30 Jul, 13 | by EBM
Editor’s note: For those of you outside the US this story will seem ridiculous…also, as after this post was written, the Boston Globe also published a front page article on how a hospital will pay a >$5 million fine for using “observation” status too little (the status that leads to patients paying more) with no mention of the issues below. See http://bo.st/13UYDFu
recent reports have shown that Medicare inflation (3.9%) is significantly below that of private insurors. a recent article in the Boston Globe (see http://www.bostonglobe.com/opinion/2013/07/18/medicare-disguised-form-rationing/W6sF7dkTW08oGOlSekzlFI/story.html?s_campaign=email_BG_TodaysHeadline) notes a major part of the reason: cost-shifting to consumers. key points:
— editorial writer presents case of his 99yo mother admitted to hosp after fall and kept there 4 days for severe maxillofacial bruising. Medicare reassessed care after she was already admitted for several days and decided it was “observation”, resulting in her being considered an outpatient (Medicare B), with 20% co-pay of the $20,000 physician fees. and, since the admission was effectively denied, no access to rehab facility or skilled nursing through Medicare
–this after-the-fact review is done by “recovery audit contractors”, for-profit vendors hired by Medicare and whose payment is linked to their denying claims!!! Although their denials can be appealed, it is a long and expensive process for the hospitals or the patients. The American Hosp Assn has a pending lawsuit against this practice
–the above system is part of George Bush (the second) approach to reducing Medicare costs using market incentives. this same George Bush also enacted Medicare C and D. Medicare C allows commercial HMOs to skim: targeting healthy seniors and thereby reaping large profits. and Medicare D is the senior drug program, with seniors responsible for often large medicine co-pays and perhaps descending into the abyss of the “donut hole” requiring full medication payments. this was done through the for-profit drug system, an unmanageably huge array of profitable cvs/walgreen/etc/etc supporting remarkably profitable drug companies, instead of through bulk governmental drug purchasing as through the VA system, which would have saved on the order of 70% of the drug costs!!!!. these private sector approaches to Medicare C&D cost hundreds of billions of dollars more than if done through rational public-sector solutions. and now to decrease Medicare program costs, patients get hit with cost-shifting from Medicare to them!
and, so, yet again, our health care system [in the US] is not the cohesive, coherent system of care that we all need. the above, unfortunately, affects Medicare, which not only is the basic health insurer for our vulnerable elders but is also (if fixed) the potential starting point for developing an all-inclusive government-sponsored single payer system.