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Politico:
House Republicans are moving toward introducing a bill that would lift the debt limit until the first quarter of 2015, while patching the Medicare reimbursement rate for nine months and reversing recent changes to some military retirement benefits, according to multiple sources familiar with internal deliberations.

The bill could come up for a vote as soon as next week.

Patching the reimbursement rate for doctors who treat Medicare patients — known as the Sustainable Growth Rate or “doc fix” — and changing cost of living benefits for the military could be costly. Under the emerging plan, House Republicans would seek to pay for those items with an extra year of cuts to mandatory spending and changes to pension contributions.

But wait. On the one hand, WH refusal to negotiate on the debt ceiling means all that extra stuff might just be stripped out after House passage. And meanwhile in a parallel universe:

Association of Health Care Journalists:

An agreement has finally been reached in both houses of Congress that replaces the Medicare physician sustainable growth rate formula, or SGR, with plan that provides stable funding updates based pay-for-performance and increases reimbursements by 0.5 percent annually for the next five years. The SGR, part of the 1997 Balanced Budget amendment, essentially ensured that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.

However, as health care costs began to outpace inflation, the SGR began to fall short of the actual cost of health care services and Congress has repeatedly stepped in to suspend or adjust the payments (“doc fix”). Many physicians groups, including the AMA, have called for a more permanent, less formulaic, solution.

Sarah Kliff:
Something weird is happening on Capitol Hill right now. Something just about unprecedented: Republicans and Democrats are agreeing on a multibillion-dollar health policy proposal.

On Thursday, legislators released a plan to overhaul how Medicare pays doctors, one that would do away with the "doc-fix" ritual and more closely tether the amount that providers make to the quality of care they provide.

So while one GOP proposal treats the "doc fix" as a temporary political sweetener in the debt limit scheme (the one that has to pass with or without extra stuff), another proposal in Congress looks at the long term correction to SGR that's been decades in coming. More on this below the fold.

Here's a Brookings explainer from December:

Although much media coverage around health care reform recently focused on the Obamacare rollout, another profound but far less publicized change could be coming. Congress is closer than ever to correcting the sustainable growth rate (SGR) formula, an ill-conceived policy that annually threatens physicians with indiscriminate cuts in fees to control Medicare spending.

In a previous post, we explained the origins of the SGR in the 1997 Balanced Budget Act and reasons it failed to work as planned. Now, there are 2 congressional proposals intended to fix the problem.

If passed, such legislation would make the biggest changes to Medicare physician payments in more than a generation. The proposals would repeal the SGR-mandated cuts and essentially eliminate roughly $140 billion in planned physician fee rollbacks. In return, Medicare would largely change its way of paying physicians. Most importantly, Medicare would move away rapidly from traditional fee-for-service payments and hold physicians more accountable for quality. Such an approach could help physicians change practices to deliver better and less expensive care—reshaping health care delivery across the nation. However, major areas of uncertainty remain.

So, here's a twist that gives you an idea where this is going: CVS dumping the sale of cigarettes as of Oct. Why would they give up $2 billion in sales?

Well, imagine a world where instead of doctors getting paid for every visit, every test, every service they do ("fee for service"), they now get paid based on measurable outcomes ("pay for performance"). Imagine further that you are a physician group or an insurance entity, and because you want to find out whether patients are taking their medicine to help you achieve your outcomes, you hire someone to check out your patient compliance with medication. Or, maybe you want to see if the doctors in the system are prescribing the cheapest possible medication version.

Enter CVS Caremark:

Our Strengths

We are uniquely positioned to deliver significant benefits to health plan sponsors through effective cost management solutions and innovative programs that engage plan members and promote healthier, cost-effective behaviors. Our integrated pharmacy services model enhances our ability to offer plan members and consumers expanded choice, greater access and more personalized services to help them on their path to better health.

Our Businesses

We effectively manage pharmaceutical costs and improve health care outcomes through our pharmacy benefit management (PBM), mail order and specialty pharmacy division, CVS Caremark® Pharmacy Services, our CVS/pharmacy® retail stores, our retail-based medical clinic subsidiary, MinuteClinic® and our online retail pharmacy, CVS.com®.

Now, if your outcomes are better lung health, and you've hired CVS or are considering them, why would you want them to be selling cigarettes?

Pharmacy benefit management is the future, not item sales from brick and mortar stores. And if you followed this far, you now know why CVS dumped ciggies from their store.

We'll walk you through it on the Kagro in the Morning show from Friday.

In other news, Reuters:

The opening of the Winter Olympics was supposed to be a triumph for Vladimir Putin that ended months of criticism of the Russian president over gay rights and talk of corruption surrounding the Games.

But a technical glitch and the choice of an athlete who tweeted what was widely seen as a racist photo of U.S. President Barack Obama to light the Olympic flame meant it ended up stoking controversy.

Efforts by state television to conceal from viewers the moment when one of the five rings that make up the Olympic Games symbol failed to light up, and complaints by a singer that her music was used without permission, made matters even worse.

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Comment Preferences

  •  Thanks for the roundup, Greg! (26+ / 0-)

    It's interesting to see the labyrinthine connections between the health care industry and the pharmaceutical industry. Wonder if we'll see other drugstores following suit?

    And isn't outcome-based fee payment for health care exactly what was described in the Michael Moore film, "Sicko"? Seems to me that's what the doctor in London told Moore--that the more patients who stopped smoking and lost weight, the more compensation he received.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sat Feb 08, 2014 at 04:42:14 AM PST

    •  we're laggards (14+ / 0-)

      no question.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Feb 08, 2014 at 05:10:05 AM PST

      [ Parent ]

    •  PS good thing to familiarize ourselves (6+ / 0-)
      Recommended by:
      MartyM, skohayes, wasatch, SueDe, Mary Mike, thomask

      with risk corridors, the 3 R's and SGR. It's gonna come up again.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Feb 08, 2014 at 05:12:18 AM PST

      [ Parent ]

    •  I just have to wonder? (0+ / 0-)

      If places like sleazy convenience stores are going to welcome their lost tabacco business?

      "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

      by Stude Dude on Sat Feb 08, 2014 at 06:17:47 AM PST

      [ Parent ]

      •  I'd have been more impressed (1+ / 0-)
        Recommended by:
        SoCalSal

        if they stopped cigarette sales AND alcohol sales.
        But to me it was just a meaningless gesture, since as you pointed out, the customer just goes next door to the convenience store or the Walgreens across the street.
        How about if they stopped selling cigarettes AND offered huge discounts on smoking cessation aids?

        Your beliefs don't make you a better person. Your behavior does.

        by skohayes on Sat Feb 08, 2014 at 06:43:14 AM PST

        [ Parent ]

    •  Question about cherry-picking (0+ / 0-)

      So let's say I'm a physician practice. I am not required to treat all comers; I can limit the numbers of patients I'm responsible for.

      What (if anything) prevents me from saying to a patient, "Look, here's the deal. You have six months to quit smoking and lose 75 pounds, or else we will not be able to continue serving as your doctors." If that patient is going to skew your statistics, you want him or her out of there.

      Having struggled all my life with weight issues, it's tough. I imagine that quitting smoking, or any other addictive behavior, is much toughter.

      It's no different from charter schools finding reasons to expel problematic students just before the standardized tests so that their numbers look better.

      It's also like penalizing teachers for their students' learning difficulties, even if those are caused not by bad teaching but by homelessness or other out-of-school issues.

      Is there something in the new payment schemes that penalizes doctors for kicking people out, or that compensates them for taking on the really tough cases?

      •  seems completely different to me (0+ / 0-)

        if I (as the doc) am rewarded by counseling and suggesting, not by results (complex factors interplay there), I win and they don't lose because there is no reason to dump the patient.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Feb 08, 2014 at 10:03:25 AM PST

        [ Parent ]

  •  Another victim of the Empire. Athletic effort (2+ / 0-)
    Recommended by:
    Rikon Snow, a2nite

    and discipline subjected to the propaganda needs of the Emperors.  Putin/USA/corporatists/security statistics.  Matrix, indeed.

    Patriotism may be the last refuge of scoundrels, but religion is assuredly the first.

    by StrayCat on Sat Feb 08, 2014 at 04:44:01 AM PST

  •  GOP taketh away then giveth back (14+ / 0-)

    Finally agreeing to patch up Sustainable Growth Rate and backing off COLA cuts to the military they had previously proposed.  How magnanimous.  

    It's as if they've taken a page from Gov Rick Scott's playbook - in 2011 he cut teachers pay by 3%, in 2013 he gives teachers a $2500 annual pay raise fully expecting to be thanked and praised for giving back what he'd previously taken away.  

    As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them. John F. Kennedy

    by JaxDem on Sat Feb 08, 2014 at 04:57:59 AM PST

  •  Le plus ca change (6+ / 0-)

    So, over the last few months, we've seen Russia pretend to care about peace to embarrass the US and the US pretend to care about human rights to embarrass Russia. Le plus ca change....

  •  Bloody Hell, they pre-empted Kornacki. (3+ / 0-)
    Recommended by:
    hulibow, David54, wintergreen8694

    I'm stuck watching C-Span's Washington Journal about the crap the middle class is going through.  I know that crap, I was wanting to hear what was new with Christie.  I wonder if the Bergen Star Ledger is online...

  •  I have no expertise (16+ / 0-)

    whatsoever in the health care industry, just personal memories that have jaded my perspective. My dad was a one-man office pediatrician for 30 years. At the end of his career he sold his practice to a hospital conglomerate with an agreement that his office would stay open for a period of time and he would be salaried. The clearest memory I have of that transition was his anger - the regular charges he submitted for services doubled and in some cases tripled because they were dictated by what insurance would pay for, not what they actually cost. It pissed him off to no end - suddenly he felt like the practice he had built was a racket. The bigger picture was watching the "why" drift away - it was no longer about his passion for taking care of kids, it was business. That situation and the year he had to hire someone just to handle the insurance bureaucracy were the low points in his long career.

    •  so one more twist (3+ / 0-)
      Recommended by:
      skohayes, wintergreen8694, hulibow

      the world beyond the R House is already changing medicine in ways that are unrecognizable to folks who retired just a few years ago, and the pace of change is accelerating.

      The R House wants to repeal.

      Who wins?

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Feb 08, 2014 at 05:26:22 AM PST

      [ Parent ]

      •  It would be nice to know what's going on in the (2+ / 0-)
        Recommended by:
        Stude Dude, wintergreen8694

        area of education and employment. I know that the nursing field was already one of the best bets for a sustainable job before the ACA, but my understanding was that we would need a lot more doctors and nurses, etc.

        Haven't heard much about that lately.

        Also, are we allowing foreign med students to stay permanently (to the detriment of their home countries, and displacing US citizens ) to pursue highly profitable practices,
        or are we helping train doctors who are going back where they're desperately needed.

        I know that the gop idea of "comprehensive immigration reform" is to allow any and all highly trained professionals and tech workers to stay here, and keep everyone else in a second class, semi-criminal class.

        You can't make this stuff up.

        by David54 on Sat Feb 08, 2014 at 06:17:18 AM PST

        [ Parent ]

        •  there are more slots for med students now (5+ / 0-)

          and physician assistants and APRNs will pick up much of the slack for physician shortage needs. The bottleneck is in residency programs which have not budged re size.

          I don't know the answer re foreign grads.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Feb 08, 2014 at 06:25:14 AM PST

          [ Parent ]

          •  My understanding is that most of them stay here (0+ / 0-)

            instead of going back. (Among other things, they may have massive loans to pay back, which they can't do on salaries from home. Or they've married and started a family here.) If you want to train nurses for hospitals in Manila or Nairobi, put the school there.

            Also newly minted RNs are having a heck of a time finding that first job, as hospitals have cut back staffing, there are a lot of unemployed experienced nurses for any vacancies, and no one wants to do the intensive training that's needed for someone straight out of school.

            In theory, the ACA should increase demand (and funding) and therefore jobs. I'm not sure it will. The push for "efficiency" and "productivity" will put pressure on everyone to do "more" with fewer people, even if "more" doesn't mean "better for the patient."

            I'd like to think the quality-billing rather than fee-for-service would push back on that, but in most places I would expect practices to try to do the extra work by hiring unskilled $10-an-hour telephone "customer service" people who work from a script, rather than RNs, MDs, and other high-priced employees.

    •  I have concerns about outcome based (9+ / 0-)

      reimbursement for medicine just as I do "merit based" pay for teachers.  What about physicians and hospitals who care for the sickest or poorest or highest risk patients?  Or teachers working in very poor inner city schools or rural communities?

      Greg--I'd appreciate your thoughts on this issue.

      •  This isn't a reply to hulibow. (0+ / 0-)

        Misplaced my comment.

      •  the way this is leaning is the better (7+ / 0-)

        reward is for what the doc does over what the patient doesn't. For example: more reward for offering a flu shot (up to the doc) than % of vax patients in a practice (up to the doc AND the patient).

        Why ding the doc for weight loss when the doc advises, the patient (for whatever reason) doesn't or can't follow through?

        seems rational.

        If you have time to listen to the Kagro show from yesterday, discussed in depth.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Feb 08, 2014 at 05:41:57 AM PST

        [ Parent ]

        •  I will try to listen (0+ / 0-)

          I've never listened to the show, but there's always a first time.  We now have an internet connection that allows us to stream.  How long is the discussion?  Have a full plate today and headed out later on a trip to another town.

        •  How do you document what a doctor (0+ / 0-)

          suggests to a patient?

          •  you can order a test (6+ / 0-)

            the record says you did because you did it electronically.

            You ordered the insulin because the record says you did, you prescribed electronically.

            You recommended a vax and the pt refused, it says so in the record.

            You can (in the discussion part of your not)e say: i recommended x, y and z, and the pt acknowledged."

            Some offices actually have the pt sign at the end of the visit.

            "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

            by Greg Dworkin on Sat Feb 08, 2014 at 06:00:52 AM PST

            [ Parent ]

            •  Sorry to be cynical but (1+ / 0-)
              Recommended by:
              Heart of the Rockies

              how long before someone figures out a software patch that automatically checks all the boxes on everyone's electronic record, whether or not the doctor actually mentions "shingles vaccine"?

              I am just astounded at the willingness of thousands of people to commit outright fraud, if it will enable them to pull down millions of federal dollars. The medical equipment scams seem to be the worst, but if the money is available elsewhere, a certain percentage will figure out how to get it without actually doing the work.

              •  as I noted (0+ / 0-)

                there is a trend to have the pt sign the report at the end of the visit, or give the pt the report so that they have a copy of you saying you discussed it.

                if it actually gets given, the order, the lot number, etc are recorded.

                it is a legal document. Penalties apply for fraud.

                "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

                by Greg Dworkin on Sat Feb 08, 2014 at 10:06:53 AM PST

                [ Parent ]

        •  So, with all the problems, the ACA seems to have (8+ / 0-)

          done the most important thing of all regarding health care.
          The consensus was that the "health system" in general was "untouchable" by pols, a Kafkaesque, Byzantine (supply your adjective here) nightmare, a runaway train, a growing snowball tumbling toward disaster, etc.

          Congress was a corrupt, dysfunctional cesspool of leeches capable only of deciding which wine to order with the medallions of beef in truffle sauce when dining with the lobbyists.

          With all the obstruction and complaining, diversion and dis-informing, it looks like we're finally getting around to making meaningful corrections in the system.

          Apparently this is going to take decades, but at least things are starting to move.

          You can't make this stuff up.

          by David54 on Sat Feb 08, 2014 at 06:05:55 AM PST

          [ Parent ]

      •  I'm worried about beer sales. and wine. (2+ / 0-)
        Recommended by:
        Stude Dude, skohayes

        Just kidding, partly. May start brewing my own.

        You can't make this stuff up.

        by David54 on Sat Feb 08, 2014 at 05:54:58 AM PST

        [ Parent ]

      •  Well, obviously that has to be built in (2+ / 0-)
        Recommended by:
        Stude Dude, wintergreen8694

        to the outcome, especially in states like Florida, where a majority, or at least a large minority are seniors. It would certainly improve the "roll them in roll them out" based medicine in some hospitals.
        My dad went into the hospital after breaking his hip. He was there for a week after hip replacement surgery (at age 86?), and then released to a rehab. A day after arriving at the rehab, he was diagnosed with pneumonia and sent back to the hospital. Treated with antibiotics, another week in the hospital and into another rehab. Then had an infected bedsore, and back to the hospital where he died a week later.
        Outcome based is different than merit based for teachers, because there are actual measureable differences in hospitals. Why did this particular hospital have so many readmissions and this one did not is one obvious example.
        So many legislators want children and administrators to weigh in on the teacher's "merit", without using measureable numbers to judge a good teacher from a bad one.

        One is subjective, the other is objective.

        Your beliefs don't make you a better person. Your behavior does.

        by skohayes on Sat Feb 08, 2014 at 06:17:50 AM PST

        [ Parent ]

      •  As a teacher, I share the same concerns (3+ / 0-)

        So many of my students do not read at home, stay up late and watch tv, come to school late or have poor attendance etc.  It's hard to get the desired results from them no matter how hard I work!

        “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

        by musiclady on Sat Feb 08, 2014 at 07:38:40 AM PST

        [ Parent ]

        •  and some students are homeless (1+ / 0-)
          Recommended by:
          Heart of the Rockies

          or couch-surfing, or food-insecure, or working 40 hours a week to keep the family afloat. You're right that a lot of the issues have little to do with teaching quality or expertise.

          •  Actually you describe many of my students. (0+ / 0-)

            My school has a 70% poverty rate.  I have some students living in shelters and I have students who have no adult supervision due to the fact that their parents (or single parent) are working 2 or 3 jobs to pay the rent.  

            “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

            by musiclady on Sat Feb 08, 2014 at 08:35:15 PM PST

            [ Parent ]

  •  I liked the spinning doves. (4+ / 0-)
    Recommended by:
    PsychoSavannah, freerad, SueDe, Patango

    In the Olympics opening. That was cool. I feel I should say something nice since few are. People worked hard on that show.

    You know this is democracy in action. People like this Putin guy. Just something to keep in mind.

    We're fools whether we dance or not, so we might as well dance.

    by PowWowPollock on Sat Feb 08, 2014 at 05:31:06 AM PST

    •  I'm a bit annoyed (4+ / 0-)

      with the media making the Olympics about politics and their own personal comfort. You are right - the people that are making it happen and the athletes should be celebrated. I was pleasantly surprised that Huffpo's big headline this morning was a medal winner and not some new complaint.

    •  I thought the opening of the Olympics (2+ / 0-)
      Recommended by:
      Patango, wintergreen8694

      was a fantastic show.  I was watching and listening to an announcer who explained the show as a march through the changes in Russia throughout the 20th century, from before the Revolutions and Soviet era up to the present. Quite a good thumbnail view of the country's political and social history (although a lot of inconvenient history was ignored), and the presentation was spectacular.

      "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

      by SueDe on Sat Feb 08, 2014 at 07:35:49 AM PST

      [ Parent ]

    •  I also thought to olympic opening was wonderful (1+ / 0-)
      Recommended by:
      wintergreen8694

      The art work was fantastic , and all those people coming together to make it happen

      Listen to the Russians in interviews and how excited and proud they are , tennis champ Maria Sharapova grew up in Sochi , she was full of joy to host the world and show off her people

      America has many flaws also , but we would all be proud to show case America and host the world

      Political hack Romney is not impressive on the world stage either

      Beer Drinkers & Hell Raisers

      by Patango on Sat Feb 08, 2014 at 07:58:26 AM PST

      [ Parent ]

    •  "This is democracy in action." ? (0+ / 0-)
      "People like this Putin guy."
      Even among those who like Putin or think he is somehow necessary for Russia right now, I think few would say Putin's perpetual "Presidency" is democracy in action. If people liked him so much, he would not  need to attack and imprison his opposition and effectively establish a one-party state. Make no mistake in thinking that he is a good person or even that he is looking out for Russia's best interests. He is looking out for himself.

      Just doing my part to piss off right wing nuts, one smart ass comment at a time.

      by tekno2600 on Mon Feb 10, 2014 at 07:04:09 AM PST

      [ Parent ]

  •  The Salute to Stalinism section was a little flat (3+ / 0-)
    Recommended by:
    Tribecastan, sweatyb, RadGal70

    Can't wait for German Olympics to include a review of German history.  Mel Brooks' vision of Hitler on Ice might actually be realized.  

    •  Putin needs to Salute the KGB establishment (0+ / 0-)

      that brought him to power. How better than to honor the country's ultimate dictator? Maybe Putin is a little jealous of or nostalgic for Stalin.

      Just doing my part to piss off right wing nuts, one smart ass comment at a time.

      by tekno2600 on Mon Feb 10, 2014 at 07:09:42 AM PST

      [ Parent ]

  •  Why didn't ACA take care of all this? (1+ / 0-)
    Recommended by:
    DRo

    Or.. the budget agreement of 6 weeks ago?

    I understand the workings of our government less and less as the days go by.. it is baffling.

    and as far as outcome-based fee payment goes...

    In return, Medicare would largely change its way of paying physicians. Most importantly, Medicare would move away rapidly from traditional fee-for-service payments and hold physicians more accountable for quality. Such an approach could help physicians change practices to deliver better and less expensive care—reshaping health care delivery across the nation. However, major areas of uncertainty remain.
    I've never been able to figure out exactly how that works to save much money..

    First off, patient compliance is probably the #1 roadblock.

    Second, a person's primary care physician often charges the least amount for that person's care.  He/she is prescribing thousands of dollars of medications, for instance.  He gets $40 for the office visit, pharmaceutical companies make thousands.  So, the poor primary care doc is the one who will need to document outcomes (who pays for this?  the doc!) and get dinged if his patient is non-compliant or makes poor lifestyle choices?

    And all of this to save a small percent of that $40??

    Yeah.. I don't think so...

    •  you are mischaracterizing, and then (7+ / 0-)

      dismissing ;-)

      First off, patient compliance is probably the #1 roadblock.
      The idea is to reward the doc for offing the service (a vax or an appropriate screening test and appropriate advice) not ding the doc for the pt who didn't follow through (abnormal blood sugars or blood pressure or cholesterol).
      "I've never been able to figure out exactly how that works to save much money.."
      The old way was $40 for the visit but $200 for the EKG in the offcie and $150 for the bloodwork drawn in the office and... I can remember going in for  simple physical and although covered by insurance the bill came closer to $800 than $40.

      And what if you get the same set of tests 3 months later when you're in for a sore throat? Maybe you didn't need them, but "just to be certain".

      Maybe the data says get a colonoscopy every 10 yeats and not every 7 (if you are healthy and have no worrying med hx).

      So if you no longer pay for what is euphemistically called "ancillaries" (the extra test you don't need because evidence and outcomes based medicine says you don't), the price goes down.

      "So, the poor primary care doc is the one who will need to document outcomes "
      That's part of practicing medicine. Quit whining about it. Scribbling something on paper even you can't read a year later is substandard and a legal risk.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Feb 08, 2014 at 05:56:27 AM PST

      [ Parent ]

      •  As I understand it's also follow-up (0+ / 0-)

        E.g. When test results come back, how many of them get stuck in a file folder, versus a nurse calling the patient and having them come in to talk about the high cholesterol or blood sugar and do a teaching session on it. How well does the practice track their patients who are hospitalized and then returning home.

        I'm all for trying this, but just hope the bean-counters are also alert for new varieties of fraud.

        •  fraud is always overplayed (0+ / 0-)

          not as much as voter fraud (which is nearly nonexistent.)

          what is much, much more common is finding and exploiting loopholes. Like people do with the tax code.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Feb 08, 2014 at 10:10:20 AM PST

          [ Parent ]

  •  CAT Scan $$$ (4+ / 0-)
    Recommended by:
    skillet, Stude Dude, skohayes, Patango

    so I had a CT Scan on 1-24-2014

    CAT Scan - body = $4579.00

    this proved I had appendicitis

    0_0

  •  I wish there were a way to tie the medicare (7+ / 0-)

    reimbursement rate to the number of kids that can no longer get lunch at my school because of being too far over on their account. We are at 30% reduced lunch and a fair number over that are too proud to get free lunch but people are running out of money because the winter has been so cold. Cold and snow equals little work and higher heating costs.

    We've been giving classmates of my little girl a ride. The other day it was -2 when they got out of school and one of my daughter's friend's dad was there with a snow suit to put on her in the parking lot because they were walking. Little girl was crying, it was cold. I offered a ride, he said no, they were just out for a walk. I told him he had to get in my truck, no choice. They had no gas for their car. No gas for a week. We give them a ride every day now.

    Doc fix isn't a big priority in my town this year.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Sat Feb 08, 2014 at 06:27:01 AM PST

    •  shrugs shoulders (3+ / 0-)

      As it happens, we are talking about this at the moment.

      School lunch cuts and food stamp cuts and lack of jobs and UI are all HUGE. I do not understand why there's not more outrage.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Feb 08, 2014 at 06:36:49 AM PST

      [ Parent ]

      •  No outrage because (1+ / 0-)
        Recommended by:
        dfarrah

        we have been indoctrinated to think that kind of help is evil and you are a slacker if you receive it.  I hear the meme even from liberals. People are embarrassed to fight for it because they get called names and get red hot hate thrown at them.  It is a disgrace.

        Everyone! Arms akimbo! 68351

        by tobendaro on Sat Feb 08, 2014 at 09:41:30 AM PST

        [ Parent ]

    •  And I'm sitting here (1+ / 0-)
      Recommended by:
      Greg Dworkin

      thinking, well, it's really nice that the doctors get so much attention and action on their issues - while the rest of the population has to fight tooth and nail to keep their meager benefits.

      The banks have a stranglehold on the political process. Mike Whitney

      by dfarrah on Sat Feb 08, 2014 at 07:36:37 AM PST

      [ Parent ]

      •  well, so much attention and action (0+ / 0-)

        that it's been broken and not addressed since 1989.  

        "why are you talking about X when I want to talk about Y?" has been an issue for ever since there were humans.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Feb 08, 2014 at 07:57:31 AM PST

        [ Parent ]

      •  btw (1+ / 0-)
        Recommended by:
        Patango

        as for me, I've published 3541 diaries and posts and this is the second time (IIRC) I have written about SGR.

        And, today, it's only because it's now part of the debt ceiling discussion. My feeling is since that's so, we might as well know more about it.  

        Why not? Because other things are more important? They are, but we write about them, too.  ;-)

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Feb 08, 2014 at 08:05:36 AM PST

        [ Parent ]

        •  Greg (1+ / 0-)
          Recommended by:
          Greg Dworkin

          I can see your point and even appreciate your take and informed comments on SGR , I hope they do fix it

          The subject over all is "the budget" so people are expressing their frustration over gutting the safety net to pay down the debt , while , for instance , the CEO's of our defence contractors still get mega bonuses  

          I am a simple person who can connect the dots of importance of doctors getting paid to help people on medicare , but I am also witnessing 1st hand the terrible effects of the budget cuts , different people having different issues in their face

          The budget people are actively gutting funding and screaming they want to cut even more , so the voices are rising appropriately , at full volume , dems keep agreeing to cuts , while never fighting for and demanding the Romney crowd pay more than a 10% tax rate , or taking from our overly bloated defence budget , as some examples

          Not that you do not know this also , sorry to come off as preachy    

          Beer Drinkers & Hell Raisers

          by Patango on Sat Feb 08, 2014 at 08:31:57 AM PST

          [ Parent ]

          •  right (1+ / 0-)
            Recommended by:
            Patango

            very right.

            In this case, though, it's linked to the debt ceiling as the first part of the story, which is all smoke and mirrors (and this is, at heart, a politics site).

            And the more important second part of the story isn't so much that it's fixed (although it affects all seniors through Medicare), it's how it's fixed (the outcomes based shift in medicine, as seen through the prism of CVS and cigarettes), which affects, well, absolutely everyone.

            "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

            by Greg Dworkin on Sat Feb 08, 2014 at 09:25:17 AM PST

            [ Parent ]

      •  Hmmmm, (0+ / 0-)

        should be the population keeps its meager benes.

        The banks have a stranglehold on the political process. Mike Whitney

        by dfarrah on Sat Feb 08, 2014 at 12:40:12 PM PST

        [ Parent ]

  •  Good article in Salon (4+ / 0-)
    Recommended by:
    skillet, SueDe, wasatch, wintergreen8694

    about how ridiculous the Republicans are sounding on this 2 miilion jobs number, and how they changed their tune when the media picked up on what the numbers actually meant:

    The report in question concerned the effects of the Affordable Care Act. Republicans initially argued that the report said the ACA would “destroy” millions of jobs. That was a misinterpretation: It said that many Americans would voluntarily work less as a result of healthcare reform. So that became the problem: The ACA will encourage sloth and dependence! This line has resonated among certain political pundits, but I don’t expect it to win many elections. When even Ron Fournier can grasp that it’s a good thing that Americans will eventually be less dependent on employment for health insurance, there’s no excuse for any other pundit, no matter how brain-dead, to fall for Republican spin.
    http://www.salon.com/...

    And Ron Fournier, never one of my favorite people, wrote this at the National Journal:

    Cue the outrage. Republicans initially twisted the analysis to suggest that Obamacare would throw 2 million people out of work. Quickly proven wrong, they shifted their attack. They warned that millions of lazy, unmotivated Americans would take advantage of the law to live on the government dole.

    The GOP argument takes a dim view of Americans. It assumes that the only reason millions of people work is for company health care insurance—that there is no inner drive to ascend economically and socially. Give me a government check and to hell with the American Dream.

    That may be true for some Americans, but certainly not for most. The GOP argument has more than a whiff of Reagan-era racial "welfare queen" politics.

    http://www.nationaljournal.com/...

    Your beliefs don't make you a better person. Your behavior does.

    by skohayes on Sat Feb 08, 2014 at 06:38:30 AM PST

  •  Complicated issues require fact-checking scrutiny (2+ / 0-)
    Recommended by:
    wasatch, wintergreen8694

    Just like the complex ACA, the SGR and Risk Corridors are complex issues that cause MyEyesGlazeOver syndrome, and are then subject to RightWing distortion and lies.

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