October 8, 2015 The State of Connecticut’s Department of Social Services, with its state evaluator UConn’s Center on Aging, successfully transitioned more than 2,200 older and disabled Connecticut residents from nursing homes and other institutions to their own home or a community setting between 2008 and 2014, as part of the federal “Money Follows the Person Rebalancing Demonstration.” The goal of this national effort is to reduce Medicaid’s growing expenditures by rebalancing long-term care services from expensive institutional healthcare settings…..

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The University of Pittsburgh study of 137 pages is a nice academic exercise about bureaucratic policy changes that will become CMS policy but it presents no feasibility study or implementation plan.  Just more dollars spent on another wasted academic study funded by Obama Care that the private sector is expected to implement … furthering the institutional models of the past … such as bundled payment capitated population managed care … what a joke when common sense Enterprise models for episodic management using standard cost accounting would save billions in waste…..

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Unfortunately it isn’t how much they pay but what the patients aren’t getting for the Medicare money and who is at fault. The RUG’s system is for payment of input minutes of treatment not outcome improvement in mobility, home skills, transfers, strength, discharge integration back to the community … so it is first of all the fault of a terrible reimbursement method developed by professors who work for the Government. The providers are expected to implement these academic averaging methods…..

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The last people that should be explaining end of life options are the physicians and providers who have the most to lose by accepting the decision of the patient.  My experience is I have never heard a physician nor a social worker properly explain what the decision entails.  It isn’t a death wish.  It isn’t a plan.  It isn’t a matter of cost.  It is a matter of accepting end of life as inevitable and it happens at different times…..

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According to the report, recovery auditors corrected more than $2.57 billion in improper payments for FY 2014 – representing 5% of the $46 billion in wasted taxpayer dollars the program lost in a comparable period to fraud, waste and abuse. Kristin Walter Blogger comment Just like the IRS you can’t prevent gaming the system if the system is flawed.  Paying for outcomes not income would go a long ways in eliminating Government interpretations that use ex post facto rules for enforcement penalties…..

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Currently all health care providers are paid on input criteria (diagnosis DRG’s for hospitals, encounters RVU’s for physicians, meditation scripts for pharmacy, RUG’s assessment for skilled nursing, OASIS days of care for home care and outpatient OPPS encounters or ER)  not output criteria. In other words they get paid on income data not outcome results.   They get paid without adding value and are not accountable for quality. This Income Model is called Prospective Payment System and is being converted to an Institutional Academic Model. …..

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