Watch Out, Grandma: ObamaCare risks for the elderly

On May 7, the Obama administration boasted that ObamaCare was improving health-care quality for seniors, and it pulled out a bag of statistical tricks to prove it. But a closer look shows that it’s not improving care. It’s skimping on it, socking seniors with unexpected bills for “observation care” and likely shortening their lives.

President Obama’s Department of Health and Human Services announced that fewer seniors discharged from the hospital are returning for additional care within a month’s time. HHS claims that this drop in “readmissions,” from 18.5 percent in 2012 to 17.5 percent in 2013, signals quality improvement.

Nonsense. The 50 best hospitals according to US News & World Report’s Best Hospitals annual rankings have above-average readmission rates.

Nationwide, readmissions are dropping because Section 3025 of ObamaCare punishes hospitals if a senior returns within 30 days.

What happens to the senior treated for a heart attack who rushes to the hospital a week later feeling faint, possibly because of arrhythmia?

To dodge the penalty, hospitals put the patient under “observation.” It’s just a word on the chart. The patient may get the same tests and be put in the same room as if he had been admitted.

This is one of the few GOOD things in ACA. Hospitals have been doing a crap job on outcomes, sending someone to work with a person to get them strong after a surgery or and long stay is the kind of thing W. Edward Demming suggested 30 years ago. Hospitals should be on notice from insurance and patients that bad work is their responsibility and they pay to make things right.

What is your definition of bad outcomes? I work in a hospital, and this is what I see regarding re admissions.
1. The patients have a very serious disease, so a readmit is expected.
2. Patients are non compliant, in diseases such as congestive heart failure, so that they get constantly readmitted.
3. Social issues at home.
If you are really angry about “crap” outcomes, then there is really no need to go to a hospital. Treat yourself instead. To even suggest that there is anything “good” about the ACA really gets my hackles up.

What people do not realize, is that when a hospital accepts Medicare patients ( and they all have to), that Medicare forces them to apply the same rules to all insurance plans. Therefore, your Blue Cross plan that you get from work follows Medicare rules. The observation rule is being used on everyone now, not just Medicare. The writer of this articles implies that hospitals are putting patients under observation by choice, but there is strict parameters that they have to follow in which they determine if patients are observation or inpatient. The parameters (written by a company called Milliman- I sure would like to know who is behind this company), has made the rules stricter and stricter, so more and more patients are now falling under observation care. That means the patient pays more out of pocket than inpatient care. This is how they are “reducing “health care costs.

Veterans Affairs and Death by Bureaucracy

Posted By Arnold Ahlert On May 20, 2014 @ 12:19 am In Daily Mailer,FrontPage

There may finally be a scandal engulfing the Obama administration that even Democrats and their media collaborators can’t obfuscate. What happened at the VA facility in Phoenix, AZ, where employees created two sets of waiting lists to make it seem patients were being treated in a timely manner—and as many as 40 veterans allegedly died while languishing on the secret list—is an anomaly. Six more whistleblowers from around the nation have stepped forward, alleging the Department of Veterans Affairs (VA) facilities they worked at also “cooked the books.”

The despicable subterfuge, allegedly occurring in at least seven VA Medical Centers in Arizona, Colorado, Pennsylvania, Georgia, Texas, North Carolina and Illinois is as simple as it was heartless. The official waiting list is the one that ostensibly met the VA’s policy, implemented by Secretary of Veterans Affairs Eric Shinseki in 2010. It set a 14-day time limit to provide care for a veteran making an initial application for an appointment. Yet by the agency’s own admission, only 41 percent of new VA medical patients were seen within that period in 2013, down from 90 percent in 2012.

THE REST OF THE SCANDAL
http://www.frontpagemag.com/2014/arnold-ahlert/veterans-affairs-and-death-by-bureaucracy/print/

Veterans Hospitals Death Panel Scandal Is a Preview of Life Under Obamacare.

The best example of how Obamacare’s “death panels” is going to work, is the scandal of the unknown number of veteran sentenced to death for being denied or delayed medical assistance by government bureaucracies of the V.A.

That might be true if the hospital foots the bill. Instead, they skimp on the care. They do not make things right. Instead they discharge too soon and then when the patient returns deathly ill, they call it observation and bill the patient, per the article.

I ran an adult foster care 25 years ago and at the time “Diagnostic Related Groups - DRG’s” were a recent “improvement” to Medicare to hold down costs. DRG’s average out the amount of time it should take for a hospital stay based on the presenting condition - heart attack, 15 days; stroke 10 (not necessarily the right number of days, just an example for clarity).

If the hospital discharged quicker, they got to keep the money saved, if slower, they had to pay for the care and were not reimbursed.

As a result, foster cares were getting people who were not ready to be discharged, so that the hospital could keep the difference. This new penalty for readmission will exacerbate the problem, not fix it. But the system will have money to pay for illegals, so I guess it’s all good - sarcasm off.

I worked in hospitals as a medic over 25 years ago - medicine has changed - a lot. One hospital worker suggested that many of the problems are patient centered. I responded as follows.

Patients are non compliant - often this is because they live alone. Many Dallas hospitals now send home health people to assist them and thus reduce the return admission. Social issues at home - see above!! to say that healthcare is without need of a major overhaul is to say that GM makes FINE cars.

I want health care to be about health care, not financing social problems. It should also be up to the patient to request home assistance, because hospitals are spending too much money (with social workers, care managers )to work on these social problems,.This results in decreased staffing of bedside nurses in the hospital. You have a primary care physician, it is up to you to see that doctor after discharge, and obtain the necessary prescriptions for home health, which I also think is way over abused. When I started nursing in the 1980’s , we expected patients to be participatory in their health care needs post discharge. Now, everyone needs handholding because they will not do anything for themselves, even including making post hospital appointments. Do you think that a home health aide to help with activities of daily living should be considered a “health” issue? I consider it a social issue. We are spending too much health care dollars on social problems, to the detriment of money spent on actual health care. I also think a patient who has - lets say- congestive heart failure- is non compliant because they are not taking their meds, and eating the wrong foods. Not because they are living alone. Heart failure is one of the top readmits in the Medicare population.Now, we as a society have to pay people to go into the homes to deal with this. It is a social problem, not a health care problem. Hospitals now are being made to not only deal with health, but with the social ills of the society.

I would also like to add, when the healthcare system ( which means hospitals) is burdened with the societal problems, less money goes into healthcare. That home health company who goes into homes for home physical therapy ( way overabused) is siphoning dollars away from someone who needs cancer treatment. You will not believe how many patients want home PT, because it is more “ convenient” for them. Except that, the most productive part of rehab is actually getting to the PT clinic and back. A hospital should be a place where you get care when you are acutely ill, you get discharged, and your personal physician takes over your care. But, under the current system, the responsibility has shifted to the hospitals. That is not right.

I agree that health care needs some changes. But adding a layer of don’t give a flying fig govt bureaucracy that works so well (not!) for medicare and va benefits is not the way to do it.

Obamacare will inherently increase expenses and reduce coverage because of the unwieldiness of the bureaucracy, all the incentives to grow it and none to make it more efficient. And I can guarantee that the intent is to reduce coverage for the elderly in order to subsidize coverage for others - illegals, young people who don’t want to buy coverage anyway.

There is no layer being added, there is a new rule - get people well or don’t get paid. The guy that taught Toyota how to build quality into their cars, W. Edward Demming, wrote about the failure of hospitals to stop infections and to stop the revolving door of patients sent how too soon or without the possibility of help when discharged....30 years ago. Now a hospital can’t get paid if they keep getting the same person back every week for the same illness. Surprise surprise that cost has gone down in the past 18 months. Why because they are helping the patient. Oh yea the hospitals still seem to be making profits. As a guy to the right of Rush and a former medic I think I can’t be called an ACA supporter.

Wow. Do you not know any elderly people personally, or do you just dislike and disrespect the ones you do know.

Did you read my previous post. Hospitals work quite a bit along the lines of a financial model and it’s not because of abuse of the system by the elderly. As I said, my experience is with the adult foster care system. Hospitals discharge sicker and sicker patients so that they can collect the difference on the Medicare payment. The home health is needed more because of this practice.

I also know that there was no way my Mom after her knee surgery could have gotten to the hospital, nor after her cerebral hemmorhage. She was not non-compliant, she was just very ill (and discharged prematurely).

There certainly are abuses - people are getting lazier and more self-centered because they are used to being taken care of cradle to grave by our wonderful government welfare programs. But usually that abuse isn’t in the frail elderly.

Many elderly women live alone and away from their families They are the ones that need assistance - and it may be a partially social need, but social needs drive medical ones, particularly in the frail elderly and it’s cheaper for society to support someone at home, rather than them ending up back in the hospital.

Society does not have a high percentage of intact families living together with their older relatives. You may think that the elderly should just shut up and quit inconveniencing you, but you are going to be elderly at some point, so you might want to think that through.

I do not want funds for social needs co mingling with funds for healthcare. Right now, they co mingle. If society wants to take care of the elderly via home care for social reasons, then society should pay for it separate from the healthcare system. Right now, the healthcare system is so bogged down because it is all mixed together. No, I do not dislike the elderly. But, there needs to be a separation between the two. And, there is waste. I see it everyday. Why could you not take your mom to the hospital? Social issues again. Someone is not going to get their chemotherapy.

What does the hospital do when a patient refuses follow up visits, is fat, does not take their meds, among other concerns? Right now, the hospital gets penalized . Cars have warranties, However, if you do not get the oil changed, do not get the tires replaced, etc. the car companies are not responsible. How about a warranty system for patients? Do not follow advice, do not lose weight, do not make your follow up appointments, then the hospital does not get dinged.

there is a great deal of difficulty in using metaphors like cars vs humans, here is an example of something that hospitals do that is not so common in cars ....

According to the study, patients who underwent invasive surgery during their initial hospitalization were more likely to pick up a secondary infection while in the hospital, and elective surgery patients were at even higher risk of nosocomial infection. The researchers estimated that 290,000 patients in U.S. hospitals picked up sepsis, or blood poisoning, during their hospitalization in 2006, and 200,000 developed pneumonia.

my argument is that there are things to consider in medical care, for example if the stupid patient does not take their medicine at home they come back and need $5,000 worth of new insurance costs - who pays? It is insurance either Blue Cross or Medicare. Who should pay? Now if the hospital sends out a care giver and they spend $5,000 a month for an aide to look at twenty or thirty people who saves... people who might have to pay the government or the rising costs of insurance - you and ME!! Do you think every person that leaves the hospital is of such a sound mind that they will not forget some instructions?

MRSA is a infection that some patients have after surgery. Guess what? MRSA is endemic in the population, so they are bringing the infection into the hospital . Hospitals are doing MRSA swabs on patients who are in the ICU, and from what I have seen, a lot of them are positive which means they have MRSA prior to admission. If need be, they will swab everyone on admission to prevent a Medicare penalty. However, that is an additional cost. Some infections are brought in from the community which causes post op problems.
Infections can be from a number of things- such as poor surgical technique. That is not common.Another huge,huge, risk item is obesity. Obese patients have a high risk of infection . Personally, if I were a surgeon I would not operate on an obese patient.Some of them are now refusing, because it affects their Medicare complication rating. Too bad, so sad.Pneumonia can be from a number of factors, one being poor mobility after major surgery, or lowered immune system. I can force a patient kicking and screaming out of bed twice my shift, but that does not prevent them from pneumonia if they are medically fragile. That is a side effect of hospitalization and surgery. There is no way to ever change that statistic, unless you only admit young people 30-50 years old in your hospital.
I do not want to spend $5000 a month on a patient when there is family. That is the problem with society. Dump the care of your elderly parents on the government, and have them pick up the tab. I see it every day. For a forum such as FR- I see people here expouse freedom from government, , self determination, yet they act like whiney liberals when they want a government handout.
And no, I should not have to pay for social items out of my huge Medicare withdrawal from my paycheck. Especially when a lot of Medicare patients have more assests than I do. They can pay for their own aide.

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