Posts Tagged ‘emergency rooms’

Death To America, ObamaCare-Style: ObamaCare Already A Nightmare For Doctors, Soon To Be A Nightmare For Poor, Sick Patients

April 4, 2015

Remember how Barack Hussein Obama said over and over and over again that if you like your doctor, his ObamaCare would allow you to keep your doctor, and if you like your health plan, his ObamaCare would allow you to keep your health plan?

He lied.  And in the minimum of 37 times he lied on that issue alone, Barack Obama became the most documented liar in all of human history as he looked more than 300 million Americans in the eye and lied like the hell that he is again and again and again.  It was “the lie of the year,” and you’ve got to be a world-class demon-possessed liar to emerge out of all the lies that we are told in this country today.

But that was hardly this demon-possessed liar’s only lie about ObamaCare.  Obama promised his ObamaCare would help doctors, that it would help poor, sick patients, that it would bend the cost curve for healthcare down.

All lies.

Here’s an article from Saturday’s USA Today that exposes these lies (it appeared in my print edition under the title, “Maddened by metrics”):

Quality payment incentives: What’s the point?
Jordan Rau, Kaiser Health News 6 a.m. EDT April 4, 2015

Dr. Michael Kitchell initially welcomed the federal government’s new quality incentives for doctors. His medical group in Iowa has always scored better than most in the quality reports that Medicare has provided doctors in recent years, he said.

But when the government launched a new payment system that will soon apply to all physicians who accept Medicare, Kitchell’s McFarland Clinic in Ames didn’t win a bonus. In fact, there are few winners: Out of 1,010 large physician groups that the government evaluated, just 14 are getting payment increases this year, according to Medicare. Losers also are scarce. Only 11 groups will be getting reductions for low quality or high spending.

“We performed well, but not enough for the bonus,” said Kitchell, a neurologist. “My sense of disappointment here is really significant. Why even bother?”

Within three years, the Obama administration wants quality of care to be considered in allocating $9 of every $10 Medicare pays directly to providers to treat the elderly and disabled. One part of that effort is well underway: revising hospital payments based on excess readmissions, patient satisfaction and other quality measures. Expanding this approach to physicians is touchier, as many are suspicious of the government judging them and reluctant to share performance metrics that Medicare requests.

“Without having any indication that this is improving patient care, they just keep piling on additional requirements,” said Mark Donnell, an anesthesiologist in Silver City, N.M. Donnell said he only reports a third of the quality measures he is expected to. “So much of what’s done in medicine is only done to meet the requirements,” he said.

The new financial incentive for doctors, called a physician value-based payment modifier, allows the federal government to boost or lower the amount it reimburses doctors based on how they score on quality measures and how much their patients cost Medicare. How doctors rate this year will determine payments for more than 900,000 physicians by 2017.

Medicare is easing doctors into the program, applying it this year only to medical groups with at least 100 health professionals, including doctors, nurses, speech-language pathologists and occupational therapists. Next year, the program expands Medicare to groups of 10 or more health professionals. In 2017, all remaining doctors who take Medicare — along with about 360,000 other health professionals — will be included. By early in the next decade, 9% of the payments Medicare makes to doctors and other professionals would be at risk under a bill that the House of Representatives passed in March.

The quality metrics used to judge doctors vary by specialty. One test looks at how consistently doctors keep an accurate list of all the drugs patients were taking. Others track the rate of complications after cataract surgery, say, or whether patients received recommended treatments for particular cancers.

There are more than 250 quality measures. Groups and doctors must report a selection — generally nine, which they choose — or else be automatically penalized. This year, 319 large medical groups are having their reimbursements reduced by 1% because they did not meet Medicare’s reporting standards.

Physicians who do report their quality data fear the measures are sometimes misguided, usually a hassle, and may encourage doctors to avoid poorer and sicker patients, who tend to have more trouble controlling asthma or staying on antidepressants, for instance.

Leanne Chrisman-Khawam, a primary care doctor in Cleveland, said many of her patients have difficulty just getting to follow-up appointments, since they must take two or three buses. She said those battling obesity or diabetes are less likely to reform their diets to emphasize fresh foods, which are expensive and less available in poor neighborhoods. “You’re going to link that physician’s payment to that life?” she asked.

Hamilton Lempert, an emergency room doctor in Cincinnati, criticized one measure that requires him to track how often he follows up with patients with high blood pressure.

“Most everyone’s blood pressure is elevated in the emergency department because they’re anxious,” Lempert said. Another metric encourages testing the heart’s electrical impulses in patients with non-traumatic chest pain, which Lempert said has led emergency rooms to give priority to these cases over more serious ones.

“It’s just very frustrating, the things we have to do to jump through the hoops,” he said.

In the first year doctors are affected by the program, they can choose to forgo bonuses or penalties based on their performances. After that, the program is mandatory. This year, 564 groups opted out, but even if all of them had been included, only 3% would have gotten increases and 38% would have seen lower payments, mostly for not satisfactorily reporting quality measures, Medicare data show.

Smaller groups and solo practitioners are even less likely to report quality to the government. “The participation rates, even though it’s mandated, are just really low,” said Dr. Alyna Chien, an assistant professor at Harvard Medical School. It’s “a level of analytics that just is not typically built into a doctor’s office.”

Dr. Lisa Bielamowicz, chief medical officer of The Advisory Board, a consulting group, predicted more doctors will start reporting their quality scores when the prospect of fines is greater. “They are not going to motivate until it is absolutely necessary,” she said. “If you look at these small practices, a lot of them just run on a shoestring.”

This year’s assessments of big groups were based on patients seen in 2013. A total of $11 million of the $1.2 billion Medicare pays doctors is being given out as bonuses, which translates to a 5% payment increase for those 14 groups getting payment increases this year. That money came from low performers and those that did not report quality measures to Medicare’s satisfaction; they are losing up to 1%.

The exact amount any of these groups lose will depend on the number and nature of the services they provide over the year. This year, 268 medical groups were exempted because at least one of their doctors was participating in one of the government’s experiments in providing care differently.

Officials at the Centers for Medicare & Medicaid Services declined to be interviewed about the program, but said in a prepared statement that they have been providing all doctors with reports showing their quality and costs. “We hope that this information will provide meaningful and actionable information to physicians so that they may improve the coordination and integration of the health care provided to beneficiaries,” the statement said.

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

How the hell do you think fining doctors – who are already operating on a shoestring – for not doing something that massively increases their costs because making those reports is very obviously not something they are equipped to do, is going to lower the cost of healthcare?  Are you really that stupid that you believe it will???

Doctors are frustrated and getting more and more frustrated.  We’ve already seen them retiring at the highest rate since Hippocrates was working on his oath millennia ago.  It’s been going on since the damn evil law passed and it’s going to pick up speed.  We’re seeing fewer and fewer doctors left to service larger and larger networks of patients.  Now they are increasingly dropping out of ObamaCare and its reporting requirements as fast as they can.  How in the hell is that supposed to improve patient care?  Are you really that stupid that you believe it will???

You’ve got to love this prophetic title from CBS News that heralds future doom:

Obamacare 2015: Higher costs, higher penalties

With the Affordable Care Act to start enrollment for its second year on Nov. 15, some unpleasant surprises may be in store for some.

That’s because a number of low-priced Obamacare plans will raise their rates in 2015, making those options less affordable. On top of that, penalties for failing to secure a health-insurance plan will rise steeply next year, which could take a big bite out of some families’ pocketbooks.

“The penalty is meant to incentivize people to get coverage,” said senior analyst Laura Adams of InsuranceQuotes.com. “This year, I think a lot of people are going to be in for a shock.”

Oops.  Sorry, poor people.  It sort of looks like Obama and his demonic minions didn’t actually give a DAMN about you, after all.

But the real lie – the lie that makes “Democrat” truly stand for “DEMOn-possessed bureauCRAT” – is the one about helping the poor and the sick get better access to medical care.  Let me replay the lines from the article:

Physicians who do report their quality data fear the measures are sometimes misguided, usually a hassle, and may encourage doctors to avoid poorer and sicker patients, who tend to have more trouble controlling asthma or staying on antidepressants, for instance.

Leanne Chrisman-Khawam, a primary care doctor in Cleveland, said many of her patients have difficulty just getting to follow-up appointments, since they must take two or three buses. She said those battling obesity or diabetes are less likely to reform their diets to emphasize fresh foods, which are expensive and less available in poor neighborhoods. “You’re going to link that physician’s payment to that life?” she asked.

Barack Obama – in his wickedness – has designed a system that pits doctors against the poorest, sickest patients.  The doctor can treat them, sure, but only if he or she is willing to pay severely for it and be punished for it by an evil system that promised to do the very opposite of what it is in fact doing.

Barack Obama looks down on that doctor from his satanic Mt. Olympus and he sees a doctor whose stats aren’t up to muster because that doctor is treating sick patients who will tend to get sicker even with the very best of care.  And Obama decrees, “That doctor must be punished!”  And the fines and the penalties start kicking in.  Better to just leave that poor, sick patient on the side of the road, modern-day Good Samaritan physician.  Because Obama will come after you with all the power of totalitarian government arbitrariness if you try to help that patient.

Here’s another demonic DEMOnic bureauCRAT lie for you: Obama promised fewer people would use emergency rooms; when the very OPPOSITE is happening BECAUSE OF HIS DEMONIC LAW as USA TODAY documents:

More patients flocking to ERs under Obamacare

LOUISVILLE, Ky. — It wasn’t supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren’t actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

That’s just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients. […]

The same “experts” who didn’t see what we conservatives were predicting EVER SINCE THIS DEMONIC LAW THREATENED AMERICA TO BEGIN WITH are refusing the see the REAL cause: the law was based entirely on lies because the Democrats who shoved this evil monstrosity down our collectivist throats are demon-possessed liars.

Not one month ago, I wrote up my own experience with the Veterans Administration as to how this very arbitrary bureaucratic mindset is just taking over the entire system.  Within the span of one week, I suffered that arbitrariness of penalizing decent people because of the behavior of others TWICE.  First, I was contacted and ORDERED to take a urine test.  Why?  I wanted to know; I’d just taken one and that test had nothing to do with my healthcare.  Rather, it had been a drug test because I’m on oxycodone for the pain created by my service-connected medical condition.

Well, less than three months after the last test – which proved I was completely clean of anything but what I was supposed to be taking – I was being commanded to take it again.  And apparently under Obama I will have to be treated like a drug criminal at least four times a year from now on.

Why?  Because other veterans somewhere else are abusing their prescription drugs.  So the obvious thing to do – as obvious as it is to treat a 103-year-old Catholic nun in a walker like a young Middle Eastern terrorist male – is to treat EVERYONE like a criminal or an addict.

I have been receiving physical therapy for a major shoulder surgery.  I was given a month-and-a-half worth of appointments and I kept every single one of them.  In fact, I have NEVER missed an appointment with the VA.  But because somebody somewhere had missed appointments, the “system” decided to treat EVERYONE like a no-shower.

So I know firsthand exactly what these doctors are saying: it doesn’t matter if I do right or not; the system will punish me anyway.  And it will do so by protecting the very worst people (who of course vote Democrat, don’t they?) by redistributing the pain for the cost of their godawful behavior onto everyone else.  That’s what the welfare system is based on, baby: “Oh, you don’t have a job because you refuse to get off your fat, pimply ass and look for one and it’s easier to pump out ten kids and collect increased payments for each one?  Don’t worry, dearie, here’s the money somebody else earned by working his butt off.  Please don’t forget to vote for Messiah Obama unless you want mean Republicans to force you to produce something with your life besides flatulence!”

I’ve talked to several veterans who are as livid as I am.  And they are saying they’re just going to start buying the marijuana that the same damn DEMOnic bureauCRATS who are forcing them to take the piss tests for drugs are opening up for everybody else so they can be happier welfare recipients.  And why bother busting your ass to show up for appointments when you’re going to be treated like dirt whether you show up or not???

And so they are producing the very opposite thing to what they are stupidly claiming they are producing.

What Obama is producing is the same thing the ayatollahs Obama is appeasing and negotiating with are calling for: “Death to America!”

The fact of the matter is that ObamaCare was sold and marketed entirely on the basis of lies.  That is just a documented fact.

But the even sadder fact of the matter is that unless the Supreme Court finally steps in and does the right thing and overturns this fascist takeover of the American healthcare system, ObamaCare will destroy America because nothing will be able to prevent it from doing so.  It was crafted as a metastasizing cancer that will keep becoming larger and making the patient America sicker until that patient collapses and dies.

 

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Yet Another Outright LIE: Obama Sold ObamaCare Under Promise That People Would Stop Going To Emergency Rooms For Treatment

January 13, 2014

The title of the following article says it all: the whole point of “fundamentally transforming” medicine into SOCIALIZED medicine was a lie.

1/02/2014 @ 2:30PM |Avik Roy, Forbes Staff
New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare

For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. “Those of us with health insurance are also paying a hidden and growing tax for those without it—about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,” said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured.

The ‘free rider’ argument was always bunk

Just like the “if you like your plan, you can keep your plan” promise, the promise that Obamacare would make health care less expensive by expanding coverage was always a crock. Nationally, it’s estimated that we spend about $50 billion a year on uncompensated care for the uninsured. But Obamacare spends $250 billion a year of taxpayer money on covering the uninsured. Only in Washington is spending $250 billion to address a $50 billion problem considered “savings.”

In Massachusetts, under Romneycare, the math worked out in a similar way. The Bay State spent $661 million on uncompensated care in the year before Romneycare went into effect; by the 2009 fiscal year, that figure had decreased to $414 million: a savings of $247 million. But in 2011, the cost of the state’s insurance subsidy program was $830 million, and that doesn’t even count the tab paid by the federal government for the state’s expansion of Medicaid.

Did emergency-room usage in Massachusetts decline because of all this extra money? The opposite. ER visits actually rose by 7 percent between 2005 and 2007, and the state’s costs for caring for ER patients rose 17 percent between 2007 and 2009.

And one of the big holes in the myth of uninsured “free riders” is that the uninsured only account for 15 percent of the population, 14 percent of total ER visits, and 12 percent of aggregate ER expenditures, according to a study by the Kaiser Family Foundation. Medicaid beneficiaries, by contrast, accounted for 9 percent of the population, 15 percent of visits, and 9 percent of expenses.

Given all of this data and experience, it was obvious that expanding coverage through Obamacare would increase taxpayer costs, not reduce them. But predictably, the pro-Obamacare “fact-checkers,” like those at PolitiFact, have been nowhere to be found.

The latest data from the Oregon Medicaid experiment

Along come economists Amy Finkelstein of MIT and Kate Baicker of Harvard, who have been participating in the now-famous Oregon Medicaid experiment. Regular readers of The Apothecary will recall that this study compared a group of Oregonians who were uninsured, and stayed that way, to a group who had “won” a lottery to enroll in Medicaid. The study found that Medicaid “generated no significant improvement in measured physical health outcomes,” a finding that reinforces extensive published research. (I also discuss this research in my new book, How Medicaid Fails The Poor.)

Finkelstein and Baicker, in their new Science article, looked at emergency-room records for 24,646 residents of the Portland, Oregon area, spanning 12 regional hospitals, who had participated in the Medicaid experiment. The study was co-authored by Sarah Taubman of the National Bureau of Economic Research; Heidi Allen of the Columbia School of Social Work; and Bill Wright of Oregon’s Portland Medical Center. The authors found, as they had previously, that the subgroup that had gained coverage under Medicaid showed no improvement in the management of their chronic medical problems, such as high cholesterol, high blood pressure, and diabetes.

They also found that those on Medicaid used the emergency room 40 percent more than the uninsured did—1.43 ER visits per Medicaid enrollee, as against 1.02 for the uninsured. More to the point, a majority of the emergency room visits were unnecessary, because they involved conditions that could easily have been managed outside of the ER.

Of the 0.41-per-person increase in visits, 0.18 were “primary care treatable,” meaning they didn’t require ER care. 0.12 didn’t even qualify as emergency care. 0.04 did qualify as emergency issues, but could have been prevented by adequate primary care. The Medicaid-driven increases in each of these categories was statistically significant, meaning that the differences were large enough that they are highly unlikely to be statistical noise.

Medicaid-ER-2014

Medicaid is, in effect, designed to increase emergency-room usage

Why does Medicaid perform so poorly, given that we spend so much money on it—$450 billion a year? Because of fundamental flaws in the way the program was designed.

The authors of the 1965 Medicaid legislation believed that it was morally wrong to expect poor people to pay even modest sums for their own health care. So the law mandates that cost-sharing features, like co-pays, of Medicaid plans must be minimal to zero for both primary care coverage and emergency-room usage.

Because Medicaid was nearly free to the program’s enrollees, those enrollees ended up seeking—and receiving—lots of inappropriate care. That led to massive cost overruns that, even today, are bankrupting state governments. But states have had little flexibility to reform Medicaid’s cost-sharing features. The one thing they have been able to do is pay doctors and hospitals less and less to provide the same care.

That trend, in turn, has led many doctors to stop accepting new Medicaid patients. So it’s extremely difficult for Medicaid enrollees to get appointments with primary care physicians. They have to spend weeks on the phone to find someone who will treat them.

Put yourself in the shoes of that Medicaid enrollee. Why would you bother calling primary care docs all day and all week, if you can go to the emergency room and get the same care for the same price? So that’s what Medicaid patients do.

And then, consider that Medicaid pays hospitals far less than private insurers pay for the same care. Many hospitals say that they lose money on every Medicaid patient they see. But somehow, if we have more Medicaid patients, taxpayers will be better off?

It was bunk in 2009, and it’s bunk today. It’s why the states that have chosen to forego Obamacare’s Medicaid expansion were wise to do so. Governors and legislators who have ignored the data, and burdened generations of future taxpayers with this failed program, have a lot of explaining to do.

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Avik’s new book, How Medicaid Fails the Poor, is now available in paperback, Kindle, and iBooks versions.

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UPDATE: Some more details on the study, for those who are interested. The twelve hospitals in the study encompassed “nearly half of all inpatient hospital admissions in Oregon.” The period observed was approximately 18 months—from March 10, 2008 to September 30, 2009. There were “no statistically significant differences between the groups in demographic characteristics measured at the time of lottery sign-up.” As noted above, the increase in ER usage “from Medicaid is solely in outpatient visits…Medicaid statistically significantly increases visits in all classifications except for the ‘emergent, non-preventable’ category. The increases are most pronounced in those classified as ‘primary care treatable.’”

For a longer list of the President’s repeated promise that Obamacare would reduce emergency-room usage, read Michael Cannon‘s take on the study.

INVESTORS’ NOTE: Among the biggest publicly-traded players in Obamacare’s expansion of Medicaid are Molina (NYSE:MOH), WellPoint (NYSE:WLP), WellCare (NYSE:WCG), Centene (NYSE:CNC), and Humana (NYSE:HUM).

Keep in mind that the overwhelming majority of those who are getting “health insurance” under ObamaCare are being thrown into Medicaid.  And keep in mind that having Medicaid is statistically no better than having no insurance at all in terms of health or longevity due to the crappy care of your new ObamaCare program.

People are waking up to the “sticker shock” of ObamaCare.  Whether or not they can afford the premiums is completely irrelevant when the average deductible PER FAMILY MEMBER is OVER $5,000 a year.  If you can’t afford that, you are for all purposes UNINSURED whether you have a stupid little card from Obama in your wallet or not.

Add to that the fact that the ObamaCare networks are unbelievably small and limited.  There are few doctors available for way, WAY, WAAAAYYY to many patients.  And if you want a specialist because the pain pill Obama wants you to take instead of treatment isn’t quite enough for you, well, I’d say “good luck” but even that would be overly optimistic.

The purpose behind ObamaCare was “to control the people.”  The purpose was to restrict health care to the masses.

It is by now beyond a joke to try to count how many times Barack Hussein Obama was caught in an outright lie in his effort to deceive the American people and impose his wicked worldview on what used to be the greatest nation in the history of the world.  Or how many different lies he told.