The scene at Leon Medical Centers’ Healthy Living Facility in Miami on a recent Thursday resembled a cross between a luxury hotel and a theme park.
White-gloved doormen wearing porter uniforms ushered elderly patients from white vans into a gleaming lobby with colored terrazzo floors and a bubbling fountain. Greeters in green vests and ear bud radios welcomed the Medicare members and made sure their doctors knew that they’d arrived. Refreshments were proffered: Would they like a cafecito and pastelito for the wait?
And that was just the entranceway. Three more floors of the sprawling center bustled with Leon members meeting with physicians or dentists, taking healthy cooking classes, exercising in the fitness center or learning to use Facebook in a lecture hall…
With so many providers in one place ― most of them salaried employees of the center ― [Benjamin Leon, Jr., founder of the center] says members can shorten the time between primary care physician referral to specialist to diagnosis.
“What takes six to eight weeks,” he said, “we can do in 3 1/2 to four hours.”
But Leon also holds down costs by managing patients within the center’s network of providers. Fewer referrals to outside specialists means bigger savings for Leon, particularly important as Medicare Advantage cuts are phased in. He said the plan has not eliminated any benefits for 2014.
Source: KHN/Miami Herald.
Foreigners are in the top tier:
But this cash cow for the Israeli health care system may be in jeopardy.
…[M]any worry that the lure of foreign money is creating a two-tiered medical system, where hospitals shift the best doctors and facilities to the high-paying customers and lessen service to Israelis. (USA Today)
Tom Scully thinks so. This is from the NYT Magazine:
Medicare, which picks up a majority of their health bills, encourages hospitals to discharge patients quickly after surgery, but it doesn’t offer financial incentives to choose one form of post-acute care over another. And because discharging a patient to home care requires a lot of extra work — ensuring that the correct equipment will be in the home, training family members and so forth — many doctors choose the easier option. They can simply ask a nurse to send the patient to a rehab facility, and everything is handled in about a minute. Medicare automatically approves payment for 20 days of recuperation in a nursing home, and many facilities simply treat the patient for the full allotment. “Miraculously, everyone is cured on the 21st day,” Scully says…
On average, Medicare’s fee-for-service model pays for about 2,000 days in a post-acute care facility for every 1,000 beneficiaries. By comparison, Kaiser Permanente, a provider of low-cost quality care, averages 600 days per 1,000 clients while achieving better outcomes.
They measured within-hospital quality based on AHRQ’s innovative Inpatient Quality Indicators. Mortality due to heart attacks, pneumonia, and hip replacement were among the indicators examined.
Among the authors’ findings: Within hospitals, patients with private insurance had lower risk-adjusted mortality rates than Medicare patients for 12 out of the 15 indicators examined.
Source: Health Affairs.
You wouldn’t know it from Robert Pear’s write up in The New York Times this morning, but a new HHS ruling appears to be great news for hospitals and bad news for private insurance companies. Here is what Pear said:
The Affordable Care Act is the biggest new health care program in decades, but the Obama administration has ruled that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are “federal health care programs.”
The surprise decision, disclosed last week, exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare.
Here is what I think this really means: hospitals are going to be able to sign up patients for insurance in the exchange (platinum plans, of course), pay the premiums for them and wave any deductible. Just one more reason to worry about death spirals.
Necessity spawns innovation. Despite the pressing demand and constrained supply, a few relatively new Indian hospitals have devised ways of providing world-class health care…These hospitals target well-off patients, which forces them to provide care that meets global quality standards. But their purpose is to serve everyone, including patients with very low incomes, which puts pressure on the organizations to lower costs dramatically. Such a business model scales because the low costs of these hospitals attract large volumes of patients and allow the overall enterprise to be profitable. As a result, the hospitals are able to sustain their operations not through the usual government subsidies, charitable donations, or insurance reimbursements but through their revenues. Aravind Eye Care System, for instance, has paid for all its expansion projects from its profits, even though two-thirds of its patients receive free or subsidized care. These extraordinary private Indian hospitals should serve, we believe, as an inspiration to those in other developing nations and as a wake-up call to hospitals in Europe and the United States. (More)
Researchers found that hospitals eliminate 1.7 full-time jobs for every $100,000 drop in Medicare revenue, and nurses accounted for one-third of those cuts. On average, hospitals do not appear to make up for Medicare cuts by “cost shifting,” but by adjusting their operating expenses over the long run, the study says. The Medicare price cuts in the Affordable Care Act will significantly slow the growth in hospitals’ total revenues and operating expenses.