News from the Week of January 10 2014

appeal academy | cost cutting | healthcare reform

CMS can’t control your costs, so now the State will do it for you – not that this will keep people healthy, but who cares about that, right?

News Flash – Just in case you’ve been sleeping or just started reading my newsletters…

There is enormous focus on caring for people after they get sick and very little attention to keeping people healthy. The incentives that underlie payment are a major reason we have that lack of balance,” according to Joshua Sharfstein, M.D., Maryland’s health secretary, as told to the Baltimore Sun.

Ummm… Incentives that underlie payment? (Perhaps they meant to say incentives that underlie healthcare, or more succinctly, that underlie how providers deliver healthcare services?) While I’m not at all clear what the quoted phrase means, it seems to point at the fact that preventive care is not covered by payors, and therefore is not performed by providers.

But wait, there’s more!

Let’s assume for a moment you can understand that quote, and now let’s look at a fact that is quoted before that statment, as added fodder for the argument: “…at least 20 percent of Maryland’s hospitals have readmission rates above the national average.” Harumpf. Gee that sounds horrible.

Uh… but if we’re looking at the national average… by definition, aren’t 50% of all hospitals below the average, and (gasp!) at the same time, 50% of all hospitals are above the average? So, if Maryland has 20% above, doesn’t that mean that 80% are below? And… wouldn’t that point to Maryland doing a really GOOD job at reducing readmissions? I must be missing something.

Here’s a thought… anytime you see someone talking about being above or below the “averages”… run. 

At any rate, let’s assume you can see your way through to whatever proves this the existence of this “imbalance.” What is a bureaucrat to do? Why the answer is obvious, isn’t it? We’ll keep costs down by creating a pool of money for all the hospitals to share to cover all inpatient care in our state. There. Surely that will meet our goals.

Well. Maybe not. If you goal is to reduce costs, I think you’ve done that. But if your goal is to reduce readmissions… I’m not clear on how you do that by creating an arbitrary limit on what hospitals can get paid, regardless of how much or how little “care” they actually provide.

I don’t see it. Didn’t they start off by talking about keeping people healthy? And this plan does that HOW?

Over the past weekend, it was reported that the state of Maryland had reached an agreement with the feds, promising to reduce costs. It’s a strange agreement, but you decide… see the report via Maryland reaches deal with feds to cut hospital costs.

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