Basic Bob

Tue, Apr 30, 2013 : 10:36 a.m.

BCBS does not make "profits". But they might hand out some hefty bonuses to top management.

maallen

Tue, Apr 30, 2013 : 1:47 p.m.

I should have worded my sentence better and not used "you are mistaken." Instead, I should have said you need to be more precise when using the word "diabetes." You may know there are two types, but many do not. And most people think that when they hear the word diabetes then that person can just alter their lifestyle and the problem is solved. But when you have over 3 million Americans suffering from Type 1 diabetes, through no fault of their own, it can become frustrating to hear these generalizations and statements about diabetes. So, in the future, be specific.

1bit

Tue, Apr 30, 2013 : 2:32 a.m.

@maallen: Yes, I know there are two types of diabetes. Yes, I know there is more than one type of cancer. @DBH has tried to help you. Is your point that not everything is 100%? Fine. But substantially the point remains. Familiarize yourself with the following and then we can have a conversation: http://nihcm.org/images/stories/NIHCM-CostBrief-Email.pdf

DBH

Tue, Apr 30, 2013 : 1:24 a.m.

@maallen, as I had written, you are correct. Nonetheless, having written that, if 95% of the cases of diabetes in adults is Type 2, then @1bit is SUBSTANTIALLY correct. Substantially correct means that, while not 100% correct, for the most part (95%) it IS correct. There's no disagreement in reality, just a difference in emphasis.

maallen

Tue, Apr 30, 2013 : 1:10 a.m.

DBH, The point is, you can't lump type 1 and type 2 diabetes together. To make a statement saying diabetes is preventable is wrong. It's like saying cancer is preventable. One must be specific as which type of cancer is preventable. You can't just make a blanket statement.

FaithInYpsi

Tue, Apr 30, 2013 : 1 a.m.

You are not totally correct...there are a lot of conditions out of a persons control.

DBH

Tue, Apr 30, 2013 : 1 a.m.

@maallen, you are right, of course. However, in the USA Type 2 diabetes accounts for 90-95% of all cases of diabetes in adults, so @1bit's point regarding diabetes and avoidance of disease is substantially true, even without the Type 1/Type 2 qualification. http://diabetes.niddk.nih.gov/dm/pubs/statistics/

maallen

Tue, Apr 30, 2013 : 12:02 a.m.

1bit, You are mistaken when it comes to diabetes. There are two types....Type 1 and Type 2. The type 1 is commonly referred to as Juvenile Diabetes and has nothing to do with lifestyle changes. These are individuals who's pancreas does not produce any insulin whatsoever so they must take insulin through shots/pumps. Type 2 is often referred to as Adult Onset and can be controlled by lifestyle changes.

maallen

Sun, May 5, 2013 : 4:05 p.m.

DBH, As a consumer/patient on the receiving end of these tests, you have every right to decline them if you feel they are excessive. This is between the patient and doctor, not a 15 member board that is sitting in Washington DC to decide. I agree that these excessive tests are more about the fear of malpractice suits. And it would have been wise to tackle that problem, but the trial lawyers lobbied successfully against it. That would have helped more in reducing excessive testing and costs vs the government trying to limit the testing, because even with the government trying to force the issue, it will do nothing to stop all the malpractice suits and the cost of malpractice insurance. So the cost is going to continue to go up. It did nothing to resolve the issue. "Had there not been rationing, the costs undoubtedly would have been even higher." Where is your proof of such a claim? If it were to be higher, then why is England and Canada revamping their healthcare system? Canada is now allowing for private practices to be set up to have surgeries done because it can be provided cheaper and with less wait time than going through the national system. Their Supreme Court has said as much. England is getting rid of their "boards" and allowing the patient and doctor to come up with a plan becuase it helps reduce costs. In regards to readmission, it is not a hypothesis. It is already happening because that part of the law has already taken affect. Patients are not being readmitted, but instead are placed on observatory status. As some have already posted that this is happening to them, but they mistakenly attribute it to the insurance company when in fact it is the hospitals that are doing this which forced the insurance companies to have to address it and come up with a billing code, etc.

DBH

Fri, May 3, 2013 : 10:14 p.m.

@maallen, I have been on the receiving end of excessive use of technology, so I know whereof I speak in this regard. Many physicians order as many tests as they can, including utilizing as much new technology as they can, because they like to have more information rather than less, and particularly because they are concerned about missing something and a subsequent malpractice suit than they are about the adverse effects (most delayed, but statistically inevitable) of such tests, such as CT scans. Your example of countries that ration health care not resulting in a reduction in health care costs is faulty. Had there not been rationing, the costs undoubtedly would have been even higher. Rationing of the use of technology is only one way to rein in inappropriate use of technology in the medical field. Better education of physicians (and others responsible for ordering such tests) on the costs and potential adverse consequences to patients, and creating a more sensible system for filing malpractice suits to reduce frivolous filings, would go a long way to limit technology appropriately. Your arguments regarding gaming the system regarding readmissions with ACA may be valid, but it is hypothetical at this point. Whether it will prove to be correct awaits statistics regarding correlating health outcomes (including death), readmission rates, and costs. We don't have that information at this time.

maallen

Fri, May 3, 2013 : 3:24 p.m.

"The government SHOULD limit the use of technology when the benefit/risk and benefit/cost ratios are considered and determined to be too low." In Canada they already do this & it has not stopped the explosion of their healthcare costs! And because of this my nephew was affected by it. They limit their technology use, where they have only one Cat scan machine for 4 hospitals, created a long list of people waiting. The doctor suspected my nephew of having a cyst or tumor on the brain, but couldn't do a cat scan for another year because of the long list of people ahead of him. Only people who got to the front of the line were the life threatening cases. Had my nephew waited that whole year just for the cat scan it would have turned life threatening. Instead, they came here to have cat scan done. England already does this too and it has not stopped their explosion of healthcare costs! Matter in fact they routinely deny older people from receiving cataract surgery because the cost of the surgery does not outweigh the quality of life and how long the person is expected to live. So they let them go blind. No thanks to the government limiting the use of technology! It should be between the patiend and doctor, not the government.

maallen

Fri, May 3, 2013 : 3:02 p.m.

DBH, It is quite apparent that you have not read the 2,000+ pages either. Before ObamaCare, hospitals and doctors readmitted patients without any "fear" of being reprimanded. and could solely focus on the patient. But now under ObamaCare, funding for that Hospital and Doctor is severely affected if they readmit someone. Hospitals and doctors are forced to look at their bottom lines as they treat a patient. I they can keep the patient out of the hospital during a certain time frame, and give them a "bandaid" as a temporary solution, until that said time period is over, then readmit them, then they will do that because it will not affect their bottom line. So in essence what will play out is, instead of tackling the problem right away (most cost effective) they will essentially make the patient wait, give them temporary solutions, until that readmission perriod is over and then readmit the patient. In the end, it will be more costly. "The government SHOULD limit the use of technology when the benefit/risk and benefit/cost ratios are considered and determined to be too low." That is the slippery slope isn't it? Shouldn't it be left up to the patient and doctor as to what treatments and technology should be used for the best outcome for that patient? It should not be left to a board of 15 government employees to make those decisions.

DBH

Thu, May 2, 2013 : 2:07 p.m.

maallen, I have thought about it; you need to do the same. If there is a medical indication for readmission, the hospital would be penny wise/pound foolish to not readmit them. If the patient should suffer adverse consequences, including death, the cost of defending a malpractice lawsuit, and the likely payout for such a lawsuit if it should exceed their insurance limits, would be much more costly than the relatively small amount of income differential if they had just readmitted the patient and taken care of the problem. Even if the judgment or settlement was less than their insurance limits, such unconscionable behavior on the part of the hospital would lead to higher malpractice premiums, soon outstripping the modest savings achieved by not dealing with the patient properly in the first place. Yeah, that's an even worse idea. My comment regarding technology was not meant to say (nor did it say) that all technology, advanced or not, should be limited. Any technology that results in a net benefit to the patient would be appropriate, including insulin pumps. With the improvement in patient outcomes with the pumps, even insurance companies (including any funded by the government, such as Medicare or Medicaid) benefit, since the cost of care of those patients is reduced. What has gotten out of hand, though, is the overuse of technology that adds little to no benefit to the patient. Often, patients are given CT scans (very costly, and dangerous as they involve ionizing radiation) when an ultrasound or a thorough physical examination would be as informative, with no harm to the patient. Just because technology is available does not mean that it should be used. Such use of technology (much of it inappropriate) is responsible for the exploding costs of healthcare in the past couple of decades. The government SHOULD limit the use of technology when the benefit/risk and benefit/cost ratios are considered and determined to be too low.

maallen

Tue, Apr 30, 2013 : 2:03 p.m.

DBH, Think about it a little.....will a hospital be willing to readmit someone if it affects how much money they receive from the government? They will do everything in their power to keep their readmission rates low so their bottom line will be higher because the government will give them more money for their low readmission rate. Yeah, that's not such a good idea. Over the years, technology has gotten better and better and with that we are able to have early detection of diseases, manage chronic diseases better, etc. So why should the government limit the use of advanced technology? Since someone brought up Diabetes earlier, let's focus on Type 1. For years, Type 1 had to take shots multiple times a day to get insulin. Then came the insulin pump, they no longer have to take mulitple shots daily and they can have continious insulin 24 hours a day. This method has reduced long term effects of diabetes and has improved the quality of life for that diabetic. So then why should the government limit the use of technology?

maallen

Tue, Apr 30, 2013 : 2 p.m.

JayS, You do realize that BCBS has medicare plans, don't you? So yes, BCBS is directly affected by ObamaCare's payments and incentives along with hospitals and doctors. And now the government determines what premiums you pay to the insurance company. There is no false connection. It is all connected. Just read the 2,000 + pages of the bill. You did read it didn't you?

JayS

Tue, Apr 30, 2013 : 3:47 a.m.

Obamacare does not control commercial insurers like BCBS with regard to payments or incentives to healthcare facilities. It only does so for Medicare payments and incentives. So, with all due respect, you are drawing a false connection between what this story is reporting and Obamacare.

DBH

Tue, Apr 30, 2013 : 1:26 a.m.

You make those statements sound as if they are negatives. Lower readmission rates, using less expensive equipment to achieve the same end (or sometimes better end), and avoiding surgery with its attendant potential complications all are worthy goals. If these are the result of ObamaCare, then I'm all for it.

Mercutio

Wed, May 1, 2013 : 8:57 a.m.

Sorry, you're wrong on that, A2Trader. Hospitals get better reimbursement on short-stay (23 hour or less) observation. That's why all the hospitals in the area opened up Chest Pain Centers attached to their ER's a few years back, they're money-makers, all they did was re-classify what a patient was called while they were staying at the hospital. It's all how the hospital codes it to insurance, insurance companies don't tell the hospital afterward whether you were an inpatient or an observation patient. The hospitals and the insurance companies all play this game, and it's the private individual who gets screwed when they end up having to pay far more out of pocket. It's a ridiculous system that's not based on what gives the best patient outcome, but what brings the most revenue through.

rsa221

Tue, Apr 30, 2013 : 7:01 p.m.

@RuralMom, a2trader is correct.

a2trader

Tue, Apr 30, 2013 : 12:26 p.m.

The hospital is NOT the one that makes the determination that you were on "observation." Your insurance company does. If the condition and treatments don't add up to "you-were-admitted" then the insurance considers it "observation." You can actually be in the hospital for two nights and your insurance will still say it was just "Observation." So the hospitals aren't the ones scamming the system. They would rather be paid the higher rate for an inpatient stay.

RuralMom

Mon, Apr 29, 2013 : 6:46 p.m.

Its like when my Sister went into the ER for Chest pains, they ruled out a Heart Attack quickly, then kept her in the ER for 23 hours as an observation verses an admitted status. Co Pay was huge in comparison to what it would have been for her had she been fully admitted to the hospital for this observation.

rsa221

Tue, Apr 30, 2013 : 6:59 p.m.

I work at a medical office, and agree with JayS, unfortunately. UHC also bought a perfectly good (ie straightforward) private Medicaid called Great Lakes Health Plan, and now that's a nightmare to deal with, too. I will say their AARP Medicare supplement is straightforward (for now). If big providers like hospitals don't reject these difficult insurances, the insurances have little if any incentive to conduct themselves fairly.

JayS

Tue, Apr 30, 2013 : 3:36 a.m.

UHC is arguably the most despised insurer in the US (from a healthcare provider standpoint) but certainly the most difficult to deal with when it comes to credentialing (the process for becoming an in-network provider). I own a medical practice and speak from first hand experience. They are completely unapologetic for their lack customer service, they are rigid and they are a bureaucratic nightmare. If you are one of their members I sincerely wish you good luck, you likely will need it.

DBH

Mon, Apr 29, 2013 : 10:10 p.m.

If the mountain won't come to Muhammad, Muhammad must go to the mountain.

FaithInYpsi

Mon, Apr 29, 2013 : 7:54 p.m.

Be careful what you wish for...