Wednesday, January 05, 2005
What Condition My Condition Is In
This piece today from the Washington Times on the impending collapse of Medicare is one that is close to my heart and wallet. Being a nurse practitioner and part of a consulting firm that works with hospitals to improve Medicare payments, I know all too well the insanity that is Medicare.
Medicare was started in 1965 with an estimated 10-year cost of 8 billion. By 1975 the cost was 88 billion, so much for government projections. The government has since been playing cheap games with healthcare providers to reduce costs. Since the government holds all the cards, and waives the big stick, providers are trapped and spend most of their time running scared and in the red.
Since the early 80's Medicare has paid hospitals on a DRG (diagnostic related groups) system. Every diagnosis has an associated DRG number and weight that relates to a set amount of money providers will receive for that diagnosis. For example, Congestive Heart Failure is a DRG 127 and has about a 1 weight. Medicare sets the amount of money that the certain weight brings, but a 1 in weight will bring around 3,500.00. Now comes the kicker, that 3,500.00 is ALL the hospital will receive no matter how long the patient stays in the hospital, what test the physician may order or what other problems might arise during the hospital stay. One can quickly see the problems that develop from this. Hospitals become pressured to get these patients out as quickly as possible because 3,500.00 isn't usually enough to cover the cost of care. All of this is a perfect set-up for quality of care issues.
The above is just one example of Medicare's insanity. To keep the post from being as long as train smoke I'll end it here, for now. This is an issue that I'm sure to return to in the future.
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Medicare was started in 1965 with an estimated 10-year cost of 8 billion. By 1975 the cost was 88 billion, so much for government projections. The government has since been playing cheap games with healthcare providers to reduce costs. Since the government holds all the cards, and waives the big stick, providers are trapped and spend most of their time running scared and in the red.
Since the early 80's Medicare has paid hospitals on a DRG (diagnostic related groups) system. Every diagnosis has an associated DRG number and weight that relates to a set amount of money providers will receive for that diagnosis. For example, Congestive Heart Failure is a DRG 127 and has about a 1 weight. Medicare sets the amount of money that the certain weight brings, but a 1 in weight will bring around 3,500.00. Now comes the kicker, that 3,500.00 is ALL the hospital will receive no matter how long the patient stays in the hospital, what test the physician may order or what other problems might arise during the hospital stay. One can quickly see the problems that develop from this. Hospitals become pressured to get these patients out as quickly as possible because 3,500.00 isn't usually enough to cover the cost of care. All of this is a perfect set-up for quality of care issues.
The above is just one example of Medicare's insanity. To keep the post from being as long as train smoke I'll end it here, for now. This is an issue that I'm sure to return to in the future.
# posted by Joe Florida @ 7:50 AM 
