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View Diary: America’s health care cost slowdown and the disappearing debt (66 comments)

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  •  It should be pointed out that some of this... (5+ / 0-)

    decline in Medicare spending has been due to the brutal and abrupt imposition of thousands of dollars in out of pocket costs onto low income seniors.

    It's like this:
    Medicare has always had rules regarding what is considered a reimbursable service, particularly when it comes to hospitalization. In years past, Medicare's payment gurus were generally content to accept physicians' judgment regarding when a frail elderly patient required admission.

    Not any more.

    This year, Medicare has abruptly imposed an extremely stringent interpretation of requirements for hospital admission upon patients. If I admit a frail 88 year old to the hospital with a broken pelvis due to a fall at home, Medicare now most often asserts - retroactively - that the patient did not require hospital admission because (in theory) 24/7 home nursing care might meet their needs. And consequently their stay in the hospital is deemed an 'observation' stay.

    What this means in the real world is that every single test, every x-ray, every blood analysis, is now considered an 'outpatient procedure' which Medicare will not pay for. The hospital charge is subject to the patient's yearly Medicare deductible and a 20% co-pay.

    The result: an 88 year old patient with a fractured pelvis being hustled out the door the moment she can totter to the bathroom with a walker...and being handed a bill for tens of thousands of dollars Medicare will not cover.

    I can send such frail patients home from the ER, and be held criminally negligent when they die of a complication. Or I can try admitting them, earning the family's rage when they get the bill.

    Mission accomplished!

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