A. How Patients Can Manage Risk
The heavy penalties which Medicare puts on hospitals for readmitting patients, mean that doctors and hospitals may advise patients not to get treatment, if there is much chance of readmission, even when the treatment would help the patient.
So patients need to worry that advice from doctors, hospitals, or Accountable Care Organizations (ACOs) can be biased away from treatment.
Patients who want treatment can avoid being a subject of hospital penalties and hospital risk by:
Regardless of exemptions, it is possible doctors who primarily see ordinary Medicare patients will have a habit of minimal treatment, even for managed care and private insurance patients exempt from the penalties.
Patients can get a professional advocate, often a senior nurse, to advise them about recommended and alternate treatments. Some will come to the hospital to listen to doctors and advise. Others can interact with patients and doctors on Skype or Google video chat. Cost can be $60-$200 per hour, cheaper than poor health care. As long as doctors and hospitals have hidden incentives to avoid care, patients need expert advocates. (The parallel is with courts, where most people would get a lawyer, in spite of the cost.)
Free telephone help will not be as effective, but it is free for the very ill from Patient Advocate Foundation on skin, breast, cervix, ovaries, prostate, and colorectal cancer, narcolepsy, heart valves, Aetna claim problems, and dealing with other insurers.
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