HealthLeaders Media Corner Office - November 6, 2009 | What If All Your Reimbursement Was Medicare? View as a Webpage | Subscribe for Free
What If All Your Reimbursement Was Medicare?
Philip Betbeze, Senior Editor-Leadership

I'm guessing you wouldn't like it very much if all your reimbursement came from Medicare, considering that all I've heard over the years is how Medicare significantly underfunds the cost of care in its reimbursements, leaving hospitals to cross-subsidize by negotiating deals with commercial insurers that pay better. But if healthcare reform passes, and even if the public option pays you as much as 99% of costs, much higher than Medicare, you still come out way behind over time.
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  November 6, 2009

Editor's Picks
Surgeons Give Six Reasons Why Senate Reform Plan Will Worsen Care
Wow, the surgeons are unhappy with the direction healthcare reform is going? What's unbelievable is that it took so long for them to come out against it. Look, I'm not against anyone or any group fighting against something that would be against their narrow self-interest, but surgeons probably shouldn't be the final arbiter of whether this version of healthcare reform or any other gets passed. There are simply too many of them compared to primary care, and the crazy incentives of our reimbursement system only encourage more young doctors to specialize rather than enter primary care, which is clearly the redheaded stepchild among physicians—mostly because compared to surgeons, they're reimbursed pitifully. Of the six reasons they give for being against the plan, five are weak, at best. The first one is the only one for which I have any sympathy. [Read More]
Dying In a Hospital Costs More than Surviving an Inpatient Stay
Consider this item another strike against our procedure-based healthcare system. According to the federal Agency for Healthcare Research and Quality, one of every three people who died in the U.S. in 2007 died in a hospital, and the leading principal diagnosis for patients who died while receiving inpatient care was septicemia, or infection of the bloodstream. Some may jump to the erroneous conclusion that a hospital stay is not only expensive, but is likely to kill you. Of course, if hospitals simply didn't treat people who were critically injured or ill, that expense would certainly decrease markedly, but the fact remains that heroic measures to prolong life often do so only for short periods, and are outrageously expensive to boot. [Read More]
Could RAC Mass Adjustment Changes Mean More Automatic Audits?
Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with the medical record request limits) may be in for a surprise. Those limits apply only to complex audits, but no such limits exist for the number of automatic reviews RACs can perform. [Read More]
Five Projects that Could Contain Costs in Health Reform
One of the biggest criticisms of any health reform package, particularly the latest one from the House, is the lack of concrete cost containment provisions. However, my colleague Cheryl Clark says reading through the bill's 1,990 pages reveals a number of novel proposals that seek to test new ways of measuring and monitoring care. [Read More]
This Week's Headlines
Public's view of healthcare overhaul has familiar ring
Boston Globe, November 5, 2009
Democrats bet AARP support to seal healthcare
San Francisco Chronicle, November 5, 2009
Flu outrunning vaccine, experts say
Washington Post, November 5, 2009
Texas lawmakers try to give doctor-owned hospitals a dose of help
Dallas Morning News, November 5, 2009
Grady to build neighborhood health super centers in Atlanta area
Atlanta Journal-Constitution, November 5, 2009
Health bills too timid on cutting costs, experts say
Washington Post, November 4, 2009
American Academy of Family Physicians loses members over deal with Coke
Associated Press, November 5, 2009
University of Miami, Jackson Health square off at summit
Miami Herald, November 4, 2009
Tenet CEO: Silver lining on the recession cloud
Wall Street Journal Health Blog, November 4, 2009
Webcasts/Audio Conferences
Women's Health: Building a More Profitable Service Line With Existing Assets (December 17)
Marketing Cardiology: Service Line Strategies for Marketers (December 3)
Service Lines Strategies Workshop 2009: Stroke Care (November 17)
RAC Strategy: Preserve Margin, Prevent Take-backs, Promote Alignment (November 10)
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From HealthLeaders Magazine
Care Team Architecture

HealthLeaders October 2009
Creativity and flexibility count, sure. But underlying the successful care team design is a foundation of essential and lasting values. [Read More]
Service Line Management
State of Emergency

The nation's emergency departments are feeling the effects of the economic downturn, but innovations in patient throughput and other strategies offer hope for a beleaguered system. [Read More]
View from the Top

Utilizing Clinical Integration to Foster Successful Hospital Operations Improvement: Don't use impending healthcare reform and the uncertainties surrounding it as an excuse not to enact necessary clinical integration strategies that will improve operations regardless of how legislative healthcare reform eventually plays out. While considerable uncertainty still exists surrounding the details of healthcare reform, certain consequences of reform are so likely that hospitals need to address them. [Read More]
Audio Feature

Reform is Missing the Boat on Transparency: I spoke recently with John Bardis, CEO of MedAssets, a healthcare supply chain and revenue cycle management company, about his crusade against the lack of transparency in durable medical devices, contracts for which preclude hospitals from disclosing how much they pay for such devices. Bardis thinks this lack of transparency is the top financial challenge facing hospitals, and there's precious little in healthcare reform legislation that will shine a light on the murky way device companies keep prices artificially high. [