Is Quality of Care Being Affected by Medicare Payment Cuts ?

(3/15/18)- The House Energy and Commerce Committee is seeking information from the Centers for Medicare and Medicaid Services (CMS) and four national medical accreditation organizations as it seeks further information about patient safety problems at various medical facilities.

A Wall Street Journal data based investigation in September found that The Joint Commission, which accredits about 80% of the U.S. hospitals, typically takes no action to revoke or modify its accreditations when state inspectors find serious safety violations

(3/7/13)- Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found. The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions

(11/8/11)- Dr. Amy Kelly of the Mount Sinai School of Medicine, in an editorial of a recent edition of Lancelot, a British medical journal called for action to help reduce the costly surgeries, intensive-care stays and other high-intensity care for the elderly in hospitals. The editorial accompanied the results of a study that showed that 32% of elderly Americans undergo costly surgery in the year before they die.

Betsy McCaughey, author of "The Obama Health Law: What It Says and How to Overturn It" and former lieutenant governor of New York wrote an opinion on this matter entitled "Cooking the Book on Grandma's Health Care" in the Wall Street Journal that rebutted the conclusion that the researchers and Dr. Kelly arrived at.

Shedding light on this matter Ms. McCaughey pointed out that: "The Lancet investigators looked only at patients who died, making surgery appear unsuccessful. Investigators shold have considered how all surgery patients fared, including those who recovered, returned home from the hospital and resumed active lives."

She went on to point out that: "Valid data show that surgeries on older patients are successful." She then went on to point out the studies that supported this viewpoint. We at therubins congratulate Ms. McCaughey for taking the time to right this very valid rebuttal to an erroneous conclusion.

(pre-2000)- One of the most upsetting things that you can have happen to you occurs when a loved one, who has been hospitalized, is told he/she can no longer remain in a hospital even though he/she is much too ill to be sent home. As our article on "Selecting a Nursing Home" points out you select, as required, 5 possible skilled nursing facilities that the patient is willing to go to, and yet not a single one accepts the patient. Why you may ask would not even one of the five accept the prospective patient? Or as frequently may happen, it may take a much longer time for the patient to be accepted by even one of the facilities. Unfortunately this is becoming a more frequent occurrence as a result of the changes that have occurred as to Medicare payments being made to the nursing facility.

Before enactment of the Balanced Budget Act of 1997 Medicare reimbursed nursing facilities based on their costs in maintaining the beneficiary. Under the Act the Centers for Medicare and Medicaid Services, which oversees Medicare, now makes payments to the facility on a lump-sum per diem basis. Patients are placed in one of 44 categories for reimbursement purposes. This is called the prospective-payment system. Unfortunately this meant that high cost upkeep patients are not wanted by the skilled nursing facility. This group would include those on ventilators, kidney dialysis patients, etc.

If the skilled nursing facility's costs exceed the rate that Medicare would reimburse for the care, there is no inducement for the facility to take in the patient. This in turn means that the hospital must keep the patient for a longer period of time. Between 1993 and 1996 Medicare stays on average declined in hospitals from 8.1 to 6.6 days. Many now expect this trend to reverse itself. Home-health-care agency payments were also curbed by the Balanced Budget Act. There are now approximately 14% less agencies than there were in October 1997. The General Accounting Office said that beneficiaries appear to have "appropriate access" to home health services.

On June 2, 1999 Gail R. Wilensky, chairwomen of the Medicare Payment Advisory Commission released the first of the two annual required reports of the Commission. After the release of the report Dr. Wilensky, the head of Medicare under President George Bush spoke to reporters. She felt that certain nursing home and hospital services were being negatively effected by the cuts that have taken place in Medicare payments.

She also spoke of the unfairness of the cuts and caps in regards to therapy, which matter has been discussed in our article on Medicare Therapy Caps. The New York Times reported in an article by Robert Pear entitled "Chief of Panel Seeks Increase For Medicare" dated June 3.1999 that the respected doctors opinion would be given great weight by both Republicans and Democrats. She specifically called for the removal of the $1,590 for physical therapy.

She also called for a more equitable payment system for the sicker patient who required more extensive treatments. Dr. Wilensky also stated that she felt that the reimbursements should be increased for outpatient services since they help keep the overall medical bills and costs lower for everyone.

It really is amazing as we become more and more familiar with the Balanced Budget Act of 1997, how that act affects so many aspects of our lives. For more on this topic see our article on The Difficulties in Arriving at a Balanced Budget.


Allan Rubin
updated March 15, 2018

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