Ping Pong

Want to play Ping Pong? Apparently the House and Senate do. The Dems have figured out that they do NOT want a conference committee to reconcile the different version of the House & Senate healthcare reform bill.  To have a conference committee means that they might have to have Reps on the committee.  No way. So instead the House apparently intends to bring the Senate bill to the floor and then offer amendments to the Senate bill.  We should assume that any amendment offered by Dems has been pre-blessed by the Senate.  Once the House has amended the Senate bill the bill is sent back to the Senate for passage. It pings from the Senate to the House and pongs back to the Senate. If the Dems plan everything right, the Senate will then pass the House bill without amendment and it can then be sent on to the President for his signature. The President is meeting with Dem House & Senate leaders today to broker a final deal.  The possibility that this breaks down is small.  The deal will be done shortly.

Senate Passes Healthcare Bill

The Senate passed its version of the healthcare reform bill by a purely partisan vote — 60 to 39. The next step is critical in the bill’s progress.  Now that the House and Senate have passed different bills either the bills will go to a Committee made up of representatives of both the House & Senate, or the House will take up the Senate bill. Ultimately the House & Senate must have the same bill in order for it to go to the President.  There is little doubt that compromises will be found — i.e. representatives and senators paid off — to get this bill passed in some form.  We have already seen the pay off in Nebraska and Louisiana and surely more is coming. Healthcare in the U.S. will be changed forever — not a good thing.  Once the bill is passed, then it will be up to CMS and other government officials to implement.  If the implementation of the Balanced Budget Act of 1997 is any indication, the implementation of the bill will be far more important than the bill itself.  Providers of healthcare services will need to be extra cautious.

Regional Differences in Medicare Utilization

MEDPAC has come out with a new study of the variations in the level of care by area.  Not surprisingly, some areas in the US have much higher levels of care than others.  “Levels of care” are defined as the cost of providing healthcare to a Medicare patient, adjusted for geographical differences of labor costs, acuity of certain diseases and other factors that MEDPAC thought needed to be excluded or adjusted to compare “Levels of care” on an apples-to-apples basis. I think we can assume that areas that are HIGH cost are vulnerable to future reimbursement cuts and greater fraud enforcement risk. Those areas of HIGH cost? South Florida (surprise) including Ft Lauderdale, Miami & Pompano beach (highest by far) – Tenet, HCA & HMA Many Texas markets –Tenet, HCA & Universal Health Chicago – Vanguard Southern Lousiana (another surprise – #2nd highest) including all areas where LHC Group & Amedisys hang out – Tenet & HCA State of Mississippi (HMA is big here) Las Vegas  – HCA & Universal Health Tulsa & Oklahoma City – Pittsburg My identifying hospital companies in these market’s isn’t all inclusive.  LifePoint & Community also have hospitals in many of these markets, as does …

Compare the Bills

The Senate has now passed a resolution allowing debate on the healthcare reform bill.  It is likely that the debate will last several weeks. The New York Times has produced a useful comparison of the House & Senate versions of the bill.  I’ve taken the comparison, put it into Excel and then created a PDF, which is attached.  The document is ready for printing. Compare House & Senate Bills

Reid to introduce Senate Bill

FINALLY.  It now appears that the Senate bill will be introduced to the Democratic caucus this evening and to the rest of us tomorrow after weeks (months) of delays.  This is the bill that was to be introduced and passed in August. I find that the reason for the most recent delay quite telling.  Under Senate rules, the Senate can not debate a bill without a vote.  To even start the healthcare debate, the Senate must get 60 votes and without 60 votes, the bill can’t be even introduced for a debate. Now if Senator Reid is having trouble getting 60 votes to begin a debate, how does he expect to get 60 votes to pass the bill? I think the answer is that he doesn’t expect to pass the bill with 60 votes. The only way I see this bill getting through the Senate is using the budget reconciliation process, which will require 50 votes (plus the Vice President).  However, the budget reconciliation process is not appropriate for all the provisions of the bill and it is the Senate Parliamentarian who will ultimately decide what can be included.  Under the budget reconciliation rules, the Senate can pass a bill …