Uncle Sam's Plantation

[phreakwars]

But see, if you cut and splice one line with another line like TJ says, you get a whole new line. It's all a part of the conspiracy.

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[timesjoke]

When I read that over I saw that as a positive thing. Maybe I'm not getting it but it seems to me that making other care facilities more accessible would reduce fees and possibly eliminate so many costly re-admissions.

 

The problem is you don't do this with bean counters and buracracy that sets quotas. There will be a set limit of readmissions and if the hospital or doctor exceeds that line drawn in the sand, their reimbursements will be reduced. A case by case review would be fair, a blind quota is not and it forces doctors and hospitals to be constantly concerned if their getting close to their punishment number instead of doing what they feel is right for the patient.

 

 

There is a right way and a wrong way to do everything, and inserting a huge Government buracracy is always the wrong way to do anything.

 

 

Who knows though..if you're an Obama hater he'll never do anything right..the same as if McCain was elected all his choices would be seen as shitty by those who voted otherwise.

 

I don't hate Obama, I hate a lot of the damaging things he has done and wants to do but that is his actions, not him as a person. I hated the idea of the Government running healthcare when the Clintons were trying to do it and I hate the same idea now even if it is repackaged to look different. My point is I don't want Government buracrats inserted in the medical profession and screwing around.

 

 

 

 

 

Hey Bender, I gave you a direct quote out of the law proving the Government will be directly punishing doctors and Hospitals based on arbitrary quotas instead of letting doctors have a free hand in treating their patients the way they see fit. This is the first step of rationing and the biggest harm is the power, the power of Government burcrats to meddle with medical decisions and set fear of the system in the minds of our care givers.

 

there is no level of proof you will ever accept

I will accept Docket#, page, and line number, no less.

 

So now what, I showed you one piece of proof that fits into your request and do you admit to it finally or do you run away from me once again?

[emkay64]

Well if I was a doctor...rather than worry about reimbursement..it may also force me to take extra time and care...instead of treat and street. It may actually make the quality of healthcare better too. It's possible..it may not..but there is a possibility of good things happening.

[timesjoke]

Well if I was a doctor...rather than worry about reimbursement..it may also force me to take extra time and care...instead of treat and street. It may actually make the quality of healthcare better too. It's possible..it may not..but there is a possibility of good things happening.

 

"treat and street" is exactly what this kind of law forces doctors to do.

 

You have to look at the big picture emkay, I understand your trying to paint the best possible picture of the new law but we have to see reality and understand how this government buracracy must work.

 

 

They are already reducing all reimbursements accross the board anyway, doctors must worry about reimbursements because that is how they pay the bills Emkay, just like you have to be concerned how you will pay your bills.

 

 

 

So the doctor is already getting lower reimbursements for everything from a office visit to a surgical operation, but the Government then says that based on their quotas they will be reducing already reduced reimbursements? Not because of a actual case they can quote but because you reached some magical number they don't like?

 

 

 

A possibility of good things happening is not good enough for me, because there is a greater possibility of very bad things happeneing as it always does when Government buracracies get in the way.

[phreakwars]

H.R.3590-290 SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM. (a) IN GENERAL.—Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by sections 3001 and 3008, is amended by adding at the end the following novel subsection :”’(q) HOSPITAL READMISSIONS REDUCTION PROGRAM.—”’(1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)©) occurring during a fiscal year beginning on or after October 1, 2012, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(B)(3), as the case may be) for such a discharge by an amount equal to the product of—”’(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and”’(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.

 

Don't see the problem here, certainly not the one your making up...

[phreakwars]

BTW, here is the REAL text of the bill your trying to quote:

 

SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM.

(a) IN GENERAL.—Section 1886 of the Social Security Act (42

U.S.C. 1395ww), as amended by sections 3001 and 3008, is amended

by adding at the end the following new subsection:

‘‘(q) HOSPITAL READMISSIONS REDUCTION PROGRAM.—

‘‘(1) IN GENERAL.—With respect to payment for discharges

from an applicable hospital (as defined in paragraph (5)©)

occurring during a fiscal year beginning on or after October

1, 2012, in order to account for excess readmissions in the

hospital, the Secretary shall reduce the payments that would

otherwise be made to such hospital under subsection (d) (or

section 1814(B)(3), as the case may be) for such a discharge

by an amount equal to the product of—

‘‘(A) the base operating DRG payment amount (as

defined in paragraph (2)) for the discharge; and

‘‘(B) the adjustment factor (described in paragraph

(3)(A)) for the hospital for the fiscal year.

‘‘(2) BASE OPERATING DRG PAYMENT AMOUNT DEFINED.—

‘‘(A) IN GENERAL.—Except as provided in subparagraph

(B), in this subsection, the term ‘base operating DRG payment

amount’ means, with respect to a hospital for a fiscal

year—

‘‘(i) the payment amount that would otherwise be

made under subsection (d) (determined without regard

to subsection (o)) for a discharge if this subsection

did not apply; reduced by

‘‘(ii) any portion of such payment amount that

is attributable to payments under paragraphs (5)(A),

(5)(B), (5)(F), and (12) of subsection (d).

‘‘(B) SPECIAL RULES FOR CERTAIN HOSPITALS.—

‘‘(i) SOLE COMMUNITY HOSPITALS AND MEDICAREDEPENDENT,

SMALL RURAL HOSPITALS.—In the case of

 

http://frwebgate.acc...3590enr.txt.pdf

 

There are 7 versions of Bill Number H.R.3590 for the 111th Congress. Usually, the last item is the most recent.

http://thomas.loc.go...?c111:H.R.3590:

[phreakwars]

H. R. 3590—291

a medicare-dependent, small rural hospital (with

respect to discharges occurring during fiscal years 2012

and 2013) or a sole community hospital, in applying

subparagraph (A)(i), the payment amount that would

otherwise be made under subsection (d) shall be determined

without regard to subparagraphs (I) and (L)

of subsection (B)(3) and subparagraphs (D) and (G)

of subsection (d)(5).

‘‘(ii) HOSPITALS PAID UNDER SECTION 1814.—In the

case of a hospital that is paid under section 1814(B)(3),

the Secretary may exempt such hospitals provided that

States paid under such section submit an annual report

to the Secretary describing how a similar program

in the State for a participating hospital or hospitals

achieves or surpasses the measured results in terms

of patient health outcomes and cost savings established

herein with respect to this section.

‘‘(3) ADJUSTMENT FACTOR.—

‘‘(A) IN GENERAL.—For purposes of paragraph (1), the

adjustment factor under this paragraph for an applicable

hospital for a fiscal year is equal to the greater of—

‘‘(i) the ratio described in subparagraph (B) for

the hospital for the applicable period (as defined in

paragraph (5)(D)) for such fiscal year; or

‘‘(ii) the floor adjustment factor specified in

subparagraph ©.

‘‘(B) RATIO.—The ratio described in this subparagraph

for a hospital for an applicable period is equal to 1 minus

the ratio of—

‘‘(i) the aggregate payments for excess readmissions

(as defined in paragraph (4)(A)) with respect

to an applicable hospital for the applicable period; and

‘‘(ii) the aggregate payments for all discharges (as

defined in paragraph (4)(B)) with respect to such

applicable hospital for such applicable period.

‘‘© FLOOR ADJUSTMENT FACTOR.—For purposes of

subparagraph (A), the floor adjustment factor specified in

this subparagraph for—

‘‘(i) fiscal year 2013 is 0.99;

‘‘(ii) fiscal year 2014 is 0.98; or

‘‘(iii) fiscal year 2015 and subsequent fiscal years

is 0.97.

‘‘(4) AGGREGATE PAYMENTS, EXCESS READMISSION RATIO

DEFINED.—For purposes of this subsection:

‘‘(A) AGGREGATE PAYMENTS FOR EXCESS READMISSIONS.—

The term ‘aggregate payments for excess readmissions’

means, for a hospital for an applicable period, the

sum, for applicable conditions (as defined in paragraph

(5)(A)), of the product, for each applicable condition, of—

‘‘(i) the base operating DRG payment amount for

such hospital for such applicable period for such condition;

‘‘(ii) the number of admissions for such condition

for such hospital for such applicable period; and

‘‘(iii) the excess readmissions ratio (as defined in

subparagraph ©) for such hospital for such applicable

period minus 1.

[ImWithStupid]

This has been up on my status update since last night...

 

 

111th Congress; H.R. 1 ENR; TITLE VIII; Sec 804

[emkay64]

BTW, here is the REAL text of the bill your trying to quote:

 

SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM.

(a) IN GENERAL.—Section 1886 of the Social Security Act (42

U.S.C. 1395ww), as amended by sections 3001 and 3008, is amended

by adding at the end the following new subsection:

‘‘(q) HOSPITAL READMISSIONS REDUCTION PROGRAM.—

‘‘(1) IN GENERAL.—With respect to payment for discharges

from an applicable hospital (as defined in paragraph (5)©)

occurring during a fiscal year beginning on or after October

1, 2012, in order to account for excess readmissions in the

hospital, the Secretary shall reduce the payments that would

otherwise be made to such hospital under subsection (d) (or

section 1814(B)(3), as the case may be) for such a discharge

by an amount equal to the product of—

‘‘(A) the base operating DRG payment amount (as

defined in paragraph (2)) for the discharge; and

‘‘(B) the adjustment factor (described in paragraph

(3)(A)) for the hospital for the fiscal year.

‘‘(2) BASE OPERATING DRG PAYMENT AMOUNT DEFINED.—

‘‘(A) IN GENERAL.—Except as provided in subparagraph

(B), in this subsection, the term ‘base operating DRG payment

amount’ means, with respect to a hospital for a fiscal

year—

‘‘(i) the payment amount that would otherwise be

made under subsection (d) (determined without regard

to subsection (o)) for a discharge if this subsection

did not apply; reduced by

‘‘(ii) any portion of such payment amount that

is attributable to payments under paragraphs (5)(A),

(5)(B), (5)(F), and (12) of subsection (d).

‘‘(B) SPECIAL RULES FOR CERTAIN HOSPITALS.—

‘‘(i) SOLE COMMUNITY HOSPITALS AND MEDICAREDEPENDENT,

SMALL RURAL HOSPITALS.—In the case of

 

http://frwebgate.acc...3590enr.txt.pdf

 

This was the point I was making. I read all this at various other sources. It doesn't sound like a terrible thing. It may make the caregiver have to take some extra time with a patient and make sure all measures are taken so they don't have to be readmitted shrugs I don't see much of a problem. However I think they need a new system..and perhaps a few tweaks here and there (like this) to see what happens is better than a complete overhaul forcing a huge adjustment. The system already sucks..it's going to be a trial and error system to see what works anyways.

[phreakwars]

This has been up on my status update since last night...

 

 

111th Congress; H.R. 1 ENR; TITLE VIII; Sec 804

 

 

I'm not finding that, I can only find up to Sec 802

 

http://thomas.loc.go...ADOHm8:e173300:

 

What's your source?

 

Edit: NEVERMIND, FOUND IT:

 

• SEC. 804. FEDERAL COORDINATING COUNCIL FOR COMPARATIVE EFFECTIVENESS RESEARCH. (a) ESTABLISHMENT- There is hereby established a Federal Coordinating Council for Comparative Effectiveness Research (in this section referred to as the `Council').

• (B) PURPOSE- The Council shall foster optimum coordination of comparative effectiveness and related health services research conducted or supported by relevant Federal departments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources.

• © DUTIES- The Council shall--

• • (1) assist the offices and agencies of the Federal Government, including the Departments of Health and Human Services, Veterans Affairs, and Defense, and other Federal departments or agencies, to coordinate the conduct or support of comparative effectiveness and related health services research; and

• • (2) advise the President and Congress on--

• • • (A) strategies with respect to the infrastructure needs of comparative effectiveness research within the Federal Government; and

• • • (B) organizational expenditures for comparative effectiveness research by relevant Federal departments and agencies.

• (d) MEMBERSHIP-

• • (1) NUMBER AND APPOINTMENT- The Council shall be composed of not more than 15 members, all of whom are senior Federal officers or employees with responsibility for health-related programs, appointed by the President, acting through the Secretary of Health and Human Services (in this section referred to as the `Secretary'). Members shall first be appointed to the Council not later than 30 days after the date of the enactment of this Act.

• • (2) MEMBERS-

• • • (A) IN GENERAL- The members of the Council shall include one senior officer or employee from each of the following agencies:

• • • • (i) The Agency for Healthcare Research and Quality.

• • • • (ii) The Centers for Medicare and Medicaid Services.

• • • • (iii) The National Institutes of Health.

• • • • (iv) The Office of the National Coordinator for Health Information Technology.

• • • • (v) The Food and Drug Administration.

• • • • (vi) The Veterans Health Administration within the Department of Veterans Affairs.

• • • • (vii) The office within the Department of Defense responsible for management of the Department of Defense Military Health Care System.

• • • (B) QUALIFICATIONS- At least half of the members of the Council shall be physicians or other experts with clinical expertise.

• • (3) CHAIRMAN; VICE CHAIRMAN- The Secretary shall serve as Chairman of the Council and shall designate a member to serve as Vice Chairman.

• (e) REPORTS-

• • (1) INITIAL REPORT- Not later than June 30, 2009, the Council shall submit to the President and the Congress a report containing information describing current Federal activities on comparative effectiveness research and recommendations for such research conducted or supported from funds made available for allotment by the Secretary for comparative effectiveness research in this Act.

• • (2) ANNUAL REPORT- The Council shall submit to the President and Congress an annual report regarding its activities and recommendations concerning the infrastructure needs, organizational expenditures and opportunities for better coordination of comparative effectiveness research by relevant Federal departments and agencies.

• (f) STAFFING; SUPPORT- From funds made available for allotment by the Secretary for comparative effectiveness research in this Act, the Secretary shall make available not more than 1 percent to the Council for staff and administrative support.

• (g) RULES OF CONSTRUCTION-

• • (1) COVERAGE- Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer.

• • (2) REPORTS AND RECOMMENDATIONS- None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.

.

.

[ImWithStupid]

 

I am still waiting for you to tell me why Obama gave Unions that sweetheart deal to exclude them from the new healthcare taxes and why that was good for all of America Bender, if you ever stop running away from that question and honestly answer it I may decide to devote some time posting a few of the lines out of the law that gives the Government the right to ration care. My question to you was before your question, you are still dodging my question so don't expect me to go out of my way to answer yours when your just going to ignore the lines and lie about what they mean anyway when your not answering my question.

 

http://weaselzippers.us/2010/09/21/video-daily-show-mocks-unions-for-using-non-union-members-to-walk-the-picket-line/

[jokersarewild]

I love the Daily Show. That was f cking great.

[timesjoke]

BTW, here is the REAL text of the bill your trying to quote:

 

 

Still says the same thing Bender:

 

‘‘(1) IN GENERAL.—With respect to payment for discharges

from an applicable hospital (as defined in paragraph (5)©)

occurring during a fiscal year beginning on or after October

1, 2012, in order to account for excess readmissions in the

hospital, the Secretary shall reduce the payments that would

otherwise be made to such hospital under subsection (d) (or

section 1814(B)(3),

 

 

Buracrats set quotas and based on a arbitrary number set by burcrats, hospitals and doctors will be scare to readmit patients even if the patient really needs to be readmitted. That is one very big way of rationing care, creating fear in the care givers of providing certain kinds of care that the Government has determined is too expensive and wants to discourage.

 

 

 

I proved my point based on the rule your set Bender, can you admit that or not?

 

 

 

Bu the way emkay, this will promote less time with the patients so the doctor can justify sending them home instead of admitting them. The Government should not be setting quotas and cutting reimbursements just because of those numbers, there are always exceptions and reasons for everything and for buracrats to tell doctors that they will be punished for doing what they thought was necessary is BS.