The Great ObamaCare Debate, Part 237: Back to Court - Page 618 - Politics and Economics

What explains these declines? The Department of Health and Human Services has largely pointed at a set of programs that have come into effect since 2010 for catalyzing a movement towards better care and more emphasis on patient safety.

Some of them are part of Obamacare: new financial penalties for hospitals that have particularly high rates of readmissions or harm to Medicare patients. Many of those programs began in 2010 and 2011, with the money at stake rising year after year.

"THE INCREASE IN SAFETY HAS OCCURRED DURING A PERIOD OF CONCERTED ATTENTION"

Private insurers, meanwhile, have moved in the same direction, tethering their own payments to hospitals to the quality of care that patients receive. One recent report found that 40 percent of private plans' payments to hospitals were in some way contingent on quality in 2014 — a big jump from the 11 percent of incentive-based payments in 2013.

Then there's also the Partnership for Patients, a government project that's part of the Affordable Care Act, aiming to reduce the number of hospital-acquired conditions by 40 percent between 2010 and 2014. That program has enrolled more than 3,700 hospitals — who account for four in every five hospital patients — in a learning collaborative to share best practices for increasing patient safety.

"The increase in safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events," the new report argues.

12-02-2014 , 05:11 PM

#15428

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

and that's bull****. The only specific program they talk about is the medicare program. That started in oct 2012.

Believe it or not, doctors don't try to get you sick to get you to come back. There's been a huge push against nosocomial diseases in health care, and it has dick to do with obamacare.

12-02-2014 , 06:07 PM

#15429

well named

poorly undertitled

Join Date: Jun 2007 Posts: 78,078

I can't remember my healthcare.gov password or my security questions

thanks Obama.

12-02-2014 , 06:10 PM

#15430

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

But man, does it fit with anything, literally anything, good happening in health care being due to Obamacare and everything else being unrelated meme you guys have tried to push itt.

12-02-2014 , 06:31 PM

#15431

parttimepro

old hand

Join Date: Dec 2004 Posts: 1,283

Quote:

Originally Posted by ikestoys

Oh good ****ing grief vox should shut their website down. They have no credibility left.

The medicare readmissions program was effective for patients discharged after Oct 1st 2012. The drop starts well before and nosocomial infections have been a huge area of study and work well before Obamacare.

So your position is that despite ongoing work in reducing iatrogenic infections, readmission rates only started to drop off a few months before Obamacare put in financial incentives for hospitals, and this is entirely a coincidence.

12-02-2014 , 06:49 PM

#15432

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by parttimepro

It's not a coincidence, the beginning of the trend precedes obamacare's initiative by a few years, and new treatment protocols don't suddenly appear either. The protocols that lead to changes were likely being worked on years before that change.

12-02-2014 , 06:59 PM

#15433

parttimepro

old hand

Join Date: Dec 2004 Posts: 1,283

Quote:

Originally Posted by ikestoys

It's not a coincidence, the beginning of the trend precedes obamacare's initiative by a few years

This is factually wrong.

Perhaps the most parsimonious explanation is that some people were working on various protocols to reduce admissions rates, but it took the specter of financial penalties to light a fire under hospital administrators' butts and actually implement them.

12-02-2014 , 07:00 PM

#15434

neg3sd

banned

Join Date: Nov 2008 Posts: 3,335

Quote:

Originally Posted by well named

I can't remember my healthcare.gov password or my security questions

thanks Obama.

This one isn't Obama'a fault. The entire password system must be junked. It is too difficult for the general public and too easy for the hackers.

12-02-2014 , 07:04 PM

#15435

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by parttimepro

This is factually wrong.

lulz no it's factually correct. Oct 1 2012 is the first day of the medicare readmissions program. Feel free to start the trend whenever you want, but you can start all the way back in 2008 on that chart. The earliest you could possibly start is Jan '11, 1 year, 9 months before the program.

And again, derp, those protocols take quite awhile to develop.

Quote:

12-02-2014 , 07:54 PM

#15436

FlyWf

It's the other way

Join Date: Apr 2004 Posts: 58,097

LOL dudes you know when we laugh at Breitbart or whatever, we actually laugh at their content, right? You can't just dismiss Vox because the things they write are things you wish weren't true.

P.S. ikes and seattle both, when pressed on specifics, claim to support Obamacare!

12-02-2014 , 09:10 PM

#15437

Double Eagle

Health Care Thread Czar

Join Date: Dec 2003 Posts: 8,323

ITT we learn that hospital administrators only learned about readmission penalties which would drastically reduce payment rates after said penalties went into affect in 2012.

Damn, I thought they would at least have had access to Google or something cause those penalties were voted into law in March 2010. Thanks Ikes, I learned something new today!

12-02-2014 , 10:51 PM

#15438

grizy

Carpal \'Tunnel

Join Date: Dec 2006 Posts: 20,774

The admins rely on lawyers... most of whom aren't trained in finance to fully understand the financial (and more importantly, structural) impact.

Meanwhile the finance guys didn't understand the law.

Vox will stop pretending it's neutral soon.

12-02-2014 , 11:07 PM

#15439

Huehuecoyotl

Carpal \'Tunnel

Join Date: Sep 2009 Posts: 29,296

Quote:

Originally Posted by grizy

What are you talking even about? There isn't some insurmountable wall between understanding the legal and financial implications of the law. Btw there is an American Hospital Association whose whole job is to be the go between lawmakers and hospitals

Quote:

Thus, the American Hospital Association (AHA), the national organization that represents nearly 5,000 hospitals and health care networks in America, as well as 40,000 individual members, has a clear vested interest in health care reform, as it could change everything from hospital administration to patient care delivery to profitability.

Since 2008, the AHA has made sure to involve itself in the policy details of the ACA, as well as the political process that led to its passage. In 2009, the AHA spent more than $7 million dollars on its Washington lobbying campaign, ranked near the top spending in the industry. Tom Nickels, the AHA's senior vice president of federal relations, heads a team of 28 lobbyists, and the AHA also makes significant contributions to members of Congress and congressional candidates. In 2008 and 2010, the AHA contributed more than $2 million in each year to candidates, with more than $1 million going to Democrats, according to data from the nonprofit Center for Responsive Politics. In addition, Richard Umbdenstock, president and CEO of the AHA, frequently visited the White House in 2009 in the months leading up to the ACA’s passage.

With so much at stake, the AHA ultimately positioned itself as a partner in health care reform. After a series of negotiations, the AHA, along with two other hospital associations, agreed to accept $155 billion worth of cuts in Medicare reimbursements and other payments throughout the next decade in order to help the government fund other reforms. Recently, Umbdenstock commented on the final legislation, saying, “We supported it, imperfect as it is. Now it is much more important to build on it and improve it.”

http://www.medicarenewsgroup.com/new...f-ab93ab3e7246

12-03-2014 , 02:28 AM

#15440

grizy

Carpal \'Tunnel

Join Date: Dec 2006 Posts: 20,774

Insurmountable? No.*

Doesn't change the fact a lot of hospitals didn't surmount it, for a variety of reasons.

People just generally underestimate the bureaucracy hospitals deal with. The problem is only exacerbated by doctors' unwillingness to deal with any of it.

*Consolidation is already happening. Obamacare is both necessitating and facilitating consolidation of hospitals but, as I've said in earlier parts of this thread, the process will take years, possibly decades, to play out.

Last edited by grizy; 12-03-2014 at 02:42 AM.

12-03-2014 , 09:32 AM

#15441

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by Double Eagle

The trend probably goes back before obamacare was passed, and the protocol development sure as hell does.

12-03-2014 , 11:04 AM

#15442

Double Eagle

Health Care Thread Czar

Join Date: Dec 2003 Posts: 8,323

Quote:

Originally Posted by ikestoys

The trend probably goes back before obamacare was passed, and the protocol development sure as hell does.

But up until the ACA Medicare reimbursement changes were enacted Hospitals made more money when they had a higher readmission rate. Either economic incentives matter or they don't, which is it?

12-03-2014 , 11:08 AM

#15443

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by Double Eagle

But up until the ACA Medicare reimbursement changes were enacted Hospitals made more money when they had a higher readmission rate. Either economic incentives matter or they don't, which is it?

Economic incentives matter, but medicare reimbursement changes aren't the only economic incentive to provide better care. Why did any hospital provide good care at all before ACA? Why not just make sure everyone is always sick?

12-03-2014 , 11:27 AM

#15444

Cornboy

veteran

Join Date: Nov 2004 Posts: 2,427

Quote:

Originally Posted by ikestoys

The trend probably goes back before obamacare was passed

I know you want that to be true, but it's not.

RWJ Foundation did a review of 2008-10, and found no real change compared to 2004.

Quote from the report:

Quote:

This report shows that the chances of readmission after patients leave the
hospital varies markedly across regions and hospitals. Furthermore, during
the period from 2008 to 2010, overall readmission rates did not decline for
any of the five patient groups. Readmission rates decreased in some hospitals
and regions, but increased in others. The overall lack of improvement in readmissions extends back to 2004, the earliest year that the Dartmouth Atlas
studied.

12-03-2014 , 11:29 AM

#15445

Double Eagle

Health Care Thread Czar

Join Date: Dec 2003 Posts: 8,323

Quote:

Originally Posted by ikestoys

So does ACA payment reform play a role in the drop in readmission rates or not?

12-03-2014 , 11:30 AM

#15446

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by Cornboy

I know you want that to be true, but it's not.

RWJ Foundation did a review of 2008-10, and found no real change compared to 2004.

Quote from the report:

yeah that's no trend starting at 2004. 08-present is a clear downward trend.

12-03-2014 , 11:31 AM

#15447

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by Double Eagle

So does ACA payment reform play a role in the drop in readmission rates or not?

lol not a significant one. Hospitals are constantly working to provide better treatments DE, but keep ignoring why hospitals don't make people intentionally ill to treat them.

12-03-2014 , 11:34 AM

#15448

Cornboy

veteran

Join Date: Nov 2004 Posts: 2,427

Quote:

Originally Posted by ikestoys

yeah that's no trend starting at 2004. 08-present is a clear downward trend.

RWJF Quote:

Quote:

A new report from the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 at reducing hospital readmissions for elderly patients.

Quote:

Furthermore, during the period from 2008 to 2010, overall readmission rates did not decline for any of the five patient groups.

The trend began in 2010, ikes. Can you think of any major legislation passed that year?

12-03-2014 , 11:35 AM

#15449

pvn

Guest

Posts: n/a

http://www.vox.com/2014/12/3/7324613...treated-fairly

12-03-2014 , 11:37 AM

#15450

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by Cornboy

RWJF Quote:

The trend began in 2010, ikes. Can you think of any major legislation passed that year?

Yes, and that says the bigger trend started later, but there was still improvement from 2008-2010.... still 2 years before the law took effect lol. Again, these types of protocols take years of study and implementation. If it started to show effects on admissions in 2010, then it was in the works far before the passage of obamacare in 2009.

Why do you think hospitals didn't make patients intentionally ill before 2012?

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