Here we go again with the same discussion of antiquated models with way too much math and quantitation.  This is a discussion with several hospitals in the Ohio area as the are talking about the future of hospitals and yet still have the noose around their necks with the government on quality reporting and cost.  We all know HHS and CMS are dealing with outdated models and it’s making everyone nuts.  In addition you have health insurers flipping back and forth on contracts, what they cover, what they don’t cover, what changes today, what won’t be there tomorrow and so forth. image People are absolutely hating this complexity that has been created just to go get care.  Look at the link below, some hospitals can’t eve get the ER doctor groups and the hospital itself with the same insurers, so people get screwed again on balance bills. 

In Texas Hospitals Having Issues Employing In-Network Doctors With United Healthcare & Humana-Found One Insurer Still Listing An In-Network “Dead Doctor”…

The article mentions that delivery of care has changed in healthcare and that is true but you’re never going to get away from having hospitals who do have a certain amount of fixed costs that can’t go away either.  Hospitals are anticipating a decrease in the demand for care due to both preventive care and other technologies, perhaps like telehealth that will ease a little on expense.  The one big bogus item we have seen for years though is the projected savings brought by technology and in fact it’s just the opposite as all of it costs money, even if there’s fewer patients being seen at a hospital. 

In the group here is also the Cleveland Clinic and basically they are all saying “we don’t know what’s going to happen” down the road and we don’t know how to measure the quality consistently with all the constant changes.  They agree on one thing, risk is ever so present.  In California , the CMA is telling United Healthcare their Premium Ratings for Doctors are flawed, so there you go again, but as we all know United thinks you can quantitate everything and that is exactly why some of their models and the ones they helped CMS with are failing. 

United “Quantitated” California Doctor Premium Designation Ratings For Consumers, A Few Minor Changes-CMA Still of Opinion Ratings Cause Harm to MDs and Patients With Inaccurate Designations and Flaws…

Here’s yet another example of the United quantitation extremes…how can this push-pull work?  Sure there’s obvious workflow predictabilities that are helpful with monitoring disease and care and but again we have read like below about projected savings they state in a proof of concept that never arrive as models expand beyond efficiencies and dive to deep into a non linear type of projection. 

United Healthcare Wants to Expand Predictive Modeling for Medicare and Medicaid–Billions in Savings Predicted in Report Only As Good as the Day It Is Published

We are still seeing rural hospitals running out of money and closing up.  In the rural area of Virginia here they had to rely on the free clinic from Remote Area Medical to help them as their hospital closed and doctors are struggling in the area. 

Remote Area Medical Sets Up At Lee County Airport in Virginia For a Free Clinic–Rural Community Needing Care Where The Hospital Has Closed and Doctors Struggle…

Again, the “scoring” and reporting from hospitals on non relevant data could certainly ease up a bit and CMS take a hard look at what data they “really” need as this push and pull with outdated models is going to drive everyone nuts.  As you can read below the hospitals can’t predict and they too say the government tracking is not a true indication of their services so a new more flexible model just might be in order.  BD 

Health care providers expect to see fewer patients in the future as care, technology and access to treatment improve.
That means less revenue for hospitals — collectively, the country’s largest employers — which find themselves operating in a dramatically changing industry.

“The United States is going through the biggest change in its society, probably since the New Deal, affecting the biggest industry in the United States and affecting 100% of the population,” said Dr. Delos M. “Toby” Cosgrove, president and CEO of the Cleveland Clinic. “And as we do that, we recognize that we have to change the delivery system to go to value, increasing in quality and making care affordable. And that is driving change in a very, very big industry.”

Boutros said the health care industry is undergoing a metamorphosis as hospitals transition from sick care to a more holistic approach based in preventive care, which is creating as many uncertainties as potential opportunities in the delivery of care.

“This whole change from a sick-care model to a well-care model — as you know Akron General has been talking about this for over 20 years — we spent $110 million on that concept. As a doc, I really don’t understand how people are going to judge our individual practitioners in a value-based world,” Stover said. “That sort of calculus of how it’s all going to work out is something I think we’re all struggling with.”

The reasons costs are so high to patients, and vary so greatly between hospitals, range from the difficulty of assigning a value to services, Stover said, to a hospital’s costs for research and staff education. Meanwhile, Zenty pointed out, the antiquated way costs are reported to Medicare “really distorts” the true cost of care.

And as hospitals see fewer patients, Zenty said, the result is a “decrease in demand and an increase in supply.” That spells bad news for hospitals that receive a large portion of their revenue from the federal government in the form of Medicare and Medicaid, which is expected to be cut next year, Zenty said.


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