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re: Out of the Box Healthcare Ideas
Posted on 3/28/17 at 1:26 pm to onmymedicalgrind
Posted on 3/28/17 at 1:26 pm to onmymedicalgrind
quote:
Idk, whenever someone seems to propose a solution to our healthcare issue, they always begin at that assumption and then go from there. Sure it makes the discussion easier, but also makes it unrealistic.
What percentage of medical expenditures are spent on avoidable maladies?
Posted on 3/28/17 at 1:27 pm to onmymedicalgrind
quote:
You think pressing forward with all life sustaining measures = more revenue for most hospitals?
Depends on the DRG and the payor. Up until a few years ago, readmissions were big bucks for everyone. Are you denying that inappropriate utilization coupled with poor case management is a huge driver of costs in the hospital setting?
This post was edited on 3/28/17 at 1:28 pm
Posted on 3/28/17 at 1:28 pm to Antonio Moss
I like something similar to carsons plan.
The nhs pays about 2k pounds or $3k per person for national healthcare.
Give each person $3k per year from birth to death to spend on healthcare place it in a guaranteed small return investment fund.
Setup non profits to care for children who are sick at birth and those who get really sick and exhaust their funds.
Allow funds to be transferred tax free to beneficiaries upon death. This gives the elderly the opportunity to burn through their savings to hang on or deny care and give their family a gift upon their passing.
The nhs pays about 2k pounds or $3k per person for national healthcare.
Give each person $3k per year from birth to death to spend on healthcare place it in a guaranteed small return investment fund.
Setup non profits to care for children who are sick at birth and those who get really sick and exhaust their funds.
Allow funds to be transferred tax free to beneficiaries upon death. This gives the elderly the opportunity to burn through their savings to hang on or deny care and give their family a gift upon their passing.
Posted on 3/28/17 at 1:28 pm to Antonio Moss
That's a backward way of looking at, but I'm not disagreeing with it. I disagree with his assertion that there is something wrong with most people paying in more than they claim. That's how insurance works.
Posted on 3/28/17 at 1:29 pm to Antonio Moss
quote:
We need to discuss in generalities because of the size of the system and, in general, better decision-making will result in healthier life styles which will result in lower health costs. The problem is that this really isn't a healthcare issue; it's a poor decision-maker issue. We already have tons of programs available for free or extremely low costs preventive health care and the vast majority of people for whom its intended never use it.
Yes, and I understand all that.
But these solutions obviously will neglect a certain segment of the population who aren't unhealthy primarily from poor decisions. Before just casting them aside during these discussions, it would help to have numbers on how many people we are leaving out (which to my knowledge I haven't see on here).
Posted on 3/28/17 at 1:30 pm to NOFOX
quote:The idea that EVERY doctor and facility do anything is 100% bullshite. So why introduce bullshite.
The idea that every doctor and facility go along with care they know will only prolong life only because they are scared of lawsuits is 100% bullshite.
We presumably are talking generalities, in this case broad generalities. On that basis, your perception that end-of-life decisions are based on profiteering is patently ignorant.
Posted on 3/28/17 at 1:31 pm to roadGator
I work with a couple shared risk groups. Those mfers refer elderly patients with the sniffles for hospice.
Posted on 3/28/17 at 1:32 pm to NC_Tigah
quote:
The idea that EVERY doctor and facility do anything is 100% bull shite. So why introduce bull shite. We presumably are talking generalities, in this case broad generalities. On that basis, your perception that end-of-life decisions are based on profiteering is patently ignorant.
So your earlier blanket assertion in this thread is subject to this as well?
This post was edited on 3/28/17 at 1:33 pm
Posted on 3/28/17 at 1:32 pm to Ingloriousbastard
quote:
That's a backward way of looking at
How is that backwards? It's literally the definition of insurance.
Posted on 3/28/17 at 1:35 pm to onmymedicalgrind
quote:
But these solutions obviously will neglect a certain segment of the population who aren't unhealthy primarily from poor decisions.
So?
It's not like this would be the exclusive system for healthcare across the entire nation. It's simply putting in place a plan to address a glaring problem. It's only one piece of the system.
You're making perfect the enemy of better.
Posted on 3/28/17 at 1:43 pm to NC_Tigah
quote:
We presumably are talking generalities, in this case broad generalities. On that basis, your perception that end-of-life decisions are based on profiteering is patently ignorant.
I did not say that end of life decisions were based on profiteering. I said when treatment prolonging life lines up with financial incentive alternatives are rarely recommended especially in the face of obvious patient/family preferences. I also said there is a spectrum. A demented 95 year old with a broken hip is different than a cognizant 67 year old.
End of life care represents 10-20% of total medical spending. I don't see the healthcare industry making a focused effort to cut these costs by strongly counseling patients/families about the inefficiency of end of life care. Your perception that doctors/hospitals only provide end of life treatment due to fear of lawsuits is patently ignorant.
Posted on 3/28/17 at 1:45 pm to Antonio Moss
You're arguing with yourself here...
Posted on 3/28/17 at 1:47 pm to the808bass
quote:
Those mfers refer elderly patients with the sniffles for hospice.
I mean, that's kinda what medical subscription is all about.
The doctor ain't about giving up the beach house because of some fat sick diebeetus laden jack holes want to see him and use up all the fees from the healthy group.
IB Freeman makes me laugh with his subscription fairy tale.
Posted on 3/28/17 at 1:51 pm to Antonio Moss
quote:
it's a poor decision-maker issue.
This is true.
In 2011, among those with the highest costs, only 11% were in their last year of life, and approximately 13% of the $1.6 trillion spent on personal health care costs in the United States was devoted to care of individuals in their last year of life.
Medicare spends an inordinate amount (I think >30%) on the last year of life, but that's more due to the population makeup than any sort of 'failing' we can 'fix'.
A better use of efforts would be to focus on chronic illnesses, outcomes, and limiting things like HACs and readmissions.
Posted on 3/28/17 at 1:52 pm to Antonio Moss
quote:AM, aside from ACA mandates adding extraordinarily insurance costs to the system, insurance is not really high on the problem list. Get rid of the obamacare stuff, and allow interstate competition. Means test recipients of Medicaid expansion and have them pay for some portion of it.
Is there a better answer out there?
Far more important though is bringing down cost of care itself.
The cornerstone element there is tort reform. Get non-adversarial patient compensation passed, and the rest can fall into place.
Next is to reduce use of CONs and increase free market pricing competition and price transparency.
Level Drug and Device costs with those in the EU.
Publish facility and provider satisfaction ratings along with quality results.
Posted on 3/28/17 at 1:54 pm to NC_Tigah
quote:
Publish facility and provider satisfaction ratings along with quality results.
This is a decade or more behind schedule. When HSAs became a "thing" we were promised all this cost and outcome transparency.
Who is fighting it? Yep. They don't want you to know the most expensive location does not = the best outcomes always.
Posted on 3/28/17 at 1:55 pm to NC_Tigah
quote:
Publish facility and provider satisfaction ratings along with quality results.
How do you adjust the quality metrics to properly account for the disparities in patient acuity? I assure you our raw rates look worse than some community hospital in certain areas, but it's not as if we treat the same level of patient (or volume).
Posted on 3/28/17 at 1:57 pm to NOFOX
quote:
End of life care represents 10-20% of total medical spending. I don't see the healthcare industry making a focused effort to cut these costs by strongly counseling patients/families about the inefficiency of end of life care. Your perception that doctors/hospitals only provide end of life treatment due to fear of lawsuits is patently ignorant.
This is a giant truism.
Posted on 3/28/17 at 1:58 pm to Antonio Moss
How about breaking the hold insurance companies have over doctors offices? There are tons of offices that won't even see you if you don't have insurance, even if you have the money in your hand to pay for it on the spot.
Posted on 3/28/17 at 1:58 pm to BamaAtl
quote:
How do you adjust the quality metrics to properly account for the disparities in patient acuity?
The same way they rate SNFs with differing patient acuity?
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