Hospitals vs. ObamaCare: Care to Guess Who's in the Middle?

For those who knew at the outset that ObamaCare was a deliberate means to curtail American health care, drive costs up, and destroy the best health care system in the world, the headline in the Modern Healthcare supplement of August 9, 2010 will come as no surprise. "Sick, Sicker, Sickest: Hospitals say their Medicare patients are sicker and more costly to treat than ever before. But the government isn't buying it."

There you have it -- the health care practitioners will be overruled every time that the government deems it too costly to take care of sick people.

Your well-being will depend on who determines your state of health. The difference in opinion "is worth billions of dollars in Medicare payments ... to the nation's hospitals." You can bet your bottom dollar that with Dr. Donald Berwick at the helm of the Centers for Medicare and Medicaid Services (CMS), rationing will most definitely rule the day. He has clearly stated that "the decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open."

Consequently, "on July 30, the CMS in its final inpatient hospital rule for fiscal 2011 followed through on a decision to recoup 'excess spending' that took place in fiscal 2008 and fiscal 2009 as a result of hospital coding practices. Overall, the agency's final rule to set hospital inpatient rates in fiscal 2011 will result in a 0.4% reduction in payments on average, or roughly $440 million, across the industry."

So here is the first step in government control as it slows the growth of payment rates to hospitals. Eventually, this will result in doctors backing out of the Medicare program.

CMS claims that hospitals are "coding for more severe care than what patients are actually receiving." The hospitals, on the other hand, refute this by stating that "hospitals are getting penalized because CMS is unwilling to recognize that their [own] tool is doing exactly what it was designed to do -- better capture the increasing resource needs of a sicker Medicare population." The tool they refer to is known as the MS-DRG tool, or Medicare Severity Diagnosis Related Group, which is the medical coding tool used to reflect payments. CMS claims that hospitals are merely coding in order to receive more financial remuneration. On the other hand, Richard Umbdenstock, president and CEO of the American Hospital Associations, has written that "[t]he [CMS reduction] rule cuts billions of dollars from the healthcare [sic] system at a time when patients are sicker, [and] more people are losing coverage due to the economic downturn[.]" Furthermore, with these cuts, hospitals which "have been an economic mainstay during the recession" will no longer be able to offer hospital jobs, thus resulting in an unintended adverse effect on the economy. 

The American Hospital Association (AHA) states that the "CMS failed to look at real patient severity in crafting this payment adjustment. Thus, "hospitals are not 'upcoding;' they are coding more accurately under a system that was designed to pay hospitals accordingly for sicker patients in the first place."

In fact, both the CMS and the AHA supported the MS-DRG tool because it "was clearly superior and everybody agreed that this tool did a better job of capturing [medical] acuity among patients."

With a burgeoning older population, it is widely accepted that chronic conditions are on the rise. In the weeks leading up to the final rule's release, members of Congress also questioned whether "the appropriate and correct methodology had been adopted" to deal with more seriously ill patients.

The hospital industry offered anecdotal and statistical evidence that "severely ill Medicare patients were, in fact, accumulating in hospital beds, and that the CMS methodology for reducing its inpatient reimbursement was flawed." The "AHA urged the CMS to change its methodology for determining documentation and coding changes to better account for increasing patient severity and to reduce the proposed cut."

Despite congressional concerns and hospital and medical evidence, the CMS chose to ignore the issues they raised. Important to note is that many patients who had been admitted to hospitals in the past no longer meet Medicare's criteria for admission; thus, they are treated at home. By the time they do need hospital care, they are, indeed, more ill. Clearly, "lower-acuity patients are not in hospitals in the proportions they used to be." And, in fact, "patients are truly sicker" who now enter the hospital.

Since "the CMS has yet to recoup the full $6.9 billion for fiscal 2008 and fiscal 2009, let alone 2010, more "negative adjustments to inpatient reimbursement may be ahead."

If hospitals cannot be adequately compensated, what are the results to patient care? After all, Obama stated that "there will be no government rationing of medical care." In the penetrating piece entitled "ObamaCare: the Sum of all Fears," Mary Katharine Ham and Guy Benson, both in their twenties, cogently examine the promises of Obama and the subsequent realities of his health care law. Two salient features from their work include:

Promise #2: [Obama stated that ] Reform will lower America's health care spending.

On March 4, 2010, President Obama committed to the premise that, "My proposal will bring down the cost of health care for millions: Families, businesses, and the federal government." [Yet], hadn't Congressional Budget Director Doug Elmendorf warned Congress that, if anything, the legislation would actually bend the cost curve up?

Approximately a month after the vote went through, a damning report prepared by the government's very own Medicare Actuary exposed the truth: Obamacare will actually increase the nation's health care tab. In the first ten years of the program, spending will increase about 1 percent or roughly $310 billion.

Bottom line: Obamacare supporters were wrong when they told the country the legislation would lower the nation's health care costs. Ten years after its passage, health care will represent a larger percentage of GDP than the current projection.

Promise #5: [Obama promised] there will be no government rationing of medical care.

Democrats' most furious pushback against anti-Obamacare arguments resulted from predictions of government-mandated rationing. The White House website's "reality check" feature devotes two full pages to ‘debunking' so-called right-wing smears about rationing. The president himself assailed his opponents on this point.

Speaking in New Hampshire, he dismissed concerns over rationing, "that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars." Those fears, he said, were unfounded. "So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you...."

Bottom Line: "...government rationing is a frightening and unavoidable byproduct of government-administered and -- regulated health care.

Nota bene: According to ObamaCare, "increased need for basic care could lead to more use of nurse practitioners [and] physicians' assistants[.]"

Blue Cross/Blue Shield does not cover emergency room visits if a physician's assistant attends the injury. Therefore, the patient must incur the cost, as the hospital will lose money otherwise!

Bottom Line: Your medical well-being will hinge on bureaucratic regulations and deliberate deceptions by Obama and his cronies. Sick yet?

Eileen can be reached at