HEMS usage, what do you in the field think about this?

Remi

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I'm not going to go into any general political statements, nor did I intend for my statement to be taken as one.

That area in particular is a disaster and I absolutely think the politics there contributes to it. The prioritization of the city council, mayors, county, and voters definitely at a minimum keeps putting fuel into the fire, although they were probably the spark and a good dose of accelerant as well.

I don't know if you are actually familiar with the area of reference. I suspect that if you were you might be a little less eager to assume my politics are about being liberal rather than a statement of the corruption and mismanagement.
I didn't assume your politics - you made it clear in your first post that you think that simply being willing to pay higher taxes would improve the healthcare system in the area in question. I also don't need to know anything about this specific area, because that strategy has never worked anywhere. Witness the current state of our healthcare system. More state and federal money spent on healthcare = higher healthcare costs. Notwithstanding the fact that at the county level - especially a rural, poor county - the money simply doesn't exist to make much impact.

Unfortunately, it is impossible to talk about healthcare economics without also talking politics, because with nearly 50% of all healthcare dollars spent coming from some sort of federal program, and with the insurance and hospital industries being absolutely strangled by federal regulation, the two things are practically synonymous these days. It is time people wake up and stop insisting that we double down on policies that very clearly don't work.
 

RocketMedic

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*Raises hand*

Hi, literally have a master's degree in this.

Government regulation does not raise the price of health care. Government regulation increases the costs of doing business to the standards of the regulation by forcing every service provider to meet those standards. Those increased costs deter marginal providers from operating in some cases, drive up prices in others, but are not necessarily going to increase prices in all cases. In fact, in many cases, government regulation actually decreases operational and total costs, by forcing systemic changes that remove the potential for failure. For example, back in the dark ages before RNs had degrees and the Joint Commission was a thing, hospital costs were lower and there was far less regulation; but a lot of those unregulated hospitals had horrific facilities, little-to-no accountability and wildly undertrained or untrained staff. Yes, correcting these things costs money, but so does not correcting them. Yes, it is broadly accurate to say government regulation correlates with price increases, but there is not direct causation. Does anyone really want to go back to the days of journeyman physicians, "one-per-state" labs/imaging or sawdust floors?

The price of health care as we currently know it is directly derived from the educational structure of our providers (expensive, time-consuming, arduous and did I mention expensive?), the decentralized and inconsistent nature of our suppliers and payors, the lack of accountability of payors for outcomes and the American belief in correlating physical health to monetary value and employment status, and a culture of unrealistic and expensive aspirations and assumptions. Trying to make a profit out of caring for the elderly, sick and non-productive members of our society is a literal impossibility; allowing the kind of business decisions that allows for healthcare operations to be profitable caring for those people makes quality outcomes -and- price containment impossible.

More regulation would make things better. Particularly if that regulation assigns clear financial responsibilities to government, service providers and payors/patients.
 

SandpitMedic

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*Raises hand*

Hi, literally have a master's degree in this.

Government regulation does not raise the price of health care. Government regulation increases the costs of doing business to the standards of the regulation by forcing every service provider to meet those standards. Those increased costs deter marginal providers from operating in some cases, drive up prices in others, but are not necessarily going to increase prices in all cases. In fact, in many cases, government regulation actually decreases operational and total costs, by forcing systemic changes that remove the potential for failure. For example, back in the dark ages before RNs had degrees and the Joint Commission was a thing, hospital costs were lower and there was far less regulation; but a lot of those unregulated hospitals had horrific facilities, little-to-no accountability and wildly undertrained or untrained staff. Yes, correcting these things costs money, but so does not correcting them. Yes, it is broadly accurate to say government regulation correlates with price increases, but there is not direct causation. Does anyone really want to go back to the days of journeyman physicians, "one-per-state" labs/imaging or sawdust floors?

The price of health care as we currently know it is directly derived from the educational structure of our providers (expensive, time-consuming, arduous and did I mention expensive?), the decentralized and inconsistent nature of our suppliers and payors, the lack of accountability of payors for outcomes and the American belief in correlating physical health to monetary value and employment status, and a culture of unrealistic and expensive aspirations and assumptions. Trying to make a profit out of caring for the elderly, sick and non-productive members of our society is a literal impossibility; allowing the kind of business decisions that allows for healthcare operations to be profitable caring for those people makes quality outcomes -and- price containment impossible.

More regulation would make things better. Particularly if that regulation assigns clear financial responsibilities to government, service providers and payors/patients.
Regulation and directive, yes. “Free for all” or subsidized, no.
I agree with your sentiment. Well said.
 

Remi

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Government regulation does not raise the price of health care. Government regulation increases the costs of doing business to the standards of the regulation by forcing every service provider to meet those standards.
"Government regulation doesn't raise the price of healthcare. It just raises the price of providing healthcare" OK, sure, if you like semantics…..but what do you think happens when the cost of providing a service increases?

The American Hospital Association has said that the cost of compliance with the 380 or so federal regulations (not counting CMS requirements or insurance regulations) that affect acute care hospitals cost nearly $50,000 per year PER BED, on average. That's just the direct costs that can be easily measured like the cost of expensive software, IT departments to manage it, compliance offices, and educators who spend as much of their time making sure staff members are up to date with the latest reporting requirements as they do best clinical practices. It does not account for the time that nursing and clinical staff spend on this stuff. It is very significant.

CMS compliance is a whole other ballgame. Notwithsanding the fact that healthcare spending makes up over 30% of the federal budget and growing (with little positive impact on health outcomes, at least in the case of medicaid), compliance with CMS requirements absolutely eclipses compliance with other federal, state, and insurance regulations, in terms of what it takes to make sure you get at last crumb that CMS pays. Most people would be absolutely shocked at how much of modern medical care is dictated directly or indirectly by the bureaucrats at CMS. Even those with good private insurance are indirectly affected to a very significant degree.

Since the 1970's, the number of providers in the US has increased by about 150%. The number of healthcare administrators, however, has increased by something like 3700%. Why is that? Does the healthcare industry naturally value the contributions of bean counters more than clinicians? I doubt it. It's another result of the massive cost of compliance with federal, CMS, state, and insurance requirements.

At the same time, physician career satisfaction is at a record low and 90% say they would not recommend medicine as a career, and most cite the increasingly complex administrative requirements constantly being added to their list of responsibilities. I can tell you anecdotally, that many of us providers are also increasingly disenchanted by a sense that there are just so many people in line to profit from the care that we provide to patients.

Rural hospitals are closing left and right, and the ones staying open are cutting important services because they simply can't afford to provide them considering the pittance paid by CMS and how difficult they are to keep happy. The only way to make money on CMS patients (which are a very large percentage of many rural hospital's clients) is volume. As long as that is that case, the efforts to switch to a value-based reimbursement scheme will fail.

The cost of healthcare was supposed to fall after the ACA was passed in 2010. It was supposed to be this miraculous piece of legislation that all the really smart people supported because it would reign in costs, make healthcare more available, and make us all healthier. It was supported by the insurance industry because it protected them from competition. It was supported by states and hospital systems because the federal funding they rely on would have been slashed without it. What really happened? The cost of healthcare and healthcare insurance has risen even faster than it did before the law went into effect, and dozens of rural hospitals have closed.

Meanwhile, more and more practices and surgery centers are opening that refuse any type of insurance. These make private payment arrangements with individuals or their employers. Because they avoid the incredibly complicated mess of CMS and insurance billing and compliance, they tend to have very transparent pricing, cost WAY less than traditional providers, and have outcomes that are as good or better. That's right: the only part of the healthcare industry that is actually thriving and lowering costs is the small corner of the industry that has managed to shield itself from as much government involvement as possible.

If I ran a business or an entire industry and it did poorly, no one would question that it was my responsibility. Once things started doing poorly, if I doubled down on the same strategies that caused it to do poorly in the first place, people would say that I was stupid and that it was completely my fault when it continued to fail.

Well, make no mistake, the government absolutely runs the healthcare industry, and things have gotten worse and worse every year for decades now. But for some reason we give politicians and bureaucrats a pass when it comes to the actual effectiveness of their programs. It's as if intentions are more important than actual results. We haven't even talked about the VA, which is an utter national embarrassment and is a perfect prequel to what British-style completely government-run healthcare this country would actually look like.

The healthcare system is absolutely imploding and lots of people are really suffering, and so many people just want to do more of what has clearly not been working. I wish I could say I'm surprised.
 

RocketMedic

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@Remi , you’re lumping cost-containment measures along with regulations. CMS and private insurers maintain complex reporting requirements in order to deny as many claims as possible and to limit their costs of operation (both in payments and how much it costs for them to process a claim). I am more directly referencing regulations focused on quality, safety and access.

Could regulations as existent be overhauled? Absolutely, and there’s a lot of duplicative, overly-focused and poorly-directed requirements, and once we start digging into CMS administrative requirements, a lot that are superfluous. But removing regulatory mechanisms isn’t the right answer either.

Regulations directed at improving safety and quality are good things.
 

RocketMedic

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The single greatest price driver in US healthcare is the fact that there is no single designated payor for services and the funding of healthcare is nearly entirely dependent on the whims and will of glorified middlemen who broker healthcare services with an eye towards cost efficiency and short-term operational benefit.
 

DrParasite

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While this was mostly from the hospital's perspective, this video has some solid points (And I'm really loving this series, although I will also admit that it does leave out some details that would not support the host's point of view):
 
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