Paging Dr. Oh-any-doctor

[brucemacneill]

So, is this death panels or is it not? Outcome based Medicare payment plan by HHS. I think I'm glad I'm having this operation this year and not next.

www.cnbc.com/id/102368657

[majorminor]

Looks like a push towards a cap or defined benefit to me. So, yeah, twisted sentence structure and fuzzy phrasing aside I think if implemented the net affect is going to be less medical care at the end of the line for medicare patients.

[TKennedy]

Off the top of my head I'd say just the opposite. It's been long known and at least in Orthopaedics shown by studies that in major surgical procedures there is a direct correlation up to a point in the volume of that procedure done by a given surgeon or at a given hospital and outcomes. Under a certain critical number results seem to be worse and more complications seen. Not rocket science but up until now I think Medicare would pay an Orthopaedist that did two total joints a year the same as one that did fifty. Outcomes were not factored into the reimbursement schedule.

Also, in traditional fee for service payment, the service is coded when submitted and that determines how much is paid for the service. There is a multimillion industry aimed at providing seminars for medical office insurance coders to teach them "creative coding', i.e. not really breaking the law but stretching it for using existing codes to augment the payment but perhaps not really honestly reflecting the service provided if you really looked at it with a truthful eye.

It is easy to justify as Medicare has been cutting physician reimbursements for years.

I think there is a massive amount of fraud and marginal behavior in obtaining reimbursement from Medicare and very poor policing of the system. From what I read in the article I think this is probably not a bad idea on paper and may actually lead to better outcomes for medicare recipients and save money in the long run.

When I was a resident and we took care of a lot jerks in the ER we used to joke that when some dickhead was giving us a lot of trouble screaming, cursing, vomiting on us, trying to hit and bite the nurses, etc. we would tell him we had evaluated him on the asshole index and we were sorry but his score allowed us to just go ahead and kill him. Pretty dark but you had to be there.

[brucemacneill]

Thanks, Terry, I was looking for a real medical perspective. I suppose it will depend upon the enforcement. I do wonder if more doctors will stop seeing Medicare patients though or require up-front payment like some dentists do now. My periodontist doesn't accept any insurance. He gets his fee from the patient and his secretary gives the patient a form to send to their insurance company for whatever reimbursement they can get. I'd hate to see doctors do that.

[coachdoc]

I'm glad I'm done soon.

[Chesapeake]

Wonder if this would be covered.

[Deleted]

Sarah Palin, Michelle Bachmann and others invented and propagated the "Death Panels" Politifact 'Lie of the year' and the scary phrase has hung around like a strange smell ever since.

[millring]

Well, to give the obviously unavoidable necessity a name certainly made it somewhat incendiary, but the reality isn't going anywhere.

[jdd2]

Bruce--you could always consider medical tourism.

[brucemacneill]

Jan 27, 2015 6:54:02 GMT -5 jdd2 said:

Bruce--you could always consider medical tourism.

I don't travel well. Besides, most doctors here don't speak English so it's like medical tourism without the TSA.

[Deleted]

I find it surprising that the majority of doctors there do not speak English.

[Doug]

Jan 27, 2015 10:30:11 GMT -5 @elf said:

I find it surprising that the majority of doctors there do not speak English.

It's not really that they don't speak English it's just that you can't understand them. Like calling a help line. 

[Russell Letson]

Jan 27, 2015 5:47:50 GMT -5 millring said:

Well, to give the obviously unavoidable necessity a name certainly made it somewhat incendiary, but the reality isn't going anywhere.

That label was a deliberately inflammatory falsification, and the assertions that accompanied it were equally false. Part of the genesis was reaction to a proposal for Medicare coverage for end-of-life planning sessions, which include the writing of living wills and do-not-recuscitate directives. (Which my doctor mentioned in my annual checkup a couple weeks ago--is he trying to tell me something?)

I'll leave it to the medical doctors to describe the logistical, financial, and practical-ethical environments in which they operate, but this doctor of words is still willing to call bullshit on inflated, manipulative, and dishonest descriptions of those environments.

[millring]

So, then, I assume you disagree with that terminology?

[Russell Letson]

I think it has its problems.

[PaulKay]

I'll believe "Outcome based Medicare" when the doctors and hospital don't get paid when the patient dies.

[Chesapeake]

Jan 27, 2015 10:33:39 GMT -5 Doug said:

Jan 27, 2015 10:30:11 GMT -5 @elf said:

I find it surprising that the majority of doctors there do not speak English.

It's not really that they don't speak English it's just that you can't understand them. Like calling a help line. 

[Chesapeake]

The above intends no disrespect to all the fine foreign-born doctors we are privileged to have in this country.