Obamacare wins? See you in 2014

kbot · Post by **kbot** » 10-25-2013 07:10 PM

True, but that still does not alleviate the underlying issues that are built into the system.

Look at this example: CMS/ Medicare/ "the government" REQUIRES as a part of he Conditions of Participation, that the organization actively collect and make available a whole range of data.

So, let's look, for example, at CT Scans.

In order for a patient to even be considered for a CT Scan, the ordering physician MUST get a prior authorization (permission) form the patient's insurance company. So, that's the physician, his clerical person who contacts the insurance company, and the insurance company's contact person.

Then, the exam must be scheduled. Again, the office's clerical person, and the facility's scheduling dept person, who must now run the request through software to check for medical necessity (does the reason given match the cpt code for the exam). If not, try again....

The patient MAY need to take a prep (enter the Pharmacy to review), and MAY need Lab tests to check kidney function prior to giving contrast. Otherwise, the patient's kidneys may shut down (that would be a bad thing...).

The patient needs to be screened and any meds the patient is taking cross-checked against the contrast media being used to determine if there might be drug-drug-interaction (enter the Pharmacy again) then if there are no issues, the test proceeds.

IF a critical finding is discovered, this MUST be communicated to the patient's ordering doc, and this MUST be documented. Also, what occurred as a result of the finding. This MUST BE documented.

Now, if contrast was used, what type, how much was used. This MUST be documented.

Now the coders get involved and they code the exam, type of contrast used, how much and this information is picked-up by Medicare and they track compliance.

If this information isn't documented, we don't get paid.

Now, with the threat of reduced reimbursements, the costs associated with millions of CT Scans performed annually being paid less than what is expected is huge, so, facility's will want t do what they can in order to maintain compliance.

But, get this, compliance in this scenario isn't all that cut and dried. Medicare "may not" pay (the charges are bundled). BUT, the threat is inherent. Don't document and you may not get paid.

So, they're looking for patterns of abuse. So, in order to avoid patterns of abuse, facilities hire whole depts of people just to comply with regs that actually don't amount to much.

They're good for statistical analysis, but, do they really contribute to overall health? Some would question that. We have an extremely bloated system - but its mostly due to these regulatory requirements

voguy · Post by **voguy** » 10-26-2013 07:22 AM

I agree with you, KBOT. Medicine has become as bureaucratic as the government. And we know that anything run by government is highly inefficient.

Dare I say there are more paper pushers in medicine than there are pill pushers?

I look at my own medical group where there are five doctors, and 27 others. In fairness, five are probably LPNs or RNs, but the rest just sit there and churn out the paperwork.

The thing that bothers me is the level of care, or quality has diminished over the years. It's now what I call "Walmart Medicine" where the goal is to get the numbers through the door, get the billing, and move on. I notice A LOT of mis-diagnosis by doctors, and one of those reasons is doctors don't listen to patients.

I think the last time I was in I spent a whole 3 minutes with my doctor who gave me some pills and sent me on my way, only to return to urgent care later, and a third trip to the doctor. First, what about quality of care. Second, this whole healthcare debate is about controlling costs. Tell me, why do we have the time and money to spend on the second and third time, but not the first?

Cherry Kelly · Post by **Cherry Kelly** » 10-26-2013 11:19 AM

An associate retired from a billing department at a large hospital - year or so ago. She reports how many times they would often have to file reports with insurance companies - because - policy changed from the time the patient went in and was released and the hospital had to fill out the NEW form. Often they did not get paid for several months. Then some things that had been covered was no longer covered or only partially covered so they would have to contact the patient to get fully paid.

That was then. Another associate who was working in a similar area - different hospital was informed that due to the ObamaCare, the work hours would be cut. Then they had a big mandatory meeting to go over the original law. Sometime later they had a mandatory three day meeting to discuss the additions (pertinent to their department). This person quit about a month ago and took early retirement...said there was no way anyone in that department could do all the things required JUST to comply with ACA.

ehh.. what a mess!

kbot · Post by **kbot** » 10-26-2013 12:28 PM

voguy wrote: I agree with you, KBOT. Medicine has become as bureaucratic as the government. And we know that anything run by government is highly inefficient.

Dare I say there are more paper pushers in medicine than there are pill pushers? I look at my own medical group where there are five doctors, and 27 others. In fairness, five are probably LPNs or RNs, but the rest just sit there and churn out the paperwork.

The thing that bothers me is the level of care, or quality has diminished over the years. It's now what I call "Walmart Medicine" where the goal is to get the numbers through the door, get the billing, and move on. I notice A LOT of mis-diagnosis by doctors, and one of those reasons is doctors don't listen to patients.

I think the last time I was in I spent a whole 3 minutes with my doctor who gave me some pills and sent me on my way, only to return to urgent care later, and a third trip to the doctor. First, what about quality of care. Second, this whole healthcare debate is about controlling costs. Tell me, why do we have the time and money to spend on the second and third time, but not the first?

I agree with you. One result of Obamacare's requirement of the implementation of electronic medical records is that staff spend much more time inputting information rather than focusing on the delivery of patient care, because everything needs to be documented, which in turn means that everything - all data - will be collected and analyzed.

Its been happening for a while now. Did you ever see those ads run by hospitals that say that this hospital or that hospital scored in the top 10 hospitals nationwide? How do you think they know that? The (the accrediting agencies) collect data that's been input by a whole group of people.

With Obamacare, the input and collection of data will be continuous and never-ending. The goal is to create "better outcomes", but some fear it will lead to rationing as studies are conducted that will be able to utilize much more data.

I know that when I was hospitalized I didn't see the staff all that much, and when I did it was because they were coming-in to give me something r to check something, but every action was documented in the computer system. Every med has a bar code, as do patient ID bracelets. Lab specimens are bar-coded, etc.

Used properly, this can be a good thing. But, from what can see this is a lot of time staff spend with the computer system rather than with the patient.

kbot · Post by **kbot** » 10-26-2013 12:40 PM

Cherry Kelly wrote: An associate retired from a billing department at a large hospital - year or so ago. She reports how many times they would often have to file reports with insurance companies - because - policy changed from the time the patient went in and was released and the hospital had to fill out the NEW form. Often they did not get paid for several months. Then some things that had been covered was no longer covered or only partially covered so they would have to contact the patient to get fully paid.

That was then. Another associate who was working in a similar area - different hospital was informed that due to the ObamaCare, the work hours would be cut. Then they had a big mandatory meeting to go over the original law. Sometime later they had a mandatory three day meeting to discuss the additions (pertinent to their department). This person quit about a month ago and took early retirement...said there was no way anyone in that department could do all the things required JUST to comply with ACA.

ehh.. what a mess!

Yup........ What people forget is that there are already provisions in place that pre-date Obamacare that will affect hospitals for many more years to come that were enacted under the Deficit Reduction Act as other measures. Plus insurers just arbitrarily decide on their own what they will and won't cover. One of my favorites is one of our healthcare exchanges here in mas that will cover the cost of a nuclear medicine scan....... but they won't pay for the isotope. Kinda hard to do nuc med scan without the isotope. But, this is how they get around things - "Well, we offer to cover the test...". Sure, but they won't pay for the supplies that are needed to even DO the test. Some of these isotopes can easily run into the thousands of dollars because they're made in nuclear generator labs which are not only heavily regulated but also carry safety issues.

What a mess is right

voguy · Post by **voguy** » 10-26-2013 01:08 PM

kbot wrote: Did you ever see those ads run by hospitals that say that this hospital or that hospital scored in the top 10 hospitals nationwide? How do you think they know that? The (the accrediting agencies) collect data that's been input by a whole group of people.

That, and the fact that some rig the ballot process. Our local hospital was "caught" rigging the results amidst a MRSA outbreak. Basically, (using round numbers), if you have 100 patients, 7% get MRSA, and 19% complain and give them a failing grade, you can't say you have a 97% satisfaction. That is, you can..... if you toss out 25% of negative complaints.

FWIW, their biggest issue was running ads about how you would see a doctor in less than 30 minutes upon arrival at the ER or Urgent Care. Media documented it as 2-hour 23-minutes. Proving again, you can say anything in advertising.

Riddick · Post by **Riddick** » 10-27-2013 11:32 AM

From the "Hey, WE'RE Not Complaining!" Dept.

The Obamacare Success Stories
From a retired business owner in Arkansas to a young freelance filmmaker in Hollywood, Eleanor Clift highlights a few of the people the media has found who are happy to have Obamacare.

Cherry Kelly · Post by **Cherry Kelly** » 10-28-2013 11:04 AM

BUT gee -- Obama claims he knew nothing about OBAMACARE (ACA) problems...

and NOW he claims he knew nothing about NSA...

what's next - when will he claim he knew nothing about all the IRS rule changes...

OR any of the other scandals....

HE still has not explained where he was when Benghazi happened.

kbot · Post by **kbot** » 10-28-2013 11:10 AM

Cherry Kelly wrote: BUT gee -- Obama claims he knew nothing about OBAMACARE (ACA) problems...

and NOW he claims he knew nothing about NSA...

what's next - when will he claim he knew nothing about all the IRS rule changes...

OR any of the other scandals....

HE still has not explained where he was when Benghazi happened.

The new Sgt Schultz???????

kbot · Post by **kbot** » 10-28-2013 11:15 AM

Interesting article. Using Obamacare's system, MOST peple have opted to sign-up for state-administrered MEDICAID rather than private or federal programs. Even so, many GOP-controlled states have opted to not expand Medicaid within heir states. The graphics (these didn't carry-over to this post) associated with this article will continuously be upgraded

115,000 people have signed up through the exchanges. At least 82,000 got Medicaid.
on October 25, 2013

Editor's note: The graphics in this story will be continually updated to reflect our latest data, but the original text will remain. On some Web browsers, the most current version of our graphics won't show up until you reload the page or clear your cache.

Dan Diamond, Managing Editor

Two conclusions from spending three-plus weeks compiling and analyzing early enrollment data from the Obamacare exchanges.

1) Lots of people are getting coverage through the 15 state-based exchanges. 2) Most of them (so far) are signing up for Medicaid.

Here's a quick state-by-state look at that enrollment data, as it stood on Thursday afternoon.

With a few exceptions—mostly in the states that have had tech glitches with their exchanges—officials have been consistently updating enrollment figures and growing increasingly transparent when releasing that data.

That's allowed us to get an early read on how many people have used the state exchanges to pick a plan. And as of Oct. 24, we'd counted at least 115,060:

http://www.advisory.com/Daily-Briefing/ ... h-Medicaid

voguy · Post by **voguy** » 10-28-2013 04:15 PM

If you deny you know anything, and the people won't press the issue, you have in effect dodged the bullet.

kbot · Post by **kbot** » 10-29-2013 10:41 AM

And what constitutes "pressing the issue"? Most press conferences are rigged anyway withquestions being submitted in advance - they don't like your question - you won't be called-on

Cherry Kelly · Post by **Cherry Kelly** » 10-29-2013 12:58 PM

so you write a question - then change it and add what you really want to ask!! Seen that a few times - and watched the person answering just walk off....

Oh newest fix to the OC program - crashed.

AND gee you can't find information about alternatives...

---
OH BTW - some states have limits of who and how many qualify for Medicaid -- or total allowed on the program.

voguy · Post by **voguy** » 10-29-2013 03:16 PM

kbot wrote: And what constitutes "pressing the issue"?

The electorate becoming enraged and demanding change.

When the protests start, such as in France and other countries overseas, that's when the socialists will take their money and run away. As soon as they are gone, and some people with brains start turning things around you'll see major changes.

kbot · Post by **kbot** » 10-29-2013 05:26 PM

I was listening to a segment on the radio going to work this morning - might have been last nights Coast show - and the speaker was talking about how he thinks that the pendulum is about to swing back the other way - people are pissed with the progressive agenda of wealth redistribution and expanding the social agenda. He quoted some study that said that the country now has more people collecting some form of aid from the government than working. Some collecting you can expect in the form of social security, but some is due to enabling generations to collect.