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Tuesday, October 16, 2012


Tuesday, 8:30 AM.  47 degrees F, wind W, calm. It is overcast and raining gently, as it has been for some time.  the barometer predicts more rain, which we need badly.  This is the kind of rain that soaks in, and will not blow the remaining leaves off the trees.  Overnight the tamaracks in the yard have turned from their usual light green to something bordering on chartreuse, and very shortly they will turn to gold,  enthralled by the alchemy of fall.
        As most of my readers are aware, Joan and I are both on Medicare, so I am rather sensitive to changes in the program which will and are already occurring to it because of Obamacare.  Most people are aware of the big controversy over the $716 billion being transferred from Medicare to help fund Obamacare  (effectively enrolling everyone in Medicare by a different name). But there are many other aspects of the Obamacare law that are much more subtle because they don’t sport huge identifiable dollar figures.  That doesn’t mean that they are trivial in their affect on Medicare recipients and the health industry.
        One such stealth change levies heavy fines on hospitals if a Medicare/Obamacare patient returns to a hospital within thirty days of being released from it after treatment.  This went into effect last week, according to news sources.  Sounds like a good way to force hospitals to do their job better, doesn’t it?  Make those surgeons and those critical care nurses be really careful, right? 
        Well, most hospitals are now for-profit businesses, or have to act like one.  I can envision a hospital CFO analyzing the new law, and recommending a number of ways to avoid the “heavy fines”:
    1) Let’s not take the complicated cases that may not easily fit the   new “no return” policy.  Do reverse triage at the door.
      2) Let’s not release any patients who are not absolutely guaranteed 100% cured, fixed, or otherwise non-returnable. We will run up the bill for the patient and Medicare as much as possible.  Don’t take any chances with releases, we have plenty of excess beds.  We can make money on this if we are smart.
        3) If we get stuck with really tough cases, that look like losers, let’s pawn them off on other care givers as quick as we can so we don’t get stuck with them. Stick them in hospice, nobody returns from there.  And for sure don’t take any iffy referrals from other hospitals just because we have better resources to cure the patient.
        4) Dead men tell no tales, and don’t return from the undertaker to the hospital.  Better dead than in our bed.
        5) Find the weakest link in the government oversight chain, and pay it off.
        6) Everyone be creative.  It's worth a bonus.

        Now, I am an admitted skeptic, and perhaps my arguments are too cynical.  But don’t bet on it.

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