Life Without Medicare - Patients

Despite all the consequences of losing Medicare on hospitals and physicians, the most dramatic impact would be on the patients. Medicare was put into place because the over 65 population was a group of people that nobody wanted to pay to care for. Lawmakers then believed that the healthy population could pay for the elderly population in a cost shifting principle.

The only way Medicare could go away is for people to save for the medical care much like they do for their retirement. The common belief is that everyone can put their money in a tax-deffered account and then use it when they turn 65. This idea is ok, but the problem then becomes how do you save money for people who have none. Then, what do you do with the people who did not save their entire lives and then cannot afford care.

None of this will work.

The only idea that I would have is to begin to take the human element out of health care and reduce the marginal cost of care. This includes greater use of computers, machinery, and robotics that can outperform humans. While this may sound like science-fiction, the government needs to defer money from some of their Medicare programs and incentive research in these areas.

What's Your Best Quality?

Hospitals and the public often think about quality in hospitals in the context of safety. This is absolutely a very important aspect of quality, but I want to delve deeper into quality. When was the last time your hospital looked at total organizational quality?

Many hospitals have heard of the Malcolm Baldrige award for quality. In fact, last year two health care organizations won this award.

Mercy Health System
Sharp Healthcare

There are six criteria that Baldrige award nominies are judged on including:

1. Leadership`
2. Strategic Planning
3. Customer & Market Focus
4. Measurement & Analysis
5. Workforce Focus
6. Process Management

We will explore each of these criteria in the coming weeks hoping to find something that you can institute at your hospital to improve your organizational quality. Please leave comments about anything that you may do at your hospital to address these criteria.

Finding Direction: The New Mission

As many of you know this is a very "green" blog that I started about six months ago. Up until this time, we have been drifting along without a direction.

That now all changes...At the Prognosis we have the goal of becoming the publication that every health care management professional reads to help them improve their hospital.

We want you to come here when you are looking for ideas to improve your facility. We want you to come here and share new and innovative ideas that you have discovered at your facility that we can share with the community. We want you to come here when you are looking for mental stimulation and keep you energized in your career.

We hope you enjoy this publication and we welcome any and all feedback.

Life Without Medicare - Physicians

Physicians much like hospitals would be greatly effected by any dissolving of the Medicare system. I could be wrong, but I believe that physicians were a major driver of the implementation of Medicare in the first place.

I believe getting rid of Medicare would put physicians at the mercy of for-profit insurance companies and consumers. Each would have a different effect on how physicians practice medicine. For-profit insurers are getting less tolerant of the autonomy of physicians. There would be less creativity in the practice of medicine and more "by the book" medicine.

Consumers would also have an effect on the way physicians practice. Consumers can be very loyal to physicians that they have had for many years, but that exists mainly for primary care physicians. Specialists however would have a more difficult time because they are less likely to have great customer service. Without the guarantee of payments from Medicare, physicians would find themselves in a less competitive position.

The prospect of the loss of Medicare would have a very dramatic effect on the way that physicians practice medicine and changing the way physicians practice medicine would ripple throughout the health care system.

Life Without Medicare - Hospitals

Take any business whether it be for profit or tax-exempt and tell them that they are going to lose half of their revenues and they are done. That's what would happen at many acute care hospitals if Medicare were to disappear.

The first thing that would happen is that hundereds of hospitals would likely close. This would take much of the excess capacity out of the system. Hospitals would then be faced with a population that would have to turn to the private sector for insurance.

Unfortunately, insurance companies are not going to be keen to pay for a population that is very likely to have a return on their investment. Therefore, the population is likely to pay for their own care.

In this circumstance hospitals are going to have to have the service of a hospital and the precision of an airline. Hospitals would have to being to provide real value to their patients. That means the feeling of wellness whether real or perceived must be provided to patients to the level of what hospitals are asking to be paid.

Come back for more on the effect of the dissolution of Medicare on hospitals.

Life Without Medicare

In an earlier post, I wondered out loud...what would happen to the American health care system if Medicare were to suddenly and completely cease to exist? Over the next few posts I would like to explore the effect of this from several different perspectives including; hospitals,physicians, health insurers, and the community. I would appreciate any feedback or ideas on what you think of this.

The HFMA Wrapup

The HFMA event was a sucess with the largest attendance of all time. The theme of the day seemed to be fear. There is much uncertainty in the hospital industry because no one knows what will happen with Medicare in the next few years. In addition the seizing of the credit market are going to make it difficult to fund capital. However we must not forget that after every downturn comes an upturn and we will figure out how to get through this.

Reform in Maryland

The first presentation today was from HSCRC executive director Robert Murray. Mr. Murray spoke very excitedly about the opportunity to improve access to health care in Maryland. Access to care is one of the great hallmarks of the Maryland system.

Live from the HSCRC workshop

Today I will be reporting from the HFMA's HSCRC workshop. I will attempt to comment on many of the presentations regarding the latest in payment methodology.

No Medicare

What would happen if Medicare went away tomorrow? Obviously there would be chaos initially but after that how would the delivery of care change? Would hospitals close? Would physicians change the way they practiced medicine?

Super Tuesday

Paul Krugman details the difference in the democratic candidates on health insurnace reform:

NY Times Article