Another ObamaCare Medicare Gimmick

4e0dkerry america 428 Another ObamaCare Medicare Gimmick

Today in you have to pass it to find out
what’s in it: a provision in ObamaCare that allows Massachusetts
hospitals to get hundreds of millions a year in higher Medicare
payments at the expense of every other state — inserted by John
Kerry, who until this afternoon
was the Democratic Senator from Massachusetts.The
specific trick involves an obscure Medicare payment rule
setting the floor for urban hospital reimbursements at the same
level paid by rural hospitals. In most states, rural hospital wages
are lower than their urban counterparts. But Massachusetts has just
one rural hospital,
a 19-bed facility in Nantucket, a difficult to access,
well-to-do area with high Medicare reimbursements. After being
purchased by a large hospital group, the Nantucket facility
specifically switched into the rural payment scheme in order to
goose payments for the rest of the system. As a result, hospitals
in Massachusetts are expected to get about about $3.5 billion in
extra funding over the next decade.At least, that is, if the provision isn’t altered or removed. A
group of rural hospital associations have requested that the
provision be removed from the law. And earlier today, Sen. Tom
Coburn (R-Oklahoma) and Sen. Clair McCaskill (D-Missouri)
introduced revenue neutral legislation to end the Bay
State-friendly gimmick. In the grand scheme of things, fixing a relatively small
provision like this doesn’t go very far. But the existence of the
provision does tell you something about the nightmare of the
Medicare payment system. ObamaCare supporters sometimes like to talk about the
legislation’s “delivery system reforms,” which are supposed to
change the way health care services are organized in ways that make
health care less costly and more efficient. The bulk of these
delivery system reforms are essentially payment reforms —
restructuring the way medical providers are reimbursed in hopes of
changing their incentives. But the sheer complexity of the way
Medicare pays providers means that these sorts of payment games are
not only commonplace, but key drivers of administrative decisions
in medical facilities. Medicare’s size also means that its
decisions often have ripple effects throughout the medical payment
ecosystem.That has consequences for care. Rather than optimize their
practices to patients and their illnesses, providers end up letting
coding systems and payment rules drive their decisions. ObamaCare
rearranges some of these incentives, but it leaves the complexity
in place, and in some cases adds to it. Which means we’re likely to
see these sorts of payment games and gimmicks throughout the health
care system for years to come. 

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Another ObamaCare Medicare Gimmick

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