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Reimbursement changes coming to local health care

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Posted: Thursday, August 16, 2012 12:00 am | Updated: 6:07 am, Thu Aug 16, 2012.

Major reimbursement changes are finally coming to a local health care organization and payer near you.

I agree that the public is finally becoming aware of what Bruce Schweigerdt referred to as the health care cost fiasco ("Hospitals are enabling the 'charge' versus 'cost' game," Aug. 9). Excessive health care spending continues to overwhelm America's economy. However, I would caution using Medicost.org data as an example.

The website compares every California hospital that they could find — 260 in all. Their scale compares hospital cost per dollar with the highest at No. 1 (90 cents) to the lowest at No. 260 (10 cents). Lodi Memorial Hospital is ranked number 246. I choose to look at the LMH score as being roughly in the bottom third. This is great news when compared to other acute care organizations in the state.

Unraveling the complexity of health care provider charges and payments is extremely difficult. The real concerns should be the quality of care provided and the verifiable source by which it is measured. A nationwide database is available to us. It is called Hospital Compare (www.hospitalcompare.hhs.gov). Granted, this is a government database. LMH ranks ahead of or on-par with St. Joseph's and Kaiser. Clarification: LMH is a "nonprofit" corporation. Nonprofit corporations conduct business for the benefit of the general public without shareholders and without a profit motive.

I consider LMH our community health care resource. As health care reform plays out, I want to receive high quality health care provided locally versus having to go to Stockton, Manteca or Sacramento.

We might consider supporting our unique resource whose goal is to create superior health care delivery opportunities to enrich Lodi.

Health care reform, like it or not, is changing care delivery and reimbursement of health care services. If we are to continue enjoying the luxury of having a local acute care and emergency care provider, it will be up to us to engage and become part of the solution.

J. Mark Hamilton


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Welcome to the discussion.


  • Ron Werner posted at 10:26 pm on Thu, Aug 16, 2012.

    Ron Werner Posts: 101

    Consider these points:
    1) the current method of financing health care is unsustainable. A big factor is due to cost shifting from the government programs to the private sector due to inatequate reimbursement rates and the unreimbursed expenses for treatment of the uninsured.
    2) People will demand the best and most extensive medical care when they're not paying for it. Government rationing is needed to control this.
    3) Decreasing competition certainly increases costs. That's why medical insurace rates are much higher in Northern California than Southern. I've heard that 70% of the population will be able to receive government subsidies through the exchanges. starting in 2014. So the costs won't increase for those people, only the taxpayers who pay for the subsidies. (refer to #2) . When you say costs will rise, you have to clarify for whom?
    4) The impact that healthcare reform will have in 2014 is yet to be written. It appears that most people with individual plans will have to get new insurance because their old plans will be illegal. Many small companies will no longer be able to offer group plans because employees who get subsidies from the exchange will cause big penalities.
    5) Health care reform utilizes the financial hammer to penalize hospitals for such things as infection rates and when patients are readmitted within 30 days after they have been released. I would think a single hospital like Lodi Memorial would find it more difficult to comply than a large hospital chain that can spread the risk over many facilities.
    Interesting times ahead.

  • Darrell Baumbach posted at 8:29 am on Thu, Aug 16, 2012.

    Darrell Baumbach Posts: 9405

    Can anyone post links that substantiates when the Federal government is directly involved, that the cost of doing business goes down. Through mandates, regulations and compliance the complexity and difficulty increases. Decreasing competition results in prices going up. Drifting toward a single payer system eliminates competition and quality of care. Canada and England have proven that care for the elderly and sick must be rationed in order for the system to work. Seniors should fear what is coming. People who appreciate freedom to control their destiny should fear our society gravitating toward more and more government control.

    No doubt improvements in the delivery of health care can be improved and modified... but The Affordable Care Act is not the solution. Mark is correct that like it or not change is coming. The fight is over how is will take place. One political party wrote a bill that paid dividends to the people who support their agenda.


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