Quote:
Originally Posted by tophcfa
Thanks Doc, there’s the bigger picture I’ve been trying to get folks to focus on. If that’s the case, what does that say about the future of health care in the fastest growing senior citizen community on the entire planet? People need to stop worrying about the past and contemplate the future availability of quality health care in the Villages! This unfortunate event most certainly doesn’t make the future look more positive.
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What tophcfa is highlighting is that
1) medicare is a very low reimbursement payment program. . most doctors and hospital systems can't survive with all the CMS requirements on just medicare reimbursements alone. That is why CMS has an additional reimbursement for improved outcomes, separate from individual encounter reimbursements. retirees have less opportunity for improved outcomes
2) most non retirement area hospitals have a mix of higher private pay insurance which is primarily employer sourced insurance, which pays a higher rate to offset the medicare rate to break even or not lose money.
3) So to stay financially solvent, taking only medicare isn't sustainable. . . upcoding with MA makes elderly patients financially viable. . . keep that in mind. .
So the problem with rapid growth of housing for long lived Medicare members, ie, the villages, can easily and quickly outstrip the hospital capacity without also planning and building simultaneously hospital capacity. This would fall on the developer, which he may or not make as a close secondary priority. .
So let's say the developer did keep up building hospital beds in the proper ratio, which health care system would lease out and operate out of the buildings if the primary reimbursement is medicare? and what's the probability that CMS will be able to pay for the reduced improved outcome potential? especially if one wants to reduce the federal deficit [b]without]/b] increasing taxes?. . . .
the whole US health care system is a financial conundrum/dilemma/enigma/paradox, which currently has no solution on the horizon. .
its a damn can being kicked down the road. .
best to stay healthy and realize that there are limits to everything, there are no unlimited sources of money