsidies and (2). figure out what the price of the fed policy would be if they actually couldn't use their coersive powers to mandate what they pay (remember that MCare pays between 20% and 40% LESS than the evil insurance companies.
After you do that, we'll start an apples to apples discussion.
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