Dave Mittman from Clinician One has asked me to, and I will begin to post this blog on the Clinician One site. I will try to crosspost here as much as possible as well, but thought that I should inform you.
I will post the direct link, once I have it.
Mike
Thursday, August 20, 2009
MORE on Prometheus....
I've posted about this before, but here is an article from the NEJM, which is a bit more substantive.
Prometheus....NO, not the god who was forever condemned to watch his liver being eaten every day, but a healthcare payment system that was first implemented in Rockford, Ill.
More HERE
Prometheus in Practice
A 63-year-old white man with chest pain and a history of unstable angina is admitted to a teaching hospital. The patient has hypertension and diabetes. An electrocardiogram reveals ST-segment elevation in the lateral leads. The man is taken to the cardiac catheterization laboratory, where coronary angiography reveals severe triple-vessel disease as well as 60% stenosis of the left main coronary artery. A left ventriculogram shows mitral regurgitation (grade 2 to 3) with papillary muscle dysfunction. The patient is then taken urgently to the operating room, where he receives two venousgrafts and a left-internal-thoracic-artery graft. In addition, a mitral-valve reconstruction procedure is performed to correct the mitral regurgitation. The surgery is a success, and the patient returns to the intensive care unit in stable condition. However, his blood sugar is out of control, and he requires an insulin drip. His stay in the intensive care unit is prolonged by 2 days, and he must stay another day in the step-down unit. He is discharged 8 days after surgery in stable condition. One week after discharge, he is readmitted for a wound infection in his leg from the vein harvest site. He requires wound débridement and a course of antibiotics.
Under fee-for-service payment, the hospital would receive $47,500 for the bypass surgery, and the surgeon would receive $15,000 for performing the procedure. The extended hospital stay that was necessitated by the uncontrolled diabetes would result in an additional $12,000 for the hospital and $2,000 for the physician, and the readmission costs would total $25,000, for a grand total of $101,500.
Under Prometheus, the case-payment rate for this patient would include a severity-adjusted budget for typical costs of $61,000 for the hospital and $13,000 for the physician. The severity-adjusted allowance for PACs would be $15,300, for a total budget of $89,300. Had the readmission been prevented, the hospital and physician would effectively have earned a bonus of $12,800 ($101,500 – $25,000 = $76,500, which is $12,800 less than the Prometheus budget).
BTW, Doctors HATE this concept. But they pretty much hate anyone telling them what to do.....
Prometheus....NO, not the god who was forever condemned to watch his liver being eaten every day, but a healthcare payment system that was first implemented in Rockford, Ill.
More HERE
Prometheus in Practice
A 63-year-old white man with chest pain and a history of unstable angina is admitted to a teaching hospital. The patient has hypertension and diabetes. An electrocardiogram reveals ST-segment elevation in the lateral leads. The man is taken to the cardiac catheterization laboratory, where coronary angiography reveals severe triple-vessel disease as well as 60% stenosis of the left main coronary artery. A left ventriculogram shows mitral regurgitation (grade 2 to 3) with papillary muscle dysfunction. The patient is then taken urgently to the operating room, where he receives two venousgrafts and a left-internal-thoracic-artery graft. In addition, a mitral-valve reconstruction procedure is performed to correct the mitral regurgitation. The surgery is a success, and the patient returns to the intensive care unit in stable condition. However, his blood sugar is out of control, and he requires an insulin drip. His stay in the intensive care unit is prolonged by 2 days, and he must stay another day in the step-down unit. He is discharged 8 days after surgery in stable condition. One week after discharge, he is readmitted for a wound infection in his leg from the vein harvest site. He requires wound débridement and a course of antibiotics.
Under fee-for-service payment, the hospital would receive $47,500 for the bypass surgery, and the surgeon would receive $15,000 for performing the procedure. The extended hospital stay that was necessitated by the uncontrolled diabetes would result in an additional $12,000 for the hospital and $2,000 for the physician, and the readmission costs would total $25,000, for a grand total of $101,500.
Under Prometheus, the case-payment rate for this patient would include a severity-adjusted budget for typical costs of $61,000 for the hospital and $13,000 for the physician. The severity-adjusted allowance for PACs would be $15,300, for a total budget of $89,300. Had the readmission been prevented, the hospital and physician would effectively have earned a bonus of $12,800 ($101,500 – $25,000 = $76,500, which is $12,800 less than the Prometheus budget).
BTW, Doctors HATE this concept. But they pretty much hate anyone telling them what to do.....
Thursday, July 30, 2009
Best Damn Editorial in a long time.
Those of you that faithfully follow this blog know a few things, number one, I am not a fan of the DNP degree mandate for several workforce supply issues and reasons that I have expanded on in the past. Secondly, I have been saying for months, that trying to simply expand coverage, and NOT implement or attempt to reign in the substantial increases in healthcare spending that occur annually, will NOT WORK. It's that simple.
YOU CANNOT ESCAPE THE RULE OF 6.9%. In a year, FY2008, which saw the worst economic collapse in five decades, and saw the year finish with NEGATIVE GDP growth. Yep,
-5.8%, healthcare spending still increased by 6.9%. Businesses which saw record losses, and had to cut staff, production, and benefits, saw health premiums increase by 5% on average. The current iterations put forth by the house, and the HELP version from the Senate DO NOT DO THIS. SO, we will simply be spending ourselves further and further into oblivion.
Right now, by 2050, Medicare and Medicaid spending alone will consume almost all federal taxes levied, and by 2080, Medicare will consume MORE than all federal taxes collected. This year, 2009, the predicted increase in healthcare spending will be close to 7.4%, and for every year now for decades, healthcare spending increases have outpaced GDP growth. It cannot continue.
This idea, of taxing healthcare, may help. It is one of the few ideas coming out of congress that actually has merit, but it is politically unpopular, cause most americans don't really understand macroeconomics, or the real, REAL need for restraint in healthcare spending.
If the economy could stay elastic and continually expand, we wouldn't even have any of this conversation, but it cannot. In fact, right now, it is still contracting, although the latest economic indicators show that this had slowed substantially, healthcare does not respond like a typical commodities market. Cause it's not. Right now, as most of you know, we have a mixed payor system. Unfortunately, this is the worst of both worlds. Anyway, please read:
THIS
YOU CANNOT ESCAPE THE RULE OF 6.9%. In a year, FY2008, which saw the worst economic collapse in five decades, and saw the year finish with NEGATIVE GDP growth. Yep,
-5.8%, healthcare spending still increased by 6.9%. Businesses which saw record losses, and had to cut staff, production, and benefits, saw health premiums increase by 5% on average. The current iterations put forth by the house, and the HELP version from the Senate DO NOT DO THIS. SO, we will simply be spending ourselves further and further into oblivion.
Right now, by 2050, Medicare and Medicaid spending alone will consume almost all federal taxes levied, and by 2080, Medicare will consume MORE than all federal taxes collected. This year, 2009, the predicted increase in healthcare spending will be close to 7.4%, and for every year now for decades, healthcare spending increases have outpaced GDP growth. It cannot continue.
This idea, of taxing healthcare, may help. It is one of the few ideas coming out of congress that actually has merit, but it is politically unpopular, cause most americans don't really understand macroeconomics, or the real, REAL need for restraint in healthcare spending.
If the economy could stay elastic and continually expand, we wouldn't even have any of this conversation, but it cannot. In fact, right now, it is still contracting, although the latest economic indicators show that this had slowed substantially, healthcare does not respond like a typical commodities market. Cause it's not. Right now, as most of you know, we have a mixed payor system. Unfortunately, this is the worst of both worlds. Anyway, please read:
THIS
Trip Home with my Daughter
SO, I decide to take my 3 year old daughter home last week for a family reunion. Let me tell you folks, a 12 hour car ride BY YOURSELF with a 3 year old is not something to be taken lightly. She did so, SO good though. She truly was Daddy's big little girl. She loved being at the farm and seeing my mom, and at the tender age of 3, rode a horse for the first time BY HERSELF. Last year, she'd sit on the saddle, but only if mom or dad were with her. For those that are wondering, my wife's brother is terminal with stage IV adenoca of the lung, and her father is also quite ill as well. She does not have much leave from work currently, and decided to stay home to save leave.
I will say that having a 3 year old cry, and scream that they have to "GO POTTY" while you are stuck in construction with no exits anywhere in sight is a new experience for me.
I will say that having a 3 year old cry, and scream that they have to "GO POTTY" while you are stuck in construction with no exits anywhere in sight is a new experience for me.
Friday, July 17, 2009
Prometheus is upon us.....
WHOA, the physician community is not so happy about this.
This is a new system funded by the Robert Wood Johnson foundation, and is akin to forced capitation. Obama and the current administration are quite interested in this, and various states, including my own are thinking about implementing it as well. I'd be interested in Happy's take on this.
I wonder how the guys in McAllen would take this.....(ducks)
More HERE
This is a new system funded by the Robert Wood Johnson foundation, and is akin to forced capitation. Obama and the current administration are quite interested in this, and various states, including my own are thinking about implementing it as well. I'd be interested in Happy's take on this.
I wonder how the guys in McAllen would take this.....(ducks)
More HERE
20th High School Reunion
Wow, what the hell happened? HOW has it been 20 years already. I didn't go to my 5th or 10th, or any of my other reunions, but I just finalized my travel plans to go back in about 3 weeks for my 20th. Like anything, there will be some people I really want to see and catch up with, and others that I didn't know really well. Oh well, a good bottle of 21 year old MacCallan, and life is good.
Pneumonia SUCKS
Wow, I can't remember being this sick in a long time. I was diagnosed almost two weeks ago. Left lower lobar consolidation. Treated appropriately, but I am still coughing stuff up. Missed a couple of days at work initially, cause I just couldn't go. I can tell I am getting older. When I was 15 years younger, I would have recovered in a few days, but I am still getting over this 2 weeks later.....WTF?
Sunday, July 5, 2009
Pay Cuts for Specialists, and increases for Primary Care..
Obama's initiative to CMS, re-allocate your re-imbursements! Estimates are that primary care physicians could see a pay increase of 6-8%, while some specialists, specifically cardiology as mentioned, could see BIG decreases. 11% overall, but up to 42% for procedures like echocardiograms.
Big changes...
See HERE
Big changes...
See HERE
Thursday, July 2, 2009
AMA does 180
SO, I think the AMA is doing their very best imitation of John Kerry at the moment, first they were against it, and now.......not so much.
Look HERE
Just gotta wonder.
Look HERE
Just gotta wonder.
Walmart...makes me laugh
SO, Walmart, the nations LARGEST private employer with 1.4 million employees is supportive of an employer mandate from congress for all employers to provide insurance. If only they were so accomodating to all of their employees. While I am not opposed to a mandate, I find it somewhat comical that a company with 36,000 employees on MEDICAID, yes, Medicaid, and has historically been somewhat reluctant to expand employee benefits would suddenly "see the light". I think that this is likely more of a power play by Walmart, to force some of their smaller competitors to provide benefits that they themselves are not even currently providing. I find it somewhat interesting considering that according to this article, only 53% of Walmart employees have health insurance sponsored by Wally, and 6% of their employee population is completely UNINSURED. Interesting statements made by them.
See more HERE
See more HERE
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