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Ten Cost Cutting Measures In Health Care Reform

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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:37 PM
Original message
Ten Cost Cutting Measures In Health Care Reform
The newest attack on health care reform revolves around the supposed lack of cost cutting measures to curb runaway growth in health care spending despite the President’s promise to make cost containment the highest priority in reform.

But the truth is, both the House and Senate bills include a variety of measures that will reduce the growth of health care costs while providing higher quality care.� The Senate bill, particularly, includes a tax on high-value “Cadillac” which often allow costs to spiral completely out of control. Another proposal creates a commission that would make binding recommendations on wasteful Medicare spending, which has also been endorsed by the Business Roundtable.

Peter Orszag, OMB Director, says that in the discussion on health care reform and cost controls, “too often other important delivery system reforms are ignored” with the result being a failure to recognize that we are “on the verge of passing fiscally responsible health insurance reform”. Mr. Orsag further stated that the current health care proposals offer “many promising ideas to improve the overall performance of the U.S. health care system” including ways to “slow long-term spending growth.”

Cost containing steps, from the White House, include:

1.Penalties for high readmissions. Too often, patients are discharged from the hospital without the necessary follow-up care leading to re-hospitalization, risks to one's health, and higher costs. Under the proposals being considered, Medicare would collect data on readmission rates by hospital and would assess penalties on those hospitals with high, preventable readmission rates.

2.Bundled payments, which pay a fixed amount for an entire episode of care rather than piecemeal for each individual treatment or procedure, would help improve patient care by encouraging better and more coordinated care than under a fee-for-service system. Bills in both the Senate and the House would develop, test, and evaluate bundled payment methods through a national, voluntary pilot program. Once we see what works and what doesn't, bundled payments can be quickly scaled up across the country.

3. Quality incentives for physicians. Creating incentives in the payment system to reward quality of care rather than just the quantity of procedures. These proposals would expand quality incentives for physicians and provide more timely feedback on physician performance based on their submitted data.

4. Accountable Care Organizations (ACOs). Under the current system, quality and efficiency are not sufficiently rewarded, and there is little incentive for physicians to collaborate in the coordination of patient care. Legislation in both Houses would encourage and reward ACOs, which are groups of providers that are jointly responsible for the quality and cost of health care services for a population of beneficiaries with chronic conditions.

4. Investing in research into what works and what doesn’t in health care.

5. Reducing hospital-acquired infections and other avoidable health-center acquired conditions through rigorous reporting and transparency.

6. Putting prevention first, rewarding care that focuses on wellness and treating the whole patient in an integrated and coordinated delivery system.

7. Tackling the insurance bureaucracy, streamlining the payment system to save time and money that is now spent processing claims and navigating through the byzantine insurance system.

8. Establishing a health insurance exchange with a public insurance option, where individuals and small businesses can buy lower-cost insurance that will spur competition and put downward pressure on costs.

In addition, these measures build on the health care reforms that were made in the American Reinvestment and Recovery Act such as beginning the transfer from paper to digital records; strengthening preventive care and patient-centered health research; and investing in the education of primary care providers.

Reference Links:
http://obama-mamas.com/blog/?p=636
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NYC_SKP Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:24 AM
Response to Original message
1. K and R!
I like them all, but number three is a big one.

My parents' 6 or 7 different doctors don't talk to one another.

Also, record keeping is archaic, should be protected but electronic, history, meds, tests, etc.

:kick:
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patrice Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 09:39 AM
Response to Reply #1
2. It is absolutely amazing. I have seen it time after time. NONE of the doctors talk to one another.
That puts the patient or the patient's advocate in the position of trying to integrate a bunch of stuff that you know nothing about. Guess what, that makes people either opt-out or they become quite adversarial. In either case, even under the best of circumstances in difficult situations, EVERYONE is un-happy and possibly even litigious over outcomes.
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patrice Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 09:43 AM
Response to Reply #1
3. P.S. I'm also finding out from my neices the nurses that there is no Organizational cross-talk
between folks like doctors and nurses and between nurses and CNAs, perhaps individually there is, but there appears to be very little between organizational levels within systems, or whatever is there is the wrong type of communication.
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NYC_SKP Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 10:24 AM
Response to Reply #3
9. Nurses are among our most knowledgable asset in troubleshooting the screwed up system.
As are front office staff in their experience with paperwork and communications.

:kick:
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mopinko Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 09:47 AM
Response to Reply #1
4. +1 on that.
specialists are like the blind guys and the elephant. i have the permanent nerve damage to prove it.
and all my medical records are electronic, available to all my providers, and it would help if they used it. but they don't.
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:20 PM
Response to Reply #1
12. Our doctors share digital records
So at least we don't do too much duplicating on that front.

But they also sent my mammogram second opinion result to my ear doctor, lol. I don't see him until February so I am interested in what he thought about getting that.

I try to keep my doctors within the same health care system. One because it's non-profit and has a sliding scale for patient portion of bills, but you do have to apply for it. The other because it's just convenient to have doctors able to access the same records. It is so important, that's true.
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NYC_SKP Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 03:09 PM
Response to Reply #12
17. Mammogram to ear doctor. Hmmm. Music to soothe the savage breast?
That's the only ear-breast connection I can come up with!

(best wishes for good health all over you).

:P
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derby378 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 09:50 AM
Response to Original message
5. Again, WHAT public option?
If I can't buy into it, it's not public. That means I'm stuck with the same insurance company that won't let me choose my own doctor, that refuses to pay for my blood tests, that denies coverage of effective pain management treatments by labelling them as "experimental," etc. All in the name of preserving the corporate bottom line.

And then there's the premiums. There's no guarantee that the House bill is going to be able to rein in my runaway premiums.
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geek tragedy Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 10:00 AM
Response to Reply #5
6. If there's no reform, you are guaranteed of things continuing
to get worse and worse.

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derby378 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 10:09 AM
Response to Reply #6
7. They'll do that under the House bill anyway...
Edited on Fri Nov-13-09 10:09 AM by derby378
...the main difference being that you'll be forced to pay for things getting worse through an individual mandate that doesn't allow you to go for a public option.

No, the best thing to do is to send the House back into the chambers for a crash program on a new insurance reform bill to be passed before the end of the year. Obama's getting impatient for his Rose Garden ceremony, after all - and I do want Obama to succeed, but not at the expense of the American public.
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geek tragedy Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 10:12 AM
Response to Reply #7
8. That's not an option. There's no going backwards
at this point.

The House bill will be a big improvement on the current situation.
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derby378 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 10:26 AM
Response to Reply #8
10. For Big Insurance, sure, but not for you and I
My premiums will continue to skyrocket, I can't choose my own doctor (even in a PPO), and the bean-counters will still exercise tremendous leeway in determining what is and isn't covered - even if it costs me my well-being. No perceivable improvement on my end, sorry.
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:13 PM
Response to Reply #5
11. Are you covered by an employer? n/t
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derby378 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:42 PM
Response to Reply #11
13. That's a tough one
I'm a state employee, but we get our insurance through Blue Cross Blue Shield.
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:53 PM
Response to Reply #13
14. How much would BCBS premiums be
If 1/2 the employees dropped their insurance to go to the exchange or the public option.

Should the state be required to spend more per employee, to manage a system that would pay the employee share to all the different plans that are available.

Should people get subsidies for the exchange or the public option, when their employer was paying the bulk of the premium before.

If you had to pay 100% of your public option premium, which would be higher than what you're paying now, would you?

Now extrapolate that to all the cities, counties, states and large employers in the country. And answer your own question as to why they are making people stay in their employer based plans, at least for now.
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derby378 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 02:09 PM
Response to Reply #14
15. The state pays less than half of my premium
And they don't pay for dental or vision, either. In addition, my co-pay just went up.

Premiums for a public option were supposed to be pegged to Medicare plus (x) percent, instead of pegged to private insurance plans. This would have saved people on the PO a lot of cash - I could probably pay 100% of a PO premium if someone stood their ground in the House.

I'm all for someone keeping their private health insurance if they like it, but private insurance has been doing so much to drive people away lately. If an individual mandate without PO access is implemented, these people have nowhere to go.
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postulater Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 02:32 PM
Response to Original message
16. Including lifetime disability support for anyone injured by
a properly performed (not malpractice) medical procedure within the cost of the procedure.

Then people who are damaged by a surgery won't be left on their own. And procedures that have a small chance of causing serious damage will be evaluated for their safety and maybe more effective less costly procedures may evolve.
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ipaint Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 04:17 PM
Response to Original message
18. The dutch government, which allows private ins.
made cherry picking customers illegal and to prevent what they knew would be abuses by private ins. the government does yearly audits of each ins. co's pool of patients. If one ins company has too many healthy people then the profits that imbalance generates is re-distributed to the ins. companies that ins. the sickest.
The financial incentive to cherrypick healthy customers is removed.


The dutch don't have the same high co-pays/deductibles/premiums as we do because the government sets prices.


We don't have near enough tough regulations or cost controls over our for profit private giants to prevent them from crushing this reform.


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C_Lawyer09 Donating Member (690 posts) Send PM | Profile | Ignore Fri Nov-13-09 08:43 PM
Response to Original message
19. Seriously, I have many family members and friends whom work in health care
Why could we not fix the current health care system, at least the glaring delivery problems before we move on to an almost 2,000 page bill? Call me a troll, Republican or whatever, but what doesn't make sense about that? Legislating from a decent foundation only makes sense
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