Medicare and Big Hospitals are Insidious

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Jered
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Joined: Wed Aug 20, 2008 1:30 am

Medicare and Big Hospitals are Insidious

Post by Jered »

I came across this article today.

Holy balls that's fucked up.

I've pasted a few bits of the article here. It's worth a read.

I knew that the government had dicked with our health care system a lot a created the mess, but, it's even worse than I knew. Holy balls.

...just...wow.
To facilitate coordination among providers for such purposes, CMS has been empowered to waive the anti-kickback statute and prohibitions on self-referral for providers participating in ACOs. Yet this obscure process represents a further step away from a level competitive playing field for providers; it tempts administrators to favor large medical systems that are easier to monitor and less disrupted by unpredictable competitive forces, and it does much to reward independent providers for integrating with them. Indeed, former HHS Secretary Kathleen Sebelius acknowledged that attempts to integrate payments were in "constant tension" with antitrust laws.
While the integrated provider systems that dominate local markets pose certain well-publicized economic risks, the political power such institutions are likely to accumulate must also be considered. When integrated providers are no longer held accountable by competition, the political process will have little capacity to challenge them either. Rather than leading providers to accept more rational payments from private payers, Medicare's clout as a single payer is inadvertently used to prevent competition from forcing them to do so.
By reimbursing for services regardless of cost-effectiveness or the availability of cheaper alternatives, Medicare's physician payment system does little to encourage physicians to be thrifty. In many cases the opposite is true. Medicare reimburses medical practices 106% of the average sales price for physician-administered drugs, implicitly providing a commission for using an expensive drug when a cheaper alternative is available. A 2011 report from the Office of Inspector General (OIG) at the Department of Health and Human Services found wasteful spending of $1 billion as a result of Lucentis (priced at $1,600 per dose) being prescribed as often as Avastin ($40 per dose), even though both are practically identical treatments for macular degeneration, a common form of blindness.
Physicians in specialties whose jobs have been made easier and more lucrative over time by labor-saving technological improvements are not quick to disclose that fact, nor are they forced by competition to lower their prices. In a March 2006 review of physician-fee adjustments, MedPAC noted that physician specialty societies aggressively lobbied for upward payment adjustments, recommending upward revisions for all but a handful of the 1,500 codes subject to comment.
Physicians therefore find themselves rewarded for inflating volumes of medical tests, procedures, and equipment provided — or "unbundling" interactions with patients into multiple claims.
Hospitals in consolidated markets are able to wield their position as "must-have providers" to inflate fees, while their "too big to fail" status can be leveraged to insist that politicians protect them from emerging competition. Politicians often propound the need for public subsidies to maintain the solvency of their local hospitals, while simultaneously advocating regulatory price controls to check their pricing power — seemingly unaware of any logical inconsistency.
The avalanche has already started. It is too late for the pebbles to vote.
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MiddleAgedKen
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Re: Medicare and Big Hospitals are Insidious

Post by MiddleAgedKen »

RONPAUL SMASH! (If only.)
Shop at Traitor Joe's: Just 10% to the Big Guy gets you the whole store and everything in it!
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skb12172
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Re: Medicare and Big Hospitals are Insidious

Post by skb12172 »

Like prison reform. Too many powerful people have a big financial incentive in keeping things the way they are. You aren't going to get any meaningful change when that is the case.
There must be an end to this intimidation by those who come to this great country, but reject its culture.
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