Posts tagged 'Hospitals'
We have been hearing a lot lately about a new way that Medicare plans to keep the highest quality of procedures and services in hospitals. Most of the feedback has been excellent, except for – you guessed it – a few hospitals whose track records aren’t so great.
The new rules are considered a bold new plan to help the elderly, seniors and those who are ill. Basically, the rules have been put into place so that hospitals can and will be more careful in the way they perform everything from drawing blood to inserting a catheter to performing serious surgery.
Any and all of these procedures can cause complications such as serious infections, blood clots, pneumonia, the need for another surgery due to mistakes during the original surgery and more. Medicare has proposed not paying for these avoidable issues for a long time now, and the rules regarding the situation went into effect today.
It is important for patients to know that hospitals are not allowed to charge the patients for these types of issues that Medicare will not pay for. The reason that Medicare will not pay for them in these cases is because the hospital was at fault due to negligence or carelessness and should have to absorb the cost. It is hoped that if this happens in a particular hospital enough times, the amount of errors, problems and complications will decline.
This is a great step toward hospitals providing higher levels of service and keeping patients safer with better outcomes. Unfortunately, some states are not following Medicare’s lead and they are reimbursing certain hospitals – especially in low-income areas – anyway. Even though Medicare states that these complications and other issues are not acceptable, some areas are reimbursing them which lets them know that some losses are acceptable, service does not have to get better and in low-income areas you get what you get.
Most states are following Medicare’s lead and looking to hospitals to make the necessary changes to become safer. Hopefully this will eventually take place throughout every state in the country. Until then, depending upon where you live, you are most likely a lot safer in the hospital today than you were yesterday before the rules went into effect.
There have been many debates recently as to how to handle the situation of healthcare for individuals who are living in the United States but are not U.S. citizens. With elections around the corner, this issue has become an intense topic for discussion on all sides of the aisle.
There are many varied opinions regarding healthcare for these individuals and families. Studies have shown that the money they generate in the economy and sometimes in taxes offsets most or all of the medical expenses they incur. Other studies say the opposite.
With Medicare and Medicaid budgets and services struggling financially there have been questions raised as to how these individuals receive medical care and what it costs the system.
In Ohio, the Columbus Dispatch Newspaper stated in an article that the poor and/or undocumented in central Ohio, line up at the free health clinic near Ohio State University. The lines begin to form hours before the clinic – which is staffed by volunteer doctors and nurses - opens for services.
There is now a proposed bill requiring Clinica Latina and other clinics that serve undocumented residents to check for immigration status and turn away any individuals who do not have documentation. The bill states that the reason is that part of the funds for this particular clinic and some others come from Ohio State University. If the clinic were to receive funds only from private sources, they could continue treating these individuals without checking their status.
The issue that this leaves could have a huge financial impact on Medicare, Medicaid and the healthcare system because it would leave undocumented citizens with only the hospital emergency room for treatment. Unlike clinics, federal law states that hospitals cannot deny services to individuals based on various issues, including immigration status. As a result, seeing a doctor at the free clinic and receiving a $5 prescription for blood pressure or diabetes medication could now cost hundreds of dollars at the emergency room, and Medicare, Medicaid and taxpayers would have to absorb those costs.
The issue of undocumented residents in this country is not a simple one, nor will it be solved simply or quickly, however, it is important for lawmakers and administrators to look at the big picture and the overall costs before eliminating programs that could save an already struggling system money just to prove a point.
Medicare Centers for Medicare and Medicaid Services (CMS) has been working on a pilot program for three years. The pilot program has involved over 250 hospitals and has monitored quality measures in those hospitals during that time, offering rewards for high quality.
This partnership between the hospital consortium and Premier and the CMS spent the three years working on the quality measures in the 250 hospitals that were part of the pilot. Premier reported that the results that were achieved included a 15.8% increase in quality in these hospitals that served 1.1 million patients. Premier President and CEO Richard Norling said, “The findings from the first three years of the project clearly show that transparency with rewards for quality achieves a higher level of performances in American hospitals.
This project actually brought up the performance standards of all hospitals involved to a better level, bringing those on the lower levels closer to the higher levels and closing the gap between them. This is great news, and if the pilot program works to raise quality levels in these 230 hospitals, it would be a tremendous idea to expand the program or at least use the standards and rewards in the pilot to improve quality of more hospitals throughout the country. The money saved because of the improvements of quality and efficiency could be used to fund the pilots or other programs for other hospitals in other areas across the country.
There was an announcement by Acting CMS Administrator Kerry Weems said in a statement, “Given these results it is time for us to take the next step and implement hospital Value Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care every time.”
There are more and more issues surrounding saving Medicare money lately, and there are a lot of ideas swirling around to make that happen. One idea that has come to the fore and was featured in the Boston Globe is a way to help patients on Medicare, give them better service and better outcomes, and, at the same time save Medicare a lot of money – possibly half of its shortfall. Is it possible to do all these things at once? According to experts, it is.
One of the highest costs that Medicare is paying for is stays in the hospital. Most of these stays are necessary, and nobody is questioning this point. The issue at hand is that many seniors on Medicare come out of the hospital only to return again within 30 days, and in many of these cases, this could be avoided.
Research has shown that patients return for several main reasons. One reason is that they acquired an infection while in the hospital and it has reoccurred or flared up. Another reason is that they are unclear about what to do upon discharge and their condition worsens because they are not following up correctly. The third reason is that nobody has followed up with them.
Some readmissions are necessary, and nobody is disputing that fact. However, studies show that if patients were cared for differently when they were in the hospital in the first place, there would be fewer complications, such as infection, and, as a result, a lower number of patients would return. It has been suggested that if Medicare paid less for readmissions but gave bonuses to hospitals whose readmissions were lower in number, the outcomes for all parties would be better. In hospitals where this was tested, the patients had less complications and readmissions, the hospitals and Medicare saved money.
In addition, helping patients understand what needs to happen after discharge is a huge factor in whether they return for readmission or not. Having a discharge nurse or coach with easy and non-confusing instructions regarding medication and other discharge information has helped lower the readmission rate in hospitals that employed this step. Also, having a nurse follow-up by calling the patient and discussing what is happening with them has lowered readmissions for cardiac patients in one hospital by over 75%.
The Boston Globe article suggested that Medicare look at how it is rewarding hospitals, and reward them with bonuses when they save money, rather than paying them well to keep their beds full – even on readmissions.
With Medicare funding at question and lawmakers searching for answers, this is an important issue and the Boston Globe article makes some logical points. Hospitals and lawmakers out there: are you listening?
Unfortunately, Medicare fraud is not a new thing. It has been around for years, though it has grown over the years to a multi-million dollar business. Whether it is unscrupulous sales people selling bogus supplemental policies to unsuspecting seniors or whether it is people sending in claims with dead doctors’ identification numbers or other creative ways to cheat and defraud the Medicare system, there are many ways that the system has been bilked out of millions of dollars – in fact, researchers say that it is now over a billion dollars.
In California, three hospitals have stooped to a new low. The hospitals are accused of picking up homeless people from the skid row area of downtown Los Angeles and bringing them to the hospitals with fake conditions. Once these people were admitted and served their usefulness by being set up for fake treatment for the fake illnesses, they were then shoved back into the ambulance and dumped back off on skid row.
Skid row is a very poor area of downtown Los Angeles where there are quite a large number of homeless individuals, so it was an easy place to perpetrate this hoax. “Runners” working for the hospitals as recruiters would get homeless people to go to a center near the hospital where they were assessed and where their Medicare and Medi-Cal were verified. Once this was done, the recruiters created the information regarding the conditions for these individuals – conditions which would get them into the hospital and get Medicare to pay the bill to the hospital.
The biggest problem is that these homeless individuals didn’t really realize what was happening and didn’t really get treated for those fraudulent conditions, when they may have actually had some actual conditions that needed to be addressed and treated. Sadly, the recruiters actually guaranteed certain numbers of these “patients” to the hospitals and once these individuals were treated – minimally – and released, everyone got paid to the tune of millions of dollars. Each of the homeless individuals was paid $20 to $30 after being released from the hospital.
One thing that the hospitals and their administrators – who were indicted on various charges – did not realize is that they were being closely watched by the FBI. This became their undoing. The FBI and local law enforcement raided the hospitals within the past few days and arrested administrators and others involved in the schemes.
With fraudulent schemes like these and some of the other issues that plague the Medicare system it’s no wonder that overhauling the system and prosecuting fraud to the full extent of the law is essential and needs to happen right now, as this situation in California shows.
Medicare Centers for Medicare and Medicaid Services (CMS) has been working on a pilot program for three years. The pilot program has involved over 250 hospitals and has monitored quality measures in those hospitals during that time, offering rewards for high quality.
This partnership between the hospital consortium and Premier and the CMS spent the three years working on the quality measures in the 250 hospitals that were part of the pilot. Premier reported that the results that were achieved included a 15.8% increase in quality in these hospitals that served 1.1 million patients. Premier President and CEO Richard Norling said, “The findings from the first three years of the project clearly show that transparency with rewards for quality achieves a higher level of performances in American hospitals.
This project actually brought up the performance standards of all hospitals involved to a better level, bringing those on the lower levels closer to the higher levels and closing the gap between them. This is great news, and if the pilot program works to raise quality levels in these 230 hospitals, it would be a tremendous idea to expand the program or at least use the standards and rewards in the pilot to improve quality of more hospitals throughout the country. The money saved because of the improvements of quality and efficiency could be used to fund the pilots or other programs for other hospitals in other areas across the country.
There was an announcement by Acting CMS Administrator Kerry Weems said in a statement, “Given these results it is time for us to take the next step and implement hospital Value Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care every time.”
