Normally rural hospitals are not like this one as it became a “rural “ hospital on a very rich affluent island, only 19 beds, which usually not the 
a case with hospitals outside the city areas. What this has done is hurt hospitals in other states and they are not happy and who wouldn’t be. It became a rural hospital when it was bought by Partners Healthcare, the group that always seems to be making money and charging more at many of their facilities so one may wonder was there any influence here with making the hospital a “rural” hospital? When the pay system changed the money went up.
What is also interesting is to hear Dr. Donald Berwick’s comments too on how any hospital would “game” it if it is there in front of you and he’s right.
“The entire way the payment system is now calculated has become so complex and so susceptible to gaming and manipulation that you’d play the game yourself if you were running a hospital, to make sure your reimbursements continue to go up,” said Dr. Donald Berwick, President Obama’s former administrator of the Centers for Medicare and Medicaid Services and a health policy lecturer at Harvard Medical School. “It’s a zero sum game. What Massachusetts gets comes from everybody else.”
These are “business models” and rules…more complex by the moment..and Texas, New York, Michigan, Florida, and Illinois are the biggest losers, tens of millions of dollars each year under the current system are lost under this rule. California hospitals benefitted in some areas too but it was because of one hospital as there are many here. Now on the other side with losing the money it’s enough to push some of the hospitals in the state over the edge to operate and in the red or be very close to it, so here we go again with one of my frequent topics here, “flawed data”. For a few years not too I have been called the doctor and hospital ratings sites very flawed come to think of it. Doing this blog I keep seeing being shifted one way and then the next all the time and smaller dollar amounts that people spend hours and and is it worth it?
Physician Rating Sites Are Seeing Fewer Reviews These Days–Flawed Data Catching Up Along With Loss of Value As Consumers and Doctors Lose Interest?
Back on topic here for Congress to get anywhere with this I’m going back to one of my old posts as you can see the math is bad and they need to model. We have the technology today to do a better job and I realize it will never be perfect but we can avoid many unintended circumstances for sure. IBM Watson would be grand for Congressional research but they couldn’t see it as we don’t have quite enough digital literacy there to recognize a tool but Citibank did and no doubt they will get more of our money with using it. It would really be a huge tool for both the House and Senate as all could use speech recognition to ask questions and everybody would start with the same number. It will be interesting to see where the changes are made here. BD
IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22
WASHINGTON — Nestled on an island 30 miles out to sea, Nantucket Cottage Hospital is the only rural hospital in Massachusetts, as defined by the federal government. Its weathered cedar shingles and widow’s walk evoke the bygone era of its founding a century ago, when the hospital consisted of just three tiny cottages.
But the 19-bed hospital on the tony island, where the number of residents balloons from 10,000 to 50,000 each summer and the median home price hovers north of $1 million, has become a national symbol of inequity and political machinations in the way the federal government reimburses hospitals for treating Medicare patients.
Under an arcane hospital payment system, 
Nantucket Cottage’s rural designation has allowed the state’s 81 other hospitals to collectively reap between a $256.6 million and $367 million annual bonus for the last two years — at the expense of other states. An Institute of Medicine report released in July referred politely to the bonanza as the “Nantucket effect.”
http://bostonglobe.com/news/nation/2013/01/13/states-planning-legislative-fight-for-massachusetts-medicare-windfall/HV4WGdUCSOISoTxIcbwSUL/story.html
funny and so true. After hearing his numbers Piers has invited Dr. Oz to come back in 6 weeks after asking Dr. Oz how long it would take to make some progress, so looks like we will get a revisit…perhaps it’s all the stress from the recent talk on his stand on guns that’s running up his blood pressure and they mention that too. Well at least the late night shows are in two cities so not too far for Dr. Oz to make TV “host” calls. Just a couple days ago we had 
This is funny and you have ultrasound right up there on the big screen and Jimmy is healthy. 
his sonogram. He actually gained 4 pounds since Dr. Oz’s last visit, and his waist size is 43. He tells Guillermo to stop drinking. Then the purple gloves come out again for a prostate exam and out comes the KY jelly, ends up in his hair, and they go into a conversation about prostate cancer. If you watched the show the next 2 guests, players from the Clippers came right out and said I don’t want any part of those purple gloves:) BD 
what’s next a spoon, chopsticks that track food? If you are eating too fast the fork vibrates and you know a fork is not the first thing I think of when I hear the word vibrate:) It’s coming out in February and will set you back about $100 dollars. You know I have a toothbrush that I love that vibrates and it serves a purpose and gets my teeth clean by I certainly don’t think I am that much of a moron that needs a device to tell me how eat as if I blow it, my own body will tell me in more ways than one. 
where we are today. Well it turns out he met with this company 
being factual too, depending on the case of either the research person cheating outright or some were given erroneous material from the start . On the actual cheating of course we all know money is at the root of it. So yes, how do we know what’s what? I guess we don’t really and sometimes some of the material we read depends on what’s being marketed too. It’s a gray, gray world out there today at times. 
way, those algos move money and there’s a lot of waster time in chasing small billing disputes today and that can go on forever. Last few days you have been hearing about the deficiencies on Wall Street with math errors, well healthcare has their big share too and to get everything perfect and aligned, well we will spend forever chasing all of this. There has to be a time when someone makes a determination of how time are you going to chase and get a big brownie point or are you going to look at a big over all picture. On the re-admission penalties it looks to me like we are “just swapping spit” back and forth and back and forth with a lot of it. 
for re-admissions to where they are looking for a “white knight algorithm” to fix all with a $3 million dollar carrot and this will go the same way as the 
intention. Do you wonder where some jobs have gone? Are companies all using this model now with the buzz words of incubator and accelerators when sponsored by big corporate conglomerates? It’s looking that way as of course it’s cheaper than hiring employees and they get something out of and most starting out have a very tiny bankroll. It is interesting to see more and more jump on this bandwagon and it does differ a bit from let’s say a start up in Israel quite a bit. I have met some of those folks at the Los Angeles Israel Conference and listened to them talk about how they work and function. Just earlier today we had this announcement with GE (who sometimes pays a little tax). 
that would help creative people and you do have to remember about 95 out of 100 might not make it but if they write something that won’t stand on it’s own, folks are there standing by to pay a nominal price for the code written and then they can go start all over again. I see the communications workers of America not too happy these days with Verizon with the status of their jobs and contracts so again what is all this? I read where they are working to get their mHealth platform approved by the FDA for their HIPAA complaint cloud service and who doesn’t have a cloud today and we do need a few to choose from that’s for sure. So again, models for cheap code? You tell me but it’s looking that way. BD 