Listening to CKLW from Widsor, Ontario

I was up late last night and pulling in a radio station I used to listen to in high school. I come from Detroit, otherwise known as the Motor City, and when I got tired of listening to the MoTown Sound, I'd switch over to CKLW in nearby Windsor Ontario.
An ad came up that struck me: It began with hospital sounds - faint regular beeping, perhaps a soft rustle of starched clothing. Then a woman sounding caring but officious said something like, "Mr. Smith? How are you feeling today?"
A deep, older male voice answered, "Much better, thank you."
She went on, "The results of your tests are in and you are well enough to leave; you can go home today."
Then there was a pause, and the man said, "Please, I'd like to stay another night?"
And an announcer broke in that this patient was homeless, and had nowhere to go.
This was an ad developed by a charity seeking donations for the homeless population. Universal access to health care is apparently so solid in Canada that such an ad can be produced with no thought that anyone will complain about the free loading homeless sucking dollars out of the hospital.
I'm not advocating that the guy should use the hospital as a free hotel, but it made me wonder how they do it. Does anyone in Canada understand what "sicker and quicker" means? What happens when a patient goes over the ALOS? Does he stay? Does the hospital now classify him an outlier? He has no address - has the hospital applied then for "emergency Medicaid?" Do they overcharge him so they can add to their bad-debt or charity care totals and therefore receive more DSH payments?
They used universal health care access to demonstrate the problem of homelessness.

Just made me wonder.

Crossposted at http://www.signalhealth.com

DID ANYONE REALLY THINK THIS WOULD WORK? (Part 1)

The marketers must have worked overtime to make the new Medicare drug benefit so complex that informed choice is impossible. I've now helped half a dozen people through the choices; I've been on the web site and signed people up to a plan I was confident was the best choice for them, only to find out that there are parts of the contract unrevealed until you've made the contract.
The first thing that happened was the co-pays changed. The PBM said that the web-accessible information was really just a suggestion - it wasn't supposed to be 100% reliable.

Great.


I have looked at all forty-seven plans available in my zip code; things one might want to know are not ON the CMS site - only some of the comparison data. If you REALLY want to be a good shopper, you should visit each plan's web site, and maybe also make a call and inquire if you have other questions. Of course, when I did that, the marketer on the telephone said she didn't know, but after I signed up I'd be sent that information.

In today's America, conscientious health care consumers must be deceived and coerced before finally relenting to buy a pig in a poke.

crossposted at http://www.signalhealth.com/node/582

WHAT IS THE COST OF CARE?

I have of late been resubmitting claims for a surgeon who has been denied payment for one reason or another. Who knew the any insure that was not a CDHP had a deductible of $10,000? Or a procedure paid for at $5500 for 75% of all insurers is paid less than $1500 by another insurer. Don’t wonder why increasing numbers of physicians are leaving managed care; given that kind of disparity, it would be crazy not to.

No one actually knows what to charge for anything anymore. Medicare makes a determination based on a formula including geographic and market basket data, the cost of labor, and many other things, and their payment is supposed to be the cost of care plus a small percentage profit. Because of the many bills I review, I can see what they pay – and I don’t see how a provider could stay in business with such miserable compensation.

So if Medicare pays a provider $175, while insurers pay between $300-$450 and then the uninsured are charged $600-$700 all for the same procedure, certain calculations come into play: what is the mix of patients I must have to make my bottom line $X. Do I practice in an area of heavy managed care penetration and what insurers are they? What are their internal benchmarks I must meet? How many Medicare patients can I realistically afford to serve? If a patient comes to me with a point-of-service option, how do I know he/she can really afford to pay me if I balance bill them?

What does any of this have to do with good health care? Nothing.


Crossposted at http://www.signalhealth.com/commentary