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  1. #1
    Sapper dirtdickens's Avatar
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    Upcoming changes in healthcare


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    I feel this is very important for everyone to know about. Please limit the political crap because we all know that derails topics and you will never change anyone's mind on the internet. For those that dont know I work for Nationwide Children's Hospital in Columbus, Ohio. Monthly we hold meetings where our lawyers explain the mandates and how it effects what we do. Starting in 2014 there will be a noticable difference in how healthcare s provided nationwide.

    - If a patient gets an infection post sugery, even a minor one within 30 days of the procedure, Obamacare will not pay the hospital for the procedure.
    - We have robots that have advanced our field to the point where you can have surgery and be at home recovering within 24 hours. We wont be able to use those any longer due to cost so you get to sit in the hospital for four days recovering. If you really want to see where we are headed take a look at Canada where they have to do more open surgeries because they dont have the technology to do something as simple as using baloons to reopen bloackages, instead they have to do open surgeries.
    -This all ties together because the risk of infection is significantly higher in open surgeries as is the risk of complication.
    -There are many patients that are going to get an infection no matter what because they do not take care of themselves, we are starting an education program for patients to try to lessen the problem.

    -We are getting a lower level of care in every aspect. Docs are replaced with PAs and Nurses are replaced with Medics. This isnt just in the primary care setting, youre talking about ER and Trauma too.

    -Every hospital will be mandated to use surveys, if a rating drops below a certain point for each patient, Obamacare will not pay. Think about the people who are upset they dont have a TV in their room. People that wait too long in the ER to be seen. Others that come to the ER for common problems like the flu.

    -The number of people that use the ER as a regular DR is so bad that we had to open numerous primary care units to keep people from coming in for things like a rash or a pregnancy test. Were talking about people that come in for Tylenol and Hydrocortisone Cream. Most clinics, urgent care units and ERs will begin to use a fast track of sorts, where they will primarily see people for cold like symptoms etc.

    -Most hospitals(almost every single one, actually) have sent letters to companies that supply them with everything needed to run a hospital stating that the companies may not raise the price of anything the hospitals purchase going forward.

    -Right now Im military so I have a pretty kick ass health plan. In a year when my contract is up I have to get insurance through my employer so I have started to look into what to expect. For me alone I will have to pay $214 a month, with an $8000 deductable. Thats not counting my wife and baby we will are having. Who in the hell is going to be able to afford care at that point? Who is going to be able to have kids with an 8k deductable? The only people that can afford any of that will be the ones with Obamacare.
    -Right now the numbers we have list 90 million Americans without work. 70 million americans did not/will not pay taxes and under a recent Senate Bill 11 million illegal aliens will be covered under Obamacare.

  2. #2
    Senior Member lowayne's Avatar
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    My wife is a nurse at top 100 hospital. Every initiative right now is to become quantitatively average.
    "Doggonnit............The Lord gave you two legs, protect them" - Coach Hart

  3. #3
    Senior Member tedwick's Avatar
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    Hi there. I try not to flash my MD/PhD student card often, but now is a good time for that. As Dirt said, it's important for people to have accurate information on these topics. Unfortunately, some of the information presented here is a little off, or presented without some key information that's necessary to interpret. Some of what Dirt said also may be true at his institution, but may be specific to his institution. So take that as a caveat.

    Dirt, I come in peace. :) Just want to clear things up, maybe for you, hopefully for others.

    Quote Originally Posted by dirtdickens View Post
    - If a patient gets an infection post sugery, even a minor one within 30 days of the procedure, Obamacare will not pay the hospital for the procedure.
    Surgical-site infections without proper prophylaxis are one of a class of events called "preventable adverse outcomes." For short, and perhaps tellingly, we call them "Never Events." Two important things to note here: First, the "without prophylaxis" part. If someone gets an infection, but was given the indicated post-surgery antibiotics, it wasn't a "preventable event." Second, this largely isn't a change to how things get done. Private insurance already has lists of "No-Pay Events," this is just bringing CMS up to speed.

    - We have robots that have advanced our field to the point where you can have surgery and be at home recovering within 24 hours. We wont be able to use those any longer due to cost so you get to sit in the hospital for four days recovering. If you really want to see where we are headed take a look at Canada where they have to do more open surgeries because they dont have the technology to do something as simple as using baloons to reopen bloackages, instead they have to do open surgeries.
    Not using robots does not mean doing open surgeries. Robots are used as a replacement for manual tools in laproscopic tools. Robots offer slightly better outcomes when compared to laproscopic, but they do so at much greater cost and only after the operating doctor has gone through thousands of hours of training on the machines. I've seen institutions make the "no robots" decision on their own due to cost considerations.

    Another important note: this is only for CMS-insured patients.

    -We are getting a lower level of care in every aspect. Docs are replaced with PAs and Nurses are replaced with Medics. This isnt just in the primary care setting, youre talking about ER and Trauma too.
    Your medical team will ALWAYS, by law, be supervised by a physician. But from a cost standpoint, it's not cost-effective for a physician with 10 years of training and experience to tell someone they've got the cold or are having hot flashes. Generally how this works is that a PA will see a patient then, if it's simple, briefly present to the attending physician. If it's not, the physician will go and take the case. I've worked in teams like this, with very competent PAs. Never saw someone complain or ask for a "real doctor." Also didn't see the PA's make a mistake. If they weren't sure, they sent it up to the physician.

    -Every hospital will be mandated to use surveys, if a rating drops below a certain point for each patient, Obamacare will not pay. Think about the people who are upset they dont have a TV in their room. People that wait too long in the ER to be seen. Others that come to the ER for common problems like the flu.
    Sort of true, but not really. CMS is starting to use aggregate patient satisfaction to determine bonus payments or docking some money. Two things here: One, it's aggregate, it's not a "No-Pay" situation if a patient isn't happy. Two, a hospital is compared to its peers on metrics like "Did the staff treat you with respect?" Shouldn't be hard to at least run with the pack on this.

    -Right now Im military so I have a pretty kick ass health plan. In a year when my contract is up I have to get insurance through my employer so I have started to look into what to expect. For me alone I will have to pay $214 a month, with an $8000 deductable. Thats not counting my wife and baby we will are having. Who in the hell is going to be able to afford care at that point? Who is going to be able to have kids with an 8k deductable? The only people that can afford any of that will be the ones with Obamacare.
    -Right now the numbers we have list 90 million Americans without work. 70 million americans did not/will not pay taxes and under a recent Senate Bill 11 million illegal aliens will be covered under Obamacare.
    Hard not to get political here when you've made political points, but I'll do my best.
    - Yes, medical care is expensive. However, it is kind of telling about our general attitude toward healthcare when I just spent several paragraphs justifying cost-saving moves and then see "but it's so expensive." If we want things, at some point, we have to pay for them.
    - Illegals aren't covered under the Affordable Care Act. Section 1312 (f)(3). They are still able to go to an emergency room and receive (expensive) care, but that hasn't changed. If anything, it's an argument for more healthcare for illegals, not less, but I digress.


    Anyway, sorry. That's a lot of text. But I wanted to give a medical perspective on where these points came from. Hope it cleared some things up for some people.
    Last edited by tedwick; 05-12-2013 at 02:30 PM.

  4. #4
    Sapper dirtdickens's Avatar
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    Were both saying the same thing.
    -no robots-revert back to what we did before, ignoring advancement in medicine. 1 day in a hopspital vs 3-4.
    -more open surgeries=more complications
    -the infections are any infection after surgery, not just the site of the procedure.
    -We are not going to have less physicians, less nurses, all replaced with one level lower. I agree PAs are great, but its not the best.
    -Illegals are absolutely covered under Obamacare.
    http://www.bing.com/search?q=senate+...0-22&sp=-1&sk=

  5. #5
    Community Moderator stonebreakerwasgod's Avatar
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    Obamacare is already costing a lot of jobs. Mostly from not hiring or expanding the workplace, so it's 'unseen'. I can only imagine the trillions it will cost the American taxpayers. God forbid if you smoke or are obese, as the insurance companies will kill you. Already been told that smokers will pay double starting next year. Seriously.
    Member: Irish Guards-GH Division




  6. #6
    Senior Member tedwick's Avatar
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    Quote Originally Posted by dirtdickens View Post
    Were both saying the same thing.
    Hey Dirt. I mean this with all due respect, but we aren't saying the same thing. I'll get on my high horse a bit and say that it's my job to know these things so that I don't kill people. When I say I hope I'm clearing things up, what I'm trying to say politely is that I'm correcting things you said that were not factual. I'd just leave it be, but like you said, this stuff is actually important.

    -no robots-revert back to what we did before, ignoring advancement in medicine. 1 day in a hopspital vs 3-4.
    -more open surgeries=more complications
    Robotic surgeries, like the DaVinci system, are augments to laparoscopic surgeries. No robotic surgeries doesn't mean more open surgeries, as if a surgery needs to be done open, it wasn't a candidate for robotic surgeries to begin with. The reason many hospitals have already chosen not to do robotic surgeries, and the reason CMS has chosen not to cover it, is because robotic surgeries have never been shown to reduce length of stay or improve outcomes over manual laparoscopic surgery. (Regular laparoscopic patients generally go home after 24hr observation.)

    For further reading, you can look here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254844/
    There's a bunch of articles just like that.

    -the infections are any infection after surgery, not just the site of the procedure.
    Infections after surgery are by and large a result of that surgery. What insurance companies and CMS regard as "No Pay" events are infections that are a sequela of surgery. For instance, they'd still pay to treat a pneumonia when you had an ankle surgery. Perhaps you misunderstood the lawyers at your hospital?

    -Illegals are absolutely covered under Obamacare.
    http://www.bing.com/search?q=senate+...0-22&sp=-1&sk=
    No, they are not. Please read the blogs you posted. The ACA and Medicare/Medicaid covers legal citizens of the US. What it would also cover is any undocumented immigrants once they've become naturalized citizens.

    Anyway, I think I've done all I can here. It seems like this conversation was started with a political bent in mind, so I'll bow out quietly now. We can't have a discussion if you've got a different set of facts.
    Last edited by tedwick; 05-12-2013 at 08:23 PM.

  7. #7
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    What the hell are you guys talking about?

  8. #8
    Senior Member Guff's Avatar
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    Quote Originally Posted by joresendez View Post
    What the hell are you guys talking about?
    They are talking about 'Obamacare'.

    So no one really knows. They are talking about a whole of uncertainty. The idea was to pass a law, any law restructuring healthcare . Once you have a law you can see what it does, change it, amend it, tweak it, etc. But the important thing, from the standpoint of those in favor, is to have something. The best thing, or worst thing - again, depending on your point of view, is that like any gov't program it can never go away.

  9. #9
    Senior Member LOVEMYIRISH's Avatar
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    Quote Originally Posted by Guff View Post
    They are talking about 'Obamacare'.

    So no one really knows. They are talking about a whole of uncertainty. The idea was to pass a law, any law restructuring healthcare . Once you have a law you can see what it does, change it, amend it, tweak it, etc. But the important thing, from the standpoint of those in favor, is to have something. The best thing, or worst thing - again, depending on your point of view, is that like any gov't program it can never go away.
    I agree there is a lot of unknown. I think what we are going to see more of in the future (from Obamacare and Insurance companies) is quality reporting. Right now you can charge 10x as much and have worse outcomes and no one is the wiser, because most of the data is confidential. That is going to change for good or ill.

    My mom and two sisters are doctors and my dad was a healthcare consultant. The changes coming are still vague, but what's going to be interesting is that for the first time in American history we are going to have a system that focuses on whether outcomes were successful or not. That's not always a good thing, but its a big change. Today, you can literally kill people slowly and no one will know.

    My mother in law was prescribed a barbiturate from 1997-2008 for her headaches. As the years went on, the headaches got worse and worse. In the last year of that she was literally bed-ridden at home with migraines 6 days a week. When they moved to Minnesota, the doctor here asked what she was given and she told him. He flipped out and explained that:
    a) a doctor in Minnesota would lose his license for doing that
    b) the drug was causing the migraines

    She went off the drug immediately and was better in 3 weeks. Not a migraine in the last 4+ years.

    Things are going to change and laws will change too as we see what works and does not work.

  10. #10
    Senior Member NDgrandson's Avatar
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    I'll keep it short and simple. Obamacare is 100% coming... and it sucks.

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