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At least the VA system has had a very good computer system with patient's history and labs, and consults for a very long time. That, I will give the VA and "A plus" on. The other features of the VA system are very lacking.
Having been the recipient of VA Medical care for several years, I can say in all honesty that the quality of service has been extremely good. All the way from labs, diagnostics and minor and major surgery. It may vary, depending on location, but in Miami, Palm Beach, Orlando and Tampa, my overall care and treatment has been great.
Having been the recipient of VA Medical care for several years, I can say in all honesty that the quality of service has been extremely good. All the way from labs, diagnostics and minor and major surgery. It may vary, depending on location, but in Miami, Palm Beach, Orlando and Tampa, my overall care and treatment has been great.
Medicare and Medicaid alone decide what they will pay for and how much of a percentage they will pay. There is no negotiation. Take it or leave it, basically. So, for example, if Medicare only pays, say, 65% of the cost for CAT scans for patients and private insurance companies pay 90% of the cost, hospitals have to make up that deficit between 65% and 90% somewhere or else they have to eat those costs--which most hospitals can't afford to do--so they start upping the costs of CAT scans for private patients because they know private insurance will pay the 90% as long as there are no coding issues and they can make up the money they are losing from Medicare. This will, in turn, up premiums for private insurance consumers since they are having to pay more for the CAT scans (or whatever else Medicare/Medicaid isn't paying for).
A lot of hospitals, especially in poor, rural areas are going under because of the large number of Medicare, Medicaid, and illegal immigrant patients. They just aren't getting the reimbursement they need to pay their bills and stay open. The hospital my mom works at is going through that now. They have laid off all of the LPNs and CNAs. They are short of nurses and they aren't hiring because they can't afford it. This is extremely dangerous for the patients as well as the nurses. Overworked nurses make mistakes and not only could a patient die, but the nurse can lose his/her license and never work again.
I understand, but compare a hospital that cares for mostly Medicare and Medicaid patients to a hospital that has a higher proportion of privately insured patients. (Let's leave illegal immigrants out of the equation.) The private-insurance hospitals are comparatively fat and sleek, making a fine profit, state of the art everything, well paid employees, etc.
That extra money is NOT simply the result of the Medicare differential padded onto the insured patients' bills. The padding that is ($Y-$X) (< from the earlier post) includes more sources than simply the Medicare differential. (Not that padding alone is the hospitals' only other source of income.)
The report didnt specify (or speculate) by how much premiums and prices to patients would come down if Medicare reimbursements were 100%.
So I think that report is misleading, and since it was sponsored by ahip, deliberately misleading.
Having been the recipient of VA Medical care for several years, I can say in all honesty that the quality of service has been extremely good. All the way from labs, diagnostics and minor and major surgery. It may vary, depending on location, but in Miami, Palm Beach, Orlando and Tampa, my overall care and treatment has been great.
You are a really lucky guy. I hope it stays that way for you. I can't tell you all of the stuff that I see on a daily basis.
This is a quote from another post I made recently:
Quote:
I work at a VA and I see more patients' care slip through the cracks than ANY of the other hospitals I have ever worked at---combined.
As a matter of fact, just had a fellow tell me today about how his prostate cancer was misdiagnosed months ago and now the docs are trying to rush him through a bunch of testing to see how far it has spread.
Another guy today told me that he had colon cancer 8 years ago. He wasn't being followed up with any imaging, not even a yearly chest x-ray, and he now has masses in his lungs and liver. This could have been caught earlier. He was given 2-4 months more to live.
A month ago, had a guy in who told us that his prostate biopsy sample was mixed up with somone else's and that his prostate was removed mistakenly. He is having all sorts of complications now and he will never be able to maintain an erection again. He's 45.
Oh, and during the course of a year and a half, we did 36 seperate procedures on a patient because of severe recurrent infections he was getting after having an elective colon surgery here.
My father-in-law is part of the VA. He only comes here for his medicines and hearing aids. He would never, ever have any surgeries or invasive procedures here.
Just had a fellow tell me yesterday that, over a year and a half ago he had a problem that when he would urinate, pea sized chunks of feces would come out. He knew it was feces. It looked like it and smelled like it. He had countless numbers of urinary tract infections. He complained of this for months before a physician actually began ordering tests. He had a colon to bladder fistula and had to have a bowel resection. Why would this take months to diagnose? Crazy.
Our vets deserve better than that, you know?
Bob, I'm really happy that you have good care. Just make sure you ask questions and stay on top of it.
Sorry about being so lengthy, but I feel it important to opine further on the subject. Five years ago, I had to go to the Emergency Room at a local Hospital. At the time I was working for a large company and had pretty good private insurance. They found I had Diabetes so bad it required immediate surgery to remove a large area of Gangrene, very painful process. While recovering from that, they found the I also had Lung Cancer, which required a lower lobe lung removal and subsequent Chemo. After decades of fast food and convenience apparently my body had been in the process of shutting down. While recovering from those processes, I took an early retirement and went on Soc. Sec. Disability. After a year my Cobra ran out and the cost of private insurance was absolutely prohibitive. Since I was on Soc. Sec. I was able to eventually get on Medicare and I also went into, thankfully, the VA for my following care.
The VA found that I had 2 arteries with 100% blockage and another that was 50% blocked and a fairly large tumor in my other lung. The VA doctors suggested bypass surgery and perhaps another lung surgery. An interesting realization happened at the VA, actually the point of all this. Since my body nearly shut down and I realized why, I had been taking aggressive steps to provide my body the fuel it needs to help itself and I had been seeing the effects of that effort in many areas. For one thing, the Diabetes, for all practical purposes, was no longer an issue. There were several other things as well. But the VA doctors were somewhat skeptical but went along with my idea to try to let my body try to do what it can for itself with the Heart Disease and the other Tumor. So far, over 2 years now, the bypass option has been tabled as the naturally built bypasses seem to be working and the tumor has been and continues to shrink. I have the feeling that had I still been in non-government care, my opinions on how to handle this, if even possible, would have been much harder to accomplish. Maybe it's because the VA doctors are less susceptible to law suits so are less inclined to "cut and go", cover all bases and move on to the next cash cow. I, for one, am extremely glad that I am in a Government run program.
You are a really lucky guy. I hope it stays that way for you. I can't tell you all of the stuff that I see on a daily basis.
This is a quote from another post I made recently:
Just had a fellow tell me yesterday that, over a year and a half ago he had a problem that when he would urinate, pea sized chunks of feces would come out. He knew it was feces. It looked like it and smelled like it. He had countless numbers of urinary tract infections. He complained of this for months before a physician actually began ordering tests. He had a colon to bladder fistula and had to have a bowel resection. Why would this take months to diagnose? Crazy.
Our vets deserve better than that, you know?
Bob, I'm really happy that you have good care. Just make sure you ask questions and stay on top of it.
Are these all at the same hospital? These stories need to be reported, and this place cleaned up, right away!
There certainly are competent doctors in the VA system.
I understand, but compare a hospital that cares for mostly Medicare and Medicaid patients to a hospital that has a higher proportion of privately insured patients. (Let's leave illegal immigrants out of the equation.) The private-insurance hospitals are comparatively fat and sleek, making a fine profit, state of the art everything, well paid employees, etc.
That extra money is NOT simply the result of the Medicare differential padded onto the insured patients' bills. The padding that is ($Y-$X) (< from the earlier post) includes more sources than simply the Medicare differential. (Not that padding alone is the hospitals' only other source of income.)
So I think that report is misleading, and since it was sponsored by ahip, deliberately misleading.
That's right. Private-insurance hospitals make a profit because they are actually being reimbursed properly. And why would you complain that a hospital looks nice, has state-of-the-art equipment, and well paid employees?
You have your own opinion and I don't feel I could convince you otherwise, but try reading the other links I posted as well. It's a real eye-opener.
B. External and internal factors affecting hospital performance
The state's hospitals face numerous external challenges. The growth of managed care enrollment, reduction in Federal Medicare inpatient and outpatient reimbursement, changes in Medicaid reimbursement, and a large uninsured population are all contributing to the decline in financial performance and are likely to persist into the next decade. Advances in technology and pharmaceuticals allow for more outpatient and non-hospital-based treatments, contributing to the downward pressure on utilization. Lack of alignment between physician and hospital payment incentives makes changing physician practice patterns difficult.
Additionally, internal factors hamper needed change. These include:
slower than needed reductions in length of stay, particularly for Medicare patients;
persistent excess and misdirected hospital capacity;
higher staffing levels than hospitals in other states;
lack of alignment between physician and hospital payment incentives, making changes in physician practice patterns difficult to implement;
board ambivalence about transitioning a hospital's services or closing facilities to appropriately meet the community's needs while ensuring adequate reimbursement to cover costs; and
inadequate education of the general public about changes in health care delivery and reimbursement.
Together these factors have contributed to higher operating costs at New Jersey hospitals when compared to their counterparts nationwide.
[LEFT]Inadequate reimbursement for trauma care was third in frequency, whether due to
lowered Medicare payments or high numbers of uninsured or “out of network” patients,[/LEFT]
and patient volume was fourth.
He explained that elderly patients who have the greatest need for local hospital services may also be the least economically desireable, because Medicare reimbursement rates are below cost for rural hospitals. Survival of rural hospitals depends, in part, on providing service for patients who pay at rates that provide a reasonable margin of revenue. These patients are the privately insured or Medicare patients with generous Medigap coverage.
Are these all at the same hospital? These stories need to be reported, and this place cleaned up, right away!
There certainly are competent doctors in the VA system.
There most certainly are competent docs in the VA system. There are also some very bad ones. The issue is that they work for the federal government. If you had this stuff happen to you on the outside, you could sue for malpractice. With the federal government, you have to get permission to sue. Good luck with that.
That's right. Private-insurance hospitals make a profit because they are actually being reimbursed properly. And why would you complain that a hospital looks nice, has state-of-the-art equipment, and well paid employees?
Hospitals make a profit because they're making more than even. The point of my post was that the hospitals and doctors with a mix of patients seem to do well even without the Medicare differential; the report didnt indicate - as far as I saw - what % the differential is in the doctors', hospitals' and insurance companies' total markups.
]There most certainly are competent docs in the VA system. There are also some very bad ones.[/b] The issue is that they work for the federal government. If you had this stuff happen to you on the outside, you could sue for malpractice. With the federal government, you have to get permission to sue. Good luck with that.
That's no different than on the 'outside'. If you think a lawsuit is quick, or easy, you have another think coming.
Quote:
Originally Posted by delusianne
Hospitals make a profit because they're making more than even. The point of my post was that the hospitals and doctors with a mix of patients seem to do well even without the Medicare differential; the report didnt indicate - as far as I saw - what % the differential is in the doctors', hospitals' and insurance companies' total markups.
And most hospitals are acutally non-profit.
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