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Thursday, May 30, 2013

What do you think of Obamacare?

The Patient Protection and Affordable Care Act (PPACA), a.k.a. Obamacare, has forced upon hospitals a new program that will punish hospitals as far as reimbursement is concerned for any COPD patient who is readmitted within a two week period of being discharged. This does not include emergency room visits, only hospital admissions. 

This provision of the law was made with the idea of giving hospitals an incentive to pay special attention to their COPD patients to make sure they are educated about their disease, are on all the best medicines, and their are follow up appointments made to make sure the patient is taking his or her medicine. 

Other people disagree with that claim. They say that the provision was implicitly placed into the law to give CMS an excuse not to reimburse hospitals for said patient.  There is some credibility to their claim considering it does not matter what the patient is readmitted for: heart failure, COPD exacerbation, high blood pressure, low blood pressure, rickets, a hand nail, or anxiety.

These patients have a high rate of morbidity, and it's nearly impossible to know, even if the physician is being proactive, what ailment might plague that patient in a day or two.  Our hospital, and every other hospital I've ever worked for, has had a steady flow of COPD patients, many who are admitted often enough to become good friends with the hospital staff.  With this law, there are many hospitals that will go under. 

There is also a stipulation in Obamacare to make it easier for hospitals to merge, and many hospitals in the geographical region where I live have merged since Obamacare went into effect.  Some of my friends claim that these provisions, and the entire Obamacare law, was implicitly put into place with the intention of causing the health care system to fail.  When the health care system fails, people will come calling to the government to bail them out with universal health care. 

With most hospitals already joined into large conglomerates, taking away competition and the incentive to lower prices, the government will have fewer companies to combine.  When Obamacare fails, they say, so too will the health care system. 

I think it was worded best by a physician friend of mine:  "The government caused the mess with health care by becoming involved in it in the 1960s, before that time it was a pay for service system, and the cost of health care was low.  Since the 1960s, health care costs have increased, making it so most people cannot afford it.  So then career politicians, the same people who caused the problem, purported to fix it with even more government. This is a system set up for disaster." 

I personally, as my regular readers already know, am among the 54-58% of Americans opposed to Obamacare.  What do you think of it?  Be nice. 


Anonymous said...

May God help you if you ever get sick.

Rick Frea said...

God will help those who help themselves, as the old saying goes.

Aiesha Grant said...

I too disagree with Obama Care! I find it unfair that the government will fail to reimburse hospitals if they are re-admitted within that two week time period even if it is not for a COPD related concern! When I was an intern at Grady Memorial Hospital here in Atlanta, many COPD patients were there from week to week and it was not always for their COPD! Many had hypertension, CHF, etc and were admitted for those reasons. I think that Obama Care is going to have the biggest impact on large, urban hospitals where the majority of patients either don't have heath insurance, are homeless, or have poor diet and overall health. Its like a downward spiral because in these areas the patients don't have the resources to stay out of the hospital. They eat poorly and as result most are obese (and we all know this leads to a host of other health problems), they don't have the finances to go to the doctor regularly for check-ups or maintenance meds that may help them, and their mentalities (at least generally) usually results in non-compliance with meds, follow-up appointments etc. Because of this, unfortunately, they WILL keep coming back. They will keep coming back despite healthcare teams best efforts to ensure they are given optimal meds, education about their illness etc. Nothing will change, except that when they come back we will lose money as a result.