Saturday, March 06, 2010

Lori sizes this one up pretty well

In an op-ed piece in today’s StarTribune entitled GAMC deal puts medical providers on the hook, Lori Sturdevant takes a look at the “deal” struck between the Legislature and Unilateral Tim on GAMC:

But legislators said that the agreement asks a great deal of medical providers, especially hospitals. "We're counting on you to continue to be the safety net," said Sen. Linda Berglin, DFL-Minneapolis, addressing providers, adding, "We did the best we could."

What Sturdevant meant is this:

Under the program, hospitals will form Coordinating Care Organizations that, in cooperation with counties, will manage and provide medical care for about 32,000 single adults. The measure must be approved by the Legislature and signed by Pawlenty.

However, hospitals will be paid a lump sum to cover all GAMC patients, so may have incentives to control costs. All care they provide beyond the single payment must be covered by the hospitals.

This should sound to you like the old “managed care” HMO model, because it is. Patients were profoundly unsatisfied with the care and service they received with this service delivery model.

This is very different of course, because we shouldn’t give a rat’s ass whether these patients are happy, satisfied, or even served. They just need, after all, to get off their duffs and get a job! One with benefits and keys to the executive washroom.

Although it merits some research, I don’t think that the existing GAMC reimbursement rates exactly encourage doctors and hospitals to over-treat GAMC patients; the financial incentives already exist.

Hospitals like HCMC and Regions are going to sign up for the new deal because they won’t have any choice. Well, they do, one supposes; they could just tell people to die in the streets. But no, the softies, they’ll sign up to take care of some of the sickest among us for a flat fee.

Sturdevant worries about this:

The bill provides $91 million over 13 months to hospitals, at least $30 million less than would have been available to hospitals under the bill Pawlenty vetoed on Feb. 18, and perhaps half as much as they would have received under the original GAMC program, which Pawlenty vetoed last May. To the extent the cost of care for the poor is not met by the terms announced Friday, it will result in two things: reduced services (and fewer jobs) at hospitals, and higher health insurance costs for everyone else.

But our taxes won’t have gone up!

In reality, your property taxes will probably go up, too, especially if you live in Hennepin or Ramsey Counties, because the bills for uncompensated care are going to have to be paid somehow.

But it would be a mistake to focus solely on the Metro; what about the small rural hospitals who will have many fewer patients, but if just a couple of really sick ones come along in a short time, it would be financially disastrous for the hospital and the little community where it is located.

This plan is destined to come to grief; maybe everyone realizes that and hope it’s a band aid big enough to cover over the problem until Unilateral Tim moves permanently to Iowa.

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