Bipartisan politics and gridlock continue with certain Republicans subverting the party almost as well as the Hillary and Sanders lovers.  The destiny of America hinges on partisan policies not high school bullying politics.  Our new president is in deep do do if the John McCain’s and Chuck Schumer’s of the Senate get their way.  Sure it’s time for coopting anything, but the Democrats are winning when they have the so called moderate or conservative Republicans voting like a spoiled Democrat.  With jealousy not solutions.  If health care costs aren’t controlled and effective changes don’t happen then the tax bill, infrastructure funding, security enforcement and border safety die on arrival with Obama Care.

Solution #1:  amend Obama Care so the Blue bloods are pulled into the vote for a better plan.   Then put together an enterprise health care plan with cost accountability developed by the private sector not Harvard or Yale professors.  (This reminds me of my attending a meeting in Washington D.C. in 1975 as the consultant for the  American Health Care Association.  The meeting was chaired by the assistant surgeon general of the U.S. Faye Abdellaha, RN, Director of the Division of Long Term Care for the Department of Health and Human Services.  At that meeting were academics from eastern universities and me, as the nursing home industry’s expert on Medicare and Medicaid payment for services and its application at the provider level.  The topic of the meeting was “how to cost the care for accountability in relation to the exorbitant prices being charged by the providers”.  I was a little late to the topic because the American health Care Association was finally allowed to join the professors on how to structure a cost system to hold providers accountable for their prices.   To make a long story short, I was asked by Director Abdellaha to make comments on what the academics were proposing for such a system.  They were proposing using a regression analysis computer program to analyze provider billings to Medicare using algorithms to impute costs for episodes of care.   Then impose ceilings on billings based on these conclusions and assumptions.  Nothing worse than an academic, administratively simple solution without an ounce of common sense.  I then took the floor with my slides presenting the components of costs of care and how standard costing would be the only method reliable enough to be effective.  My presentation was the one selected by the Director who asked that I write it up in a white paper.  The paper was presented to her in 1977 and approved for demonstration projects at some 26 skilled nursing facilities then factored into the prospective payment system passed into law in 1989.  Unfortunately, it was watered down and ended up being the throw away when it came time to implementing prospective pay in nursing homes in 1999).  So, here we are in 2017, almost forty years later still needing the same solution for all providers not just long term care … hospitals are still paid average guesstimate rates for a diagnosis (DRG’s input codes), physicians for encounters (RVU’s input codes), nursing homes  for assessment of activities of daily living (RUG’s input codes), home care (nursing time factor codes) and hospice (nurse encounter codes).  Payment purely for services not cost effective outcomes.  Letting the providers search for the highest valued code and game this averaging system.  Standard costing is used by enterprise to track and control waste and total cost of production to improve profit margins and quality ourcomes.  Sounds like a good idea for health care … to which I have written nine books outlining and promoting such a system.  Kip, my son and I have programmed a prototype that we used in our consulting practice for twenty years to enable providers to control their cost and be able to bill Medicare based on the medical necessity, the cost of care and quality outcomes.  Using this system in our consulting practice enabled the providers to send 43,500 more patients home rather than letting them malinger in institutional care for the rest of their lives.

Solution #2:  Implement standard cost accounting in all health care providers (also called performance based payment for outcomes) using the Rhoads cost accounting and care management system.  Harken Mr. President to the Trump-et’s call “amend that unaccountable law” let it fall and replace it with an enterprise model  and Trump them all.  By Blogger Jerry Rhoads