Obama to cut Medicare?

[Whamo]

The business channel was showing Obama "compromises" made awhile back that included Medicare cuts.  They keep calling Medicare and Social Security entitlements when people paid into these programs at work.  They're going broke because Reagan and his like spent the money a long time ago, and they gave away benefits to people that didn't pay into the system.  It's not fair to the people who worked and contributed for decades. 

[Joe]

I agree with you Whamo. If the politicians had just kept their fingers out of the pots, both of these programs would have remained solvent for a long time to come.

[Rerun]

Well, in 1974 people with ESRS were granted Medicare benefits no matter what age or if they ever worked or contributed.  Then they put on the Medicare tab kidney transplants (not heart or liver) NOW people want Transplants for life to be included.  Better watch what you wish for. 

[KarenInWA]

Well, in 1974 people with ESRS were granted Medicare benefits no matter what age or if they ever worked or contributed.  Then they put on the Medicare tab kidney transplants (not heart or liver) NOW people want Transplants for life to be included.  Better watch what you wish for.

I'm a member on a website called "Transplant Friends". There was a ruckus a few months ago from someone who posted about Medicare cutting off their anti-rejection drugs, and it made a lot of people upset. Come to find out it confused a lot of non-kidney transplant patients, since those with other organ transplants are on disability, and therefore, do not have their Medicare cut off after 3 years. I've chatted with some of these people, including kidney tx patients who are still on disability and say they can't work. Here I am, almost a year after transplant, have never been on government disabilty, and am working FT w/a GFR of 15 due to a post-biopsy kidney injury. I don't get how someone w/a GFR of 1.2 or somewhere around there who excercises on a regular basis can't hold a job while I can???

Anyway, all that to say, it appears that a lot of people who have other kinds of organ failure are able to get on disabilty and Medicare, both before and after their transplants. I did not know this before I joined that website.

KarenInWA

[jbeany]

I just got my letter for 3 years after transplant.  They notified me that my benefits were cut off because of that.  But, I still get them because I'm still listed as disabled, thanks to the massive complications I had.  So yes, if you don't qualify as disabled, you lose them after 3 years.  From what I've heard from friends with other types of transplants, that's true for them as well.

Medicare cuts had to be made - it was off balance, since many people don't pay in as much as they eventually take out.  When the program started, it was meant to protect the elderly who were no longer able to work, and they started that at 65.  At the time, that wasn't so much "retirement age" - it was 2 years after the average life expectancy ended.  Most people didn't collect a dime because they died long before they had the chance to start.  Medical advances have drastically improved life expectancy, and now people are much more likely to collect - and do so for much longer.  My Gram collected benefits for 28 years before she passed at 93.  That kind of life span isn't an anomaly any more - it's pretty common.  Add in the fact that the boomers did not have kids in large numbers who would pay in as they aged, and the whole system is upside down.

What I think is most distressing is that if they had started making gradual changes over a decade ago, when they knew that we were going to run short in the future, we wouldn't be having this problem.  I read one report that talked about how much financial difference raising the retirement age makes - and how it would have be even more effective the sooner it was done.  It's the math - bump it up to 66 or 67 twenty years ago, and the savings would have snowballed enough to keep us out of trouble now. 

In other words, the longer we wait to make the fixes, the harsher they are going to have to be.

[Hemodoc]

I just got my letter for 3 years after transplant.  They notified me that my benefits were cut off because of that.  But, I still get them because I'm still listed as disabled, thanks to the massive complications I had.  So yes, if you don't qualify as disabled, you lose them after 3 years.  From what I've heard from friends with other types of transplants, that's true for them as well.

Medicare cuts had to be made - it was off balance, since many people don't pay in as much as they eventually take out.  When the program started, it was meant to protect the elderly who were no longer able to work, and they started that at 65.  At the time, that wasn't so much "retirement age" - it was 2 years after the average life expectancy ended.  Most people didn't collect a dime because they died long before they had the chance to start.  Medical advances have drastically improved life expectancy, and now people are much more likely to collect - and do so for much longer.  My Gram collected benefits for 28 years before she passed at 93.  That kind of life span isn't an anomaly any more - it's pretty common.  Add in the fact that the boomers did not have kids in large numbers who would pay in as they aged, and the whole system is upside down.

What I think is most distressing is that if they had started making gradual changes over a decade ago, when they knew that we were going to run short in the future, we wouldn't be having this problem.  I read one report that talked about how much financial difference raising the retirement age makes - and how it would have be even more effective the sooner it was done.  It's the math - bump it up to 66 or 67 twenty years ago, and the savings would have snowballed enough to keep us out of trouble now. 

In other words, the longer we wait to make the fixes, the harsher they are going to have to be.

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan, more and more hospitals will close, more doctors will refuse to take Medicare patients since the payments won't cover their overhead expenses. So, not sure why folks are concerned about this issue a week after the election. Elections have consequences, Medicare is soon to be depleted not by Reagan my friend, but instead by Obama.

In Florida, Obamacare to Cause 27% of Doctors to Stop Accepting Medicare Patients

With the Presidential election one week away, it’s worth reviewing how Obamacare will impact the residents of key swing states. A new survey of physicians has found that 30 percent of doctors in Florida intend to place new or additional limits on accepting Medicare patients, with 27 percent altogether refusing to accept new Medicare patients, because of Obamacare’s impact on the fees that Medicare pays to providers of health-care services. In addition, Obamacare will deeply cut Medicare Advantage for 1.2 million Florida seniors who are enrolled in the program, and drive up the cost of private health coverage, especially for those who buy insurance on their own. Read on for more details.

http://www.forbes.com/sites/aroy/2012/10/30/in-florida-obamacare-to-cause-27-of-doctors-to-stop-accepting-medicare-patients/

[Rerun]

Karen, Medicare is different than Disability and I know you know that.  I believe Medicare only pays for ESRD issues and kidney transplants.  Now, Medicaid, which is state run may pay for liver, heart, lung if the person qualifies.  Each state has different criteria. 

Please send me a link that says Medicare pays for organ transplants or  anti rejection drugs other than kidney if you are under 65.

Thanks!

[KarenInWA]

Karen, Medicare is different than Disability and I know you know that.  I believe Medicare only pays for ESRD issues and kidney transplants.  Now, Medicaid, which is state run may pay for liver, heart, lung if the person qualifies.  Each state has different criteria. 

Please send me a link that says Medicare pays for organ transplants or  anti rejection drugs other than kidney if you are under 65.

Thanks!

Rerun, I don't have a link right now, but some of these other organ transplant patients are on disability, which then qualifies them for Medicare. Kind of like our own Chris, who has had his transplant for a lot longer than 3 years, but he is still on Medicare.

KarenInWA

[jbeany]

Please send me a link that says Medicare pays for organ transplants or  anti rejection drugs other than kidney if you are under 65.

Thanks!

http://www.medicare.gov/coverage/transplants-adults.html

[cassandra]

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan .... etc

Very possible, but medical misstakes, and readmissions within 30 are at a high. One of the many reasons could very well be the fact, that 'hospitals' get paid for making misstakes. And it might contribute to keeping patients in their care before they are released without being actually checked?

take care Cas

Edited: Modified Quote marks Rerun, Moderator

[Hemodoc]

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan .... etc

Very possible, but medical misstakes, and readmissions within 30 are at a high. One of the many reasons could very well be the fact, that 'hospitals' get paid for making misstakes. And it might contribute to keeping patients in their care before they are released without being actually checked?

take care Cas

Not really the issue at all. Prevention of readmissions in many patients is pretty much impossible. The hospital can do everything correctly, correct follow up but if the patient can't afford his meds, doesn't take his meds or is noncompliant with treatment regimens, they will end up back in the hospital.

For instance, congestive heart failure patients are perhaps the highest at risk of readmission within 30 days. Kaiser where I worked had a very aggressive program following all patients with case managers and cardiologists. In addition, they could obtain intravenous lasix in the infusion clinic if they got out of control. Even with the coordinated program with the hospital, clinic, case manager and cardiologist, it was impossible to eliminate all readmissions within 30 days. Kaiser did dramatically lower that rate, but that rate was not zero. Even in such an atmosphere, the new Medicare rules would penalize Kaiser's aggressive CHF management program. That is absurd.

Edited: Modified Quote marks Rerun, Moderator

[Rerun]

Please send me a link that says Medicare pays for organ transplants or  anti rejection drugs other than kidney if you are under 65.

Thanks!

http://www.medicare.gov/coverage/transplants-adults.html

I think that is for those over 65.  I'll call Medicare in the morning. 

[KarenInWA]

I found the link I was referring to. This was put on Facebook one day, and it upset a lot of transplant patients, and was reported as spam or some such thing. It was quite the deal.

http://www.transplantfriends.com/group/insurance/forum/topics/losing-medicare-after-transplant

[Rerun]

What is Medicare:

Medicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

So if you are 40 and need a heart transplant you may get social security disability but you are not getting Medicare.  We as ESRD patients are the lucky ones.

The certain younger people with disabilities I don't know who that is.  It use to be something like Iron Lung.

[glitter]

I know any child who becomes disabled before 18 and has a deceased parent gets medicare and SSD. My daughter was developementally delayed- she got SSD , then had to wait three years- then she got Medicare too.

[Rerun]

Karen, I understand what you are saying.  You have a kidney transplant that was injured by a procedure that was supposed to help you... not harm you.  You work full-time and have no help.  Why do some people have Social Security Disability?  Well, I have it because when I had my transplant I could travel and when I went back on dialysis I couldn't really drop everything and go 5 counties down for a week.  I suppose if I were rich and famous they would have helped me but I'm not and dialysis centers need 3 to 4 weeks advance notice for visitors.   I just couldn't do my job anymore and USDA deserved a better employee.   

You may want to look at disability one day.  But, as long as you can work and your employer is good to you then stay working 

[KarenInWA]

Karen, I understand what you are saying.  You have a kidney transplant that was injured by a procedure that was supposed to help you... not harm you.  You work full-time and have no help.  Why do some people have Social Security Disability?  Well, I have it because when I had my transplant I could travel and when I went back on dialysis I couldn't really drop everything and go 5 counties down for a week.  I suppose if I were rich and famous they would have helped me but I'm not and dialysis centers need 3 to 4 weeks advance notice for visitors.   I just couldn't do my job anymore and USDA deserved a better employee.   

You may want to look at disability one day.  But, as long as you can work and your employer is good to you then stay working

Oh no worries there, I like my job and want to keep it for as long as possible! But, on this website Transplant Friends, there's all these people who are on disability, which is fine, but why are people who are years post-kidney tx who exercise (lift weights, etc) on disability? That I don't get. There's this one guy who does the chat room all the time, and he cooks and does all sorts of things, but he says he can't work, so is on disability. I don't get it. Here I've been through what I've been through, and I still work, and won't let it get me down. I also remember talking to an older man on that site who had a single lung transplant. He told me "you can go on disability, you know". I replied that I didn't want to do that, short-term while I was recovering was fine for me. It's just weird that all these successful transplant recipients are on disability, even when they are able-bodied.

As for Medicare, since some of these patients are considered "disabled", then from what I can tell, they get to be covered under Medicare. Like our Chris. He had his transplant back in 2000, but he is on disability and Medicare. I don't know if it's due to his eyes or what, but he's on it. I always thought it was only us kidney patients who were covered under Medicare, until I saw this link on Facebook one day and how upset people got over it. I commented on that thread, mentioned the 3-year kidney tx thing, and wondered how anyone could get a kidney tx and not know that. Someone replied to me that not everyone replying are kidney tx patients, so not all of them get cut off after 3 years. It really caused an uproar, because people thought their lifeline was being taken away from them. I think the thread got deleted, but I'm going to try to find it.

KarenInWA

[Bill Peckham]

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan .... etc

Very possible, but medical misstakes, and readmissions within 30 are at a high. One of the many reasons could very well be the fact, that 'hospitals' get paid for making misstakes. And it might contribute to keeping patients in their care before they are released without being actually checked?

take care Cas

Not really the issue at all. Prevention of readmissions in many patients is pretty much impossible. The hospital can do everything correctly, correct follow up but if the patient can't afford his meds, doesn't take his meds or is noncompliant with treatment regimens, they will end up back in the hospital.

For instance, congestive heart failure patients are perhaps the highest at risk of readmission within 30 days. Kaiser where I worked had a very aggressive program following all patients with case managers and cardiologists. In addition, they could obtain intravenous lasix in the infusion clinic if they got out of control. Even with the coordinated program with the hospital, clinic, case manager and cardiologist, it was impossible to eliminate all readmissions within 30 days. Kaiser did dramatically lower that rate, but that rate was not zero. Even in such an atmosphere, the new Medicare rules would penalize Kaiser's aggressive CHF management program. That is absurd.

Yes indeed, Peter, why continue to try to scare people with misinformation when there isn't an upside for you (your candidate doing well)? It is hard for me to see a reasonable motivation.

The readmission penalty has less of a bite the ESRD's QIP:
"The largest changes affect Florala Memorial Hospital in Florala, Ala., which will see its penalty increase from 0.62 percent to 0.73 percent of its reimbursements, and Western Pennsylvania Hospital in Pittsburgh, which will see its penalty drop from 0.51 percent to 0.4 percent."

But back to the $700 billion in Medicare savings captured by Obama care. Those cuts have take effect - Medicare Advantage enrollment is up, the reason being the savings were achieved by slowing the growth in payments not by anything you or I would see as a cut. In addition the Affordable Care Act used these savings in part to close the Part D donut hole and extend the solvency of the trust fund by 8 years, from 2016 to 2024.

As far as the 30% of doctors who report wishing to limit their practice to private pay patients (in Florida no less) that is their choice - don't let the door hit you on the way out.


EDITED TO ADD:
And really? Patient noncompliance is why there are avoidable readmissions?

[jbeany]

Karen, I understand what you are saying.  You have a kidney transplant that was injured by a procedure that was supposed to help you... not harm you.  You work full-time and have no help.  Why do some people have Social Security Disability?  Well, I have it because when I had my transplant I could travel and when I went back on dialysis I couldn't really drop everything and go 5 counties down for a week.  I suppose if I were rich and famous they would have helped me but I'm not and dialysis centers need 3 to 4 weeks advance notice for visitors.   I just couldn't do my job anymore and USDA deserved a better employee.   

You may want to look at disability one day.  But, as long as you can work and your employer is good to you then stay working

Oh no worries there, I like my job and want to keep it for as long as possible! But, on this website Transplant Friends, there's all these people who are on disability, which is fine, but why are people who are years post-kidney tx who exercise (lift weights, etc) on disability? That I don't get. There's this one guy who does the chat room all the time, and he cooks and does all sorts of things, but he says he can't work, so is on disability. I don't get it. Here I've been through what I've been through, and I still work, and won't let it get me down. I also remember talking to an older man on that site who had a single lung transplant. He told me "you can go on disability, you know". I replied that I didn't want to do that, short-term while I was recovering was fine for me. It's just weird that all these successful transplant recipients are on disability, even when they are able-bodied.


KarenInWA

There are those of us who consider disability payments and state assistance like food stamps a helping hand until we can get back to work (or a saving grace if we never really can) - and there are plenty who see it as a way to keep from having to work.  I used to have a neighbor who was on SS disability as well as getting payments from his former auto-worker job because of a "debilitating back injury that kept him from working anymore."  I always wondered about that as he was chopping, splitting, and stacking his yearly supply of firewood to heat his house...

Personally, I want off.  I'm signing up for Ticket to Work to make sure I have insurance coverage just in case something happens right away or I can't physically cope with 40 hours a week of work, but I'm looking for full-time work.  At least if I can't - I'll have tried my best!  Enough of this paycheck to paycheck crap - I want a savings account again, and a regular schedule, and something productive that keeps my mind from stagnating, as well as real money, not piddly, just-getting-by checks from SSD.

[Bill Peckham]

Karen, I understand what you are saying.  You have a kidney transplant that was injured by a procedure that was supposed to help you... not harm you.  You work full-time and have no help.  Why do some people have Social Security Disability?  Well, I have it because when I had my transplant I could travel and when I went back on dialysis I couldn't really drop everything and go 5 counties down for a week.  I suppose if I were rich and famous they would have helped me but I'm not and dialysis centers need 3 to 4 weeks advance notice for visitors.   I just couldn't do my job anymore and USDA deserved a better employee.   

You may want to look at disability one day.  But, as long as you can work and your employer is good to you then stay working

Oh no worries there, I like my job and want to keep it for as long as possible! But, on this website Transplant Friends, there's all these people who are on disability, which is fine, but why are people who are years post-kidney tx who exercise (lift weights, etc) on disability? That I don't get. There's this one guy who does the chat room all the time, and he cooks and does all sorts of things, but he says he can't work, so is on disability. I don't get it. Here I've been through what I've been through, and I still work, and won't let it get me down. I also remember talking to an older man on that site who had a single lung transplant. He told me "you can go on disability, you know". I replied that I didn't want to do that, short-term while I was recovering was fine for me. It's just weird that all these successful transplant recipients are on disability, even when they are able-bodied.


KarenInWA

There are those of us who consider disability payments and state assistance like food stamps a helping hand until we can get back to work (or a saving grace if we never really can) - and there are plenty who see it as a way to keep from having to work.  I used to have a neighbor who was on SS disability as well as getting payments from his former auto-worker job because of a "debilitating back injury that kept him from working anymore."  I always wondered about that as he was chopping, splitting, and stacking his yearly supply of firewood to heat his house...

Personally, I want off.  I'm signing up for Ticket to Work to make sure I have insurance coverage just in case something happens right away or I can't physically cope with 40 hours a week of work, but I'm looking for full-time work.  At least if I can't - I'll have tried my best!  Enough of this paycheck to paycheck crap - I want a savings account again, and a regular schedule, and something productive that keeps my mind from stagnating, as well as real money, not piddly, just-getting-by checks from SSD.

I think there are many people who are on disability because it is the only way they can maintain their health insurance coverage. In 2014 this will change due to Obama care.  Obama care will allow those on the Transplant Friends board to test the employment waters without worrying they'll loose access to health insurance. Beyond those using disability Obama care will provide people with a preexisting condition the freedom to be an entrepreneur, to pursue their goals and dreams without the constraint of access to health insurance.

[Hemodoc]

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan .... etc

Very possible, but medical misstakes, and readmissions within 30 are at a high. One of the many reasons could very well be the fact, that 'hospitals' get paid for making misstakes. And it might contribute to keeping patients in their care before they are released without being actually checked?

take care Cas

Not really the issue at all. Prevention of readmissions in many patients is pretty much impossible. The hospital can do everything correctly, correct follow up but if the patient can't afford his meds, doesn't take his meds or is noncompliant with treatment regimens, they will end up back in the hospital.

For instance, congestive heart failure patients are perhaps the highest at risk of readmission within 30 days. Kaiser where I worked had a very aggressive program following all patients with case managers and cardiologists. In addition, they could obtain intravenous lasix in the infusion clinic if they got out of control. Even with the coordinated program with the hospital, clinic, case manager and cardiologist, it was impossible to eliminate all readmissions within 30 days. Kaiser did dramatically lower that rate, but that rate was not zero. Even in such an atmosphere, the new Medicare rules would penalize Kaiser's aggressive CHF management program. That is absurd.

Yes indeed, Peter, why continue to try to scare people with misinformation when there isn't an upside for you (your candidate doing well)? It is hard for me to see a reasonable motivation.

The readmission penalty has less of a bite the ESRD's QIP:
"The largest changes affect Florala Memorial Hospital in Florala, Ala., which will see its penalty increase from 0.62 percent to 0.73 percent of its reimbursements, and Western Pennsylvania Hospital in Pittsburgh, which will see its penalty drop from 0.51 percent to 0.4 percent."

But back to the $700 billion in Medicare savings captured by Obama care. Those cuts have take effect - Medicare Advantage enrollment is up, the reason being the savings were achieved by slowing the growth in payments not by anything you or I would see as a cut. In addition the Affordable Care Act used these savings in part to close the Part D donut hole and extend the solvency of the trust fund by 8 years, from 2016 to 2024.

As far as the 30% of doctors who report wishing to limit their practice to private pay patients (in Florida no less) that is their choice - don't let the door hit you on the way out.


EDITED TO ADD:
And really? Patient noncompliance is why there are avoidable readmissions?

Patient noncompliance in the CHF population is absolutely a big part of the picture just as it is in phosphorus control in the ESRD population on dialysis. Fortunately, Kaiser's program was able to reduce that dramatically as well. However, even Kaiser's well functioning plan for CHF management could not exceed Obama's requirements and they likely will be penalized as well. That is absurd to place a program in the negative for actually doing a wonderful job of keeping people out of the hospital in the first place. This is most especially true as the patient approaches end stage heart function that often proceeds into renal failure as well from the aggressive diuresis.

The patients in between renal failure and congestive heart failure are VERY difficult to manage. The nephrologist wants the patient as "wet" as possible to perfuse the kidneys and the cardiologist wants the patient as dry as possible to keep the lungs clean. It is a dramatic battle waged with no good answer at that stage. Patients in this situation get into deep trouble just for eating one pickle which many times they just can't avoid the temptation. So, no ones fault, no errors, no medical mistakes, just a sick patient facing poor choices. That unfortunately is a patient who does not have a preventable readmission pathway. From the time that they enter that situation until they are controlled with often 4 days a week dialysis, they will do terrible with multiple ER visits and hospitalizations. This is even more pronounced now that nephrologists wish to avoid early dialysis initiation.

Secondly, I guess you are not including the slush fund Obama used to prop up Medicare Advantage until after the election. Let's see what the numbers are a year from now on Medicare Advantage.

http://www.nypost.com/p/news/opinion/opedcolumnists/an_billion_trick_ImTBFfz7MeuZLJY7JzXEIJ

[Bill Peckham]

Why have this discussion a week after the election? Obamacare steals more and more from Medicare. More cuts are coming soon such as punishing hospitals for readmissions within 30 days. Under this plan .... etc

Very possible, but medical misstakes, and readmissions within 30 are at a high. One of the many reasons could very well be the fact, that 'hospitals' get paid for making misstakes. And it might contribute to keeping patients in their care before they are released without being actually checked?

take care Cas

Not really the issue at all. Prevention of readmissions in many patients is pretty much impossible. The hospital can do everything correctly, correct follow up but if the patient can't afford his meds, doesn't take his meds or is noncompliant with treatment regimens, they will end up back in the hospital.

For instance, congestive heart failure patients are perhaps the highest at risk of readmission within 30 days. Kaiser where I worked had a very aggressive program following all patients with case managers and cardiologists. In addition, they could obtain intravenous lasix in the infusion clinic if they got out of control. Even with the coordinated program with the hospital, clinic, case manager and cardiologist, it was impossible to eliminate all readmissions within 30 days. Kaiser did dramatically lower that rate, but that rate was not zero. Even in such an atmosphere, the new Medicare rules would penalize Kaiser's aggressive CHF management program. That is absurd.

Yes indeed, Peter, why continue to try to scare people with misinformation when there isn't an upside for you (your candidate doing well)? It is hard for me to see a reasonable motivation.

The readmission penalty has less of a bite the ESRD's QIP:
"The largest changes affect Florala Memorial Hospital in Florala, Ala., which will see its penalty increase from 0.62 percent to 0.73 percent of its reimbursements, and Western Pennsylvania Hospital in Pittsburgh, which will see its penalty drop from 0.51 percent to 0.4 percent."

But back to the $700 billion in Medicare savings captured by Obama care. Those cuts have take effect - Medicare Advantage enrollment is up, the reason being the savings were achieved by slowing the growth in payments not by anything you or I would see as a cut. In addition the Affordable Care Act used these savings in part to close the Part D donut hole and extend the solvency of the trust fund by 8 years, from 2016 to 2024.

As far as the 30% of doctors who report wishing to limit their practice to private pay patients (in Florida no less) that is their choice - don't let the door hit you on the way out.


EDITED TO ADD:
And really? Patient noncompliance is why there are avoidable readmissions?

Patient noncompliance in the CHF population is absolutely a big part of the picture just as it is in phosphorus control in the ESRD population on dialysis. Fortunately, Kaiser's program was able to reduce that dramatically as well. However, even Kaiser's well functioning plan for CHF management could not exceed Obama's requirements and they likely will be penalized as well. That is absurd to place a program in the negative for actually doing a wonderful job of keeping people out of the hospital in the first place. This is most especially true as the patient approaches end stage heart function that often proceeds into renal failure as well from the aggressive diuresis.

The patients in between renal failure and congestive heart failure are VERY difficult to manage. The nephrologist wants the patient as "wet" as possible to perfuse the kidneys and the cardiologist wants the patient as dry as possible to keep the lungs clean. It is a dramatic battle waged with no good answer at that stage. Patients in this situation get into deep trouble just for eating one pickle which many times they just can't avoid the temptation. So, no ones fault, no errors, no medical mistakes, just a sick patient facing poor choices. That unfortunately is a patient who does not have a preventable readmission pathway. From the time that they enter that situation until they are controlled with often 4 days a week dialysis, they will do terrible with multiple ER visits and hospitalizations. This is even more pronounced now that nephrologists wish to avoid early dialysis initiation.

Secondly, I guess you are not including the slush fund Obama used to prop up Medicare Advantage until after the election. Let's see what the numbers are a year from now on Medicare Advantage.

http://www.nypost.com/p/news/opinion/opedcolumnists/an_billion_trick_ImTBFfz7MeuZLJY7JzXEIJ

Just as with the QIP the readmission benchmarks are based on historic outcomes, they don't imagine 0 readmissions, the goal is to decrease avoidable readmissions. Readmissions due to surgical errors should not result in hospital profits. Readmissions due to early discharge should not result in hospital profits.

Even with the "slush fund" payments to Medicare Advantage were cut and enrollment increased and premiums decreased. If everything HHS did was the result of a political calculus and deft maneuvering, that would be something because it would mean that if someone benevolent was put in charge they could effect positive change but as someone who has watched the rule making process I can state with confidence that there is not an omnipotent hand guiding policy.

[Grumpy-1]

The way it was explained to me is - I'm on medicare until 3 years after the transplant (for me don't know when that will be) then IF I'm under 65, Medicare will stop UNTIL I reach age 65.  Then I can reapply.  Reasoning is that they figure after 3 years you should be well enough to go back to work.  Guess it doesn't count that the meds don't stop after 3 years.   Now if there is another reason that you are listed as disabled, then medicare will continue.   Grumpy

[Rerun]

True about medicare but if you happen to also be on Social Security Disability and get a transplant you have 12 months to find a job because they kick you off after 12 months.  Unless if you are having major problems I woudl hope they would show some grace

[jbeany]

No, they don't automatically kick you off disability at 12 months - but they do review it.  I'm past my 3 years and still getting coverage because of massive complications.  I've been through a review already.