HR3200 : Division B : Day One : Part Two

Okay, now that we have digest that whole “rebasing” idea, let’s move forward.

Section 1131 brings us back to those productivity improvements we heard so much about in the previous post, only this time it relates to outpatient hospitals, ambulance services, ambulatory surgical center services, laboratory services, and certain durable medical equipment.

Section 1141 redefines power-driven wheelchairs with “complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher” which means that Medicare and/or Medicaid will not be paying for just any power-driven wheelchair. I bet those Hover Round mobility scooter people are sweating over this one.

The next two sections relate to brachytheraphy and home infusion therapy, while Section 1144 requires ambulatory surgical centers to submit all of their cost and other data. This is a given since we’ve already discovered that everything, every piece of information about you, will be stored in a central government database.

Section 1145 defines the treatment of certain cancer hospitals.

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:

“(18) Authorization of adjustment for cancer hospitals.—

“(A) Study.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary).

“(B) Authorization of adjustment.—Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.”.

Yes, you read that correctly. If the Secretary of Health and Human Services (who is probably not a doctor of any kind) decides certain hospitals are furnishing services that exceed the costs at other hospitals, the Secretary will be authorized to adjust the payments received by those “certain” hospitals.

In other words, also known as plain English, if certain hospitals provide services for too many people, the Secretary will require them to stop or slow down to lower costs, and in effect, begin the rationing of health care in those hospitals.

Section 1148 states that once a company supplies equipment to an individual they must do so for the remainder of the life of that equipment no matter where the individual may be located.

In the case of a supplier furnishing such equipment to an individual under this subsection as of the 27th month of the 36 months described in clause (i), the supplier furnishing such equipment as of such month shall continue to furnish such equipment to such individual (either directly or though arrangements with other suppliers of such equipment) during any subsequent period of medical need for the remainder of the reasonable useful lifetime of the equipment, as determined by the Secretary, regardless of the location of the individual, unless another supplier has accepted responsibility for continuing to furnish such equipment during the remainder of such period.

So, for instance, if you require a nebulizer for your breathing problems and ACME Nebulizers provides the equipment for you, they must continue to do so for the life of the equipment, whether you live in Oshkosh, Wisconsin, Nowhere, Arizona, or Prudoe Bay, Alaska.

The next few sections deal with oxygen rental and bone mass measurement.

Subtitle C, Section 1151 aims to reduce potentially preventable hospital readmissions. If a hospital has too many readmissions, their payments will be decreased.

With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of—

“(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and

“(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.

Not only will they penalize the hospital for too many readmissions, but they are also going to set the “readmission rate” at which people can be readmitted in the first place.

The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge. Insofar as the discharge relates to an applicable condition for which there is an endorsed measure described in subparagraph (A)(ii)(I), such time period (such as 30 days) shall be consistent with the time period specified for such measure.

Once the government starts telling you when you are allowed to return to the hospital, it’s called rationing. Plain and simple. There is no other way to describe it, unless of course you bury your head in the sound and pretend you can’t hear the warning alarms.

There will be no right to sue the government for setting the payment amounts, for penalizing hospitals for excess readmissions, how the government measures readmissions, or their determination that your hospital is subject to an increased payment amount because of those readmissions.

There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—

“(A) the determination of base operating DRG payment amounts;

“(B) the methodology for determining the adjustment factor under paragraph (3), including excess readmissions ratio under paragraph (4)(C), aggregate payments for excess readmissions under paragraph (4)(A), and aggregate payments for all discharges under paragraph (4)(B), and applicable periods and applicable conditions under paragraph (5);

“(C) the measures of readmissions as described in paragraph (5)(A)(ii); and

“(D) the determination of a targeted hospital under paragraph (8)(B)(i), the increase in payment under paragraph (8)(B)(ii), the aggregate cap under paragraph (8)(C)(i), the hospital-specific limit under paragraph (8)(C)(ii), and the form of payment made by the Secretary under paragraph (8)(D).

Oh, and don’t forget, it won’t just be the hospitals who pay when they ignore Big Brother’s guidelines for readmission.

In conducting the study, the Secretary shall consider approaches such as—

(A) creating a new code (or codes) and payment amount (or amounts) under the fee schedule in section 1848 of the Social Security Act (in a budget neutral manner) for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital or critical access hospital;

(B) developing measures of rates of readmission for individuals treated by physicians;

(C) applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission; and

(D) methods for attributing payments or payment reductions to the appropriate physician or physicians.

If a physician sees a patient and readmits them they will be penalized. Forget the fact you may need additional care, forget the fact the physician may be acting in your best interest. If they readmit you before the required “ration” time, their payments will be reduced.

So what have we learned so far?

In order to obtain the “nirvana of health care” in America, the government plans to create a new Health Choices Administration with at least three levels of bureaucracy (aka Commissioners, Ombudsman, etc).

They plan to replace our entire existing health care system, violate the privacy of all Americans and take away freedoms granted by the Constitution.

They plan to violate the 10th Amendment to the Constitution, place an unfair additional tax burden on specific groups of citizens (aka those who make more money than the government thinks they should), fix prices, set rates, and penalize those who don’t comply with the arbitrary rules that the Secretary decides to put in place.

They plan to limit the amount of health care you as an individual may receive (re-read the cancer treatment and readmission sections if you still don’t think they plan on rationing health care services), and it sounds like physicians who thought Medicare and Medicaid were a handful before haven’t even begun to experience the nightmare known as Medicare/Medicaid 2.0.

With any luck we’ll get through this thing before the Obama Administration tries to convince us that they’re willing to drop all the “public options”. The bill (as it is written now) has no chance of passing in either the House or the Senate, so you know they’re not going to actually drop it. They may try to hide it later in the bill, or re-introduce it as an amendment, but believe me, it’s not gone. If it’s gone, the bill is dead, and none of the bill supporters are going to allow that to happen easily.

Tomorrow we pick up with Division B, Subtitle C, Section 1152, on page 299.

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