4 ms·

Are you saying medicare/medicaide are net-negative? Is so, what prevents hospitals from refusing to accept them? I suspect they don't because it's not financia

by bumby 3y ago

Are you saying medicare/medicaide are net-negative? Is so, what prevents hospitals from refusing to accept them? I suspect they don't because it's not financially solvent to do so, given the number of patients who use those services. That on it's face seems to bring into question the claim that they are net-negative (whether that's due to legislation or other means).

arcbyte 3y ago
Hospitals are required by EMTALA[1] to treat all emergencu patients to the point of stabilization. So it only makes sense to charge whatever insurance is available because there is no turning them away. Im not sure if there are regulations applicable to hospitals that prevent them from refusing to accept medicaid patients for elective procedures. Certaibly there are lots of surgery centers that do refuse medicaid. Also lots of doctors dont take medicaid/medicare. Its within their right to do so. [1]: https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_...
- bumby 3y ago
  You're right with regard to emergency treatment; so in the case of the withdrawal patient that holds. But hospitals are not required to accept any insurance, including medicare/aide (they are termed "non-participating"). So I don't think the premise holds in the knee-replacement scenario. So, to be generous, maybe there's a case that if a hospital gets a bulk of its revenue from the ER, it's a better business case to accept Medicare. But I don't believe that's the case for most hospitals, so it still leads me to question the premise that medicare is a net negative (or else we'd see a lot more 'non-participating' hospitals).
gniv 3y ago
At least on paper they are net-negative. If you look at a Schedule H of IRS Form 990 they report huge shortfalls from Medicare/Medicaid. This I think helps them claim "community benefit expense". Example Form 990 (search inside for Schedule H): https://my.clevelandclinic.org/-/scassets/files/org/about/financial-statements/form-990-ccf.ashx?la=en https://my.clevelandclinic.org/-/scassets/files/org/about/fi... See also page 8 of this pdf: https://www.aha.org/system/files/media/file/2023/10/Results-from-2020-Tax-Exempt-Hospitals-Schedule-H-Community-Benefit-Reports.pdf https://www.aha.org/system/files/media/file/2023/10/Results-...
- bumby 3y ago
  Thanks for sharing that. Do you happen to know how they calculate the "community benefit expense" that creates the shortfall? My understanding is that medical billing is inflated so they can anchor a high value to help in their negotiations with medical insurance. I'm wondering if this is the medicare adjusted value (i.e., what medicare says the procedures are worth) or the artificially inflated value?

by bumby 3y ago

arcbyte 3y ago

Hospitals are required by EMTALA[1] to treat all emergencu patients to the point of stabilization. So it only makes sense to charge whatever insurance is available because there is no turning them away. Im not sure if there are regulations applicable to hospitals that prevent them from refusing to accept medicaid patients for elective procedures. Certaibly there are lots of surgery centers that do refuse medicaid. Also lots of doctors dont take medicaid/medicare. Its within their right to do so. [1]: https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_...

bumby 3y ago
You're right with regard to emergency treatment; so in the case of the withdrawal patient that holds. But hospitals are not required to accept any insurance, including medicare/aide (they are termed "non-participating"). So I don't think the premise holds in the knee-replacement scenario. So, to be generous, maybe there's a case that if a hospital gets a bulk of its revenue from the ER, it's a better business case to accept Medicare. But I don't believe that's the case for most hospitals, so it still leads me to question the premise that medicare is a net negative (or else we'd see a lot more 'non-participating' hospitals).

gniv 3y ago

At least on paper they are net-negative. If you look at a Schedule H of IRS Form 990 they report huge shortfalls from Medicare/Medicaid. This I think helps them claim "community benefit expense". Example Form 990 (search inside for Schedule H): https://my.clevelandclinic.org/-/scassets/files/org/about/financial-statements/form-990-ccf.ashx?la=en https://my.clevelandclinic.org/-/scassets/files/org/about/fi... See also page 8 of this pdf: https://www.aha.org/system/files/media/file/2023/10/Results-from-2020-Tax-Exempt-Hospitals-Schedule-H-Community-Benefit-Reports.pdf https://www.aha.org/system/files/media/file/2023/10/Results-...

bumby 3y ago
Thanks for sharing that. Do you happen to know how they calculate the "community benefit expense" that creates the shortfall? My understanding is that medical billing is inflated so they can anchor a high value to help in their negotiations with medical insurance. I'm wondering if this is the medicare adjusted value (i.e., what medicare says the procedures are worth) or the artificially inflated value?