By Michael Martz
Published: August 23, 2009
Almost half of the patients treated at VCU Health Center don't have private health insurance or depend on Medicaid services for the poor.
An additional one in four of the 32,484 patients treated last year in the hospital were covered by Medicare, the federal health program for the elderly.
All of these patients depend on big government subsidies for their care. VCU received $118 million in federal and state funds last year, primarily to treat the uninsured. While VCU is reimbursed better than most hospitals for the Medicaid patients it treats, the health center and its doctors lost almost $32 million last year on Medicare patients.
"It's a big burden," said Dr. Sheldon M. Retchin, chief executive officer of the VCU Health System. He agrees the way people receive and pay for medical care in the United States needs to change, especially to ensure that tens of millions of Americans without health insurance are able to get universal coverage for primary medical care, drugs, and mental-health treatment....
Page 256 starting with line 1 addresses the payments made to physicians that change their record keeping to electronic records. Basically, physicians will receive a 5% increase in their rates when they change their records to electronic. The participation is decided based on geographic location as to the number of participating physicians to receive the increase. One physician in any region that is alone changing to electronic medical records without peers or hospitals able to participate with them is not what the system needs to expedite care and streamline diagnosis without repeated tests.
The increased fee schedule is to begin January 1, 2011 but no later than January 1, 2013. The idea is to bring all physician records on line by 2013.
The discussion of the particulars of reimbursement and quality reports goes on for quite a few pages.
The pages continue to help modify the efficiency of care, it also clarifies power driven wheelchairs and their and defining their necessity as part of a rehab environment. There is a discussion about home infusion therapy to be included as a payable component of Medicare.
There is a provision for reporting of operations of surgical centers and periodic audits of use and costs. There is inclusion of "Adjustment for Cancer Hospitals." There is removal of a 'surety bond' to pharmacies that provide durable medical equipment.
There is continuation of oxygen supply and equipment by any supplier past three year term should there be a liquidation of a supply company. The purchaser may continue the therapy with another supplier for another three years without disruption.
Page 280 discussions DRGs for the first time in relation to discharges and preventable hospital readmissions. There will be a fee adjustment to any facility if there are excessive readmissions to a facility. There is a section that discusses the fee adjustment to physicians for repeated admissions to facilities. Basically the emphasis to this section is to discharge the patient and then have the outpatient facilities pick up the care of the patient to prevent readmission including home care visits. Those equations and schedules and effective dates to all the way to Page 299 where I will end this entry.
There is an emphasis in these 50 pages to streamlining care and reducing costs. There is nothing about limiting care. If care is needed it is to be given, but, the provisions wants patients treated more often than not out of the hospital and home or otherwise non-hospital to improve quality of life while reducing costs. I find nothing neglectful about these provisions.
Good night.
