Student Loan Forgiveness

[Southpaw]

As Biden administration leans toward $10,000 in student loan forgiveness, advocates push back

Advocates expressed anger and disappointment on Friday in response to news that the Biden administration is leaning toward $10,000 in student loan relief.

www.cnbc.com

I am curious as to where most of left of center and far-left of center SDN members feel about this topic. Many of you would not receive any forgiveness while residents and students may get $10K.

Of course, I am right of center and think this is a bad idea period. Even though I would benefit from this forgiveness I oppose it on principle.

On the surface I have to say it’s a bad idea. I buckled down and paid my loans off in the first few years post-residency. But, comparatively speaking, I have a much larger hammer than the extreme large majority of college grads with loans.

The reality is they’re in so much debt because of collusion between universities and the loan industry. As others have said it’s ridiculous that student loan rates were hovering around 7% when others were far far below it. I don’t think student loans should have interest. I don’t think there should be a student loan ‘industry’. And if universities can’t control their own cost then someone should control costs for them or better yet, students need to enter the trades and stop going to college. It’s not worth it for many.

At this point I’d much prefer a Bernie as President. We all tend to focus on tax benefits thrown to individuals. Do I think 10k matters to most? Probably not - but I know it matters to some. A helluva lot of rich people (some here included) made out like bandits from government handouts during COVID. I wish no one received any of it - no COVID handouts and no student loan handouts. Comparatively speaking though, I don’t think I can get worked up about this UNLESS we start putting the clamps down on other handouts.

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[CubsDynasty]

REPAYE during residency for let's say 5 years. Then you switch to PSFL for the last 5 years or you have to start over with PSFL and make payments for 10 years?

Not sure if I understand your question, but these are separate things. PSLF requires 10 years (120 payments) of Income Based Repayments. Within the IBR bucket there are various payment plan options with REPAYE being one. REPAYE for the entire 10 years for most people makes the most financial sense.

In order to stay within IBR, every year you have to "reapply". It's a 3 minute process where you confirm you want to stay in your current payment plan or change, and then your application links to the IRS system to pull your AGI from the previous tax return. Another big plus of the interest rate freeze was that they also extended when you had to certify your previous year's income, so people are getting by with their AGI from 1-3 years ago. In the case of folks who graduated residency/fellowship and have started attending salaries this can save them tens of thousands as well.

 

[OptionOffense]

At this point I’d much prefer a Bernie as President.

Socialist communist

 

[Beeftenderloin]

Socialist communist

If you consider the rest of the western world “socialist communist” then sure, whatever you say McCarthy… In most contemporary western democracies Bernie barely falls left of center.

 

[Beeftenderloin]

Socialist communist

If you drive on roads, went to public school, enjoy the benefits/protections the military, police, firefighters and EMS provide you too are a socialist communist, comrade.

 

[OptionOffense]

If you drive on roads, went to public school, enjoy the benefits/protections the military, police, firefighters and EMS provide you too are a socialist communist, comrade.

If you privatized roads they would be a whole lot better. Public schools in general SUCK compared to pvt schools. Government does NOTHING well. Look at the VA.

 

[nimbus]

If you privatized roads they would be a whole lot better. Public schools in general SUCK compared to pvt schools. Government does NOTHING well. Look at the VA.

Public schools are fantastic around here. My daughter has attended private school for K-8, then public HS and university. She much preferred public compared to private. So did I😉. When I needed surgery last year, I went to a national referral center run by the state of California. The government doesn’t do anything well?

 

[GravelRider]

If you privatized roads they would be a whole lot better. Public schools in general SUCK compared to pvt schools. Government does NOTHING well. Look at the VA.

Then you would have to pay an annual subscription to use the roads.

I don’t understand how people who think privatizing everything is not functionally the same thing as communism. Instead of government control, you have corporate control. Instead of taxes, you have fees. I look at my cable and internet service and I can assure you, I’m not impressed with the privatization model either. Privatized roads would end up being regional or national monopolies that have zero incentive to maintain happy customers and keep costs for road users low.

 

[VA Hopeful Dr]

Public schools are fantastic around here. My daughter has attended private school for K-8, then public HS and university. She much preferred public compared to private. So did I😉. When I needed surgery last year, I went to a national referral center run by the state of California. The government doesn’t do anything well?

Come on now. I'm a very big proponent of public schools but we all know that the quality of specific public schools has very little to do with the government part of it. Otherwise, all the government schools would be good. Same thing with hospitals, otherwise all the VA hospitals would be of excellent quality.

 

[Southpaw]

If you privatized roads they would be a whole lot better. Public schools in general SUCK compared to pvt schools. Government does NOTHING well. Look at the VA.

How would they be better? From what I see the government hands out contracts to private companies for a lot of work that is done (roads included) so I'm not sure the quality of the end product is always on the government. Should we pay Jeff Bezos, Elon Musk, and Bill Gates a monthly fee (which they determine and then determine annual fee hikes) to do everything for us so we can call this what it is and finally reach the endpoint of capitalism.

 

[OptionOffense]

Then you would have to pay an annual subscription to use the roads.

I don’t understand how people who think privatizing everything is not functionally the same thing as communism. Instead of government control, you have corporate control. Instead of taxes, you have fees. I look at my cable and internet service and I can assure you, I’m not impressed with the privatization model either. Privatized roads would end up being regional or national monopolies that have zero incentive to maintain happy customers and keep costs for road users low.

And the govt has incentive to keep you happy? If the govt ran internet, there would be hours long outages all the time, guaranteed.

 

[chessknt]

Come on now. I'm a very big proponent of public schools but we all know that the quality of specific public schools has very little to do with the government part of it. Otherwise, all the government schools would be good. Same thing with hospitals, otherwise all the VA hospitals would be of excellent quality.

Same can be said for private schools. It is delusional to think every private school is superior to every public school.

 

[voxveritatisetlucis]

Some of the best high schools in the country are public (Lexington, Stuyvesant, Bergen County Academies, Boston Latin, Princeton)

Of course even these schools are lower than Hotchkiss, Deerfield, Exeter, Andover, SPS, Choate etc from what I’ve seen in that these schools sent more on a per capita basis to the Ivy I attended. However, it’s hard to parse sometimes because many of the students at these schools have parents with connections.

 

[VA Hopeful Dr]

Same can be said for private schools. It is delusional to think every private school is superior to every public school.

Completely agree. The biggest advantage private schools have are smaller class sizes, and parents who are much more dedicated to their children's education that is the average for public schools.

And this is coming from a guy with kids in private school.

 

[chessknt]

Completely agree. The biggest advantage private schools have are smaller class sizes, and parents who are much more dedicated to their children's education that is the average for public schools.

And this is coming from a guy with kids in private school.

I went to an average public school and did incredible as did all of my friends, but that would have probably happened most places I went. I think more attentive schools can confer an advantage to mediocre students although the benefits of college education in general are questionable these days outside of stem fields.

My kids will be going to public school because the only private schools near me are religious and expensive. If they struggle I will probably end up moving but we'll see. I don't think money can solve every problem and certainly can't turn a c student in to an ivy league acientist of the ability and motivation isn't there intrinsically.

 

[OptionOffense]

Some of the best high schools in the country are public (Lexington, Stuyvesant, Bergen County Academies, Boston Latin, Princeton)

Of course even these schools are lower than Hotchkiss, Deerfield, Exeter, Andover, SPS, Choate etc from what I’ve seen in that these schools sent more on a per capita basis to the Ivy I attended. However, it’s hard to parse sometimes because many of the students at these schools have parents with connections.

yes the public high schools in the 'burbs. Check out the public high schools in the major cities like Philly, Chicago, NYC, Baltimore. Poll the avg graduate and have him read a paragraph.. then ask him what did you read? It is an abomination.

 

[VA Hopeful Dr]

I went to an average public school and did incredible as did all of my friends, but that would have probably happened most places I went. I think more attentive schools can confer an advantage to mediocre students although the benefits of college education in general are questionable these days outside of stem fields.

My kids will be going to public school because the only private schools near me are religious and expensive. If they struggle I will probably end up moving but we'll see. I don't think money can solve every problem and certainly can't turn a c student in to an ivy league acientist of the ability and motivation isn't there intrinsically.

One of my professors in undergrad worked at Duke before he came to us. He left it because he was told to spend the absolute minimum amount of time teaching the undergraduates as he could because, to paraphrase, you could lock a bunch of Duke students in a closet for 4 years and they would probably come out knowing more than when they went in.

 

[GravelRider]

And the govt has incentive to keep you happy? If the govt ran internet, there would be hours long outages all the time, guaranteed.

I’m not saying they do. I am saying this dream of a privatized world is short-sighted and dumb.

 

[voxveritatisetlucis]

yes the public high schools in the 'burbs. Check out the public high schools in the major cities like Philly, Chicago, NYC, Baltimore. Poll the avg graduate and have him read a paragraph.. then ask him what did you read? It is an abomination.

Yes they defintely do tend to be in more expensive areas. For example, in Lexington the median income is around 200k and small cape houses go for 1.5 million

 

[ucladoc2b]

If you privatized roads they would be a whole lot better. Public schools in general SUCK compared to pvt schools. Government does NOTHING well. Look at the VA.

Interstate highways? Air traffic control? Military?

If you privatized everything, the organizations would want to take on monopoly status ala ABA. They would then jack up the price for a worse product. You see this pattern a lot.

At least with government, there is some accountability.

And the govt has incentive to keep you happy? If the govt ran internet, there would be hours long outages all the time, guaranteed.

Nothing like a bunch of pissed off voters with bad internet service voting you out of office…

 

[OptionOffense]

At least with government, there is some accountability.

You cannot be serious? The government is the least accountable organization. The waste,fraud and abuse is legendary. Que estas hablando WIllis? I have no idea how you came up with that!

VA accountability office says it’s improved, but whistleblowers aren’t so sure | Federal News Network

 

[chessknt]

You cannot be serious? The government is the least accountable organization. The waste,fraud and abuse is legendary. Que estas hablando WIllis? I have no idea how you came up with that!

VA accountability office says it’s improved, but whistleblowers aren’t so sure | Federal News Network

Have you seen the care people with no insurance get? The capitalist pillars of CCF and Mayo don't take care of those people. The VA actually does and it does an amazing job when you consider what the alternative would be for these destitute veterans with no insurance.

 

[OptionOffense]

Have you seen the care people with no insurance get? The capitalist pillars of CCF and Mayo don't take care of those people. The VA actually does and it does an amazing job when you consider what the alternative would be for these destitute veterans with no insurance.

If i gave you 280 billion to take care of 9 million vets you would do an amazing job too. And a few people will beg to differ with you with your "amazing" description. In other words, they are ****ing wasting your money

 

[nimbus]

$5.8 Billion in Loans Will Be Forgiven for Corinthian Colleges Students

 

[chessknt]

If i gave you 280 billion to take care of 9 million vets you would do an amazing job too. And a few people will beg to differ with you with your "amazing" description. In other words, they are ****ing wasting your money

How much should it cost to take care of them in your opinion? What is a good deal?

 

[OptionOffense]

How much should it cost to take care of them in your opinion? What is a good deal?

All I know is that medicares budget is 700 billion and they take care of 45 million really old people and prob includes everyone on disability too.

 

[chessknt]

All I know is that medicares budget is 700 billion and they take care of 45 million really old people and prob includes everyone on disability too.

Do they have to maintain a statewide hospital/clinic system and employ the people to run those hospitals? Do you think the average veteran has more or less problems than the average medicare recipient? You arent comparing apples to apples here, Medicare pays for services, VA health benefit is a health system that has to ALSO pay for health care. They already pay rock bottom wages and have price controls on drugs with negotiation to get great prices. Where is the waste? Should they shut down hospitals to save money? They are already doing that but how many can they shut down before they end up losing money having to pay for private medical care and simultaneously fail to fulfill their mission of providing care for veterans?

 

[Beeftenderloin]

If the govt ran internet, there would be hours long outages all the time, guaranteed.

Right, just like the power grid in Texas? Oh wait, that’s actually the only power grid in the country that isn’t owned/operated by the US government..

Not only is it less reliable (lol irony) and has more outages, they gauge the hell out of consumers when demand is high. When there was that snow storm a few months back and the private ERCOT grid went down, low income people were getting slammed with power bills costing $10,000+.

But for sure, government is the problem 😂.

 

[VA Hopeful Dr]

Do they have to maintain a statewide hospital/clinic system and employ the people to run those hospitals? Do you think the average veteran has more or less problems than the average medicare recipient? You arent comparing apples to apples here, Medicare pays for services, VA health benefit is a health system that has to ALSO pay for health care. They already pay rock bottom wages and have price controls on drugs with negotiation to get great prices. Where is the waste? Should they shut down hospitals to save money? They are already doing that but how many can they shut down before they end up losing money having to pay for private medical care and simultaneously fail to fulfill their mission of providing care for veterans?

Does the service connected disability come out of the VA's budget? No saying that's 100% waste... but I think we all know that a decent bit of it is. And my understanding is that they have a substantial staff at every VA to deal with that aspect of things. Again not saying its a complete waste but some of it is.

 

[GaseousClay]

Right, just like the power grid in Texas? Oh wait, that’s actually the only power grid in the country that isn’t owned/operated by the US government..

Not only is it less reliable (lol irony) and has more outages, they gauge the hell out of consumers when demand is high. When there was that snow storm a few months back and the private ERCOT grid went down, low income people were getting slammed with power bills costing $10,000+.

But for sure, government is the problem 😂.

You sure about your statement Texas is the only privately owned power grid? Maybe the only not regulated by the fed. I’m pretty sure most are privately owned but regulated by the govt.

Look no further than the formula shortage to determine that yes govt is horrible at running things. Biden said he didn’t know until April this would be an issue. They’re the ones who shut down the manufacturing plant (rightly so) and yet can’t predict a catastrophic shortage?

 

[OptionOffense]

https://www.hmpgloballearningnetwork.com/site/frmc/article/investigation-reveals-gross-mismanagement-blame-denver-va-facilitys-exorbitant-cost

 

[chessknt]

Does the service connected disability come out of the VA's budget? No saying that's 100% waste... but I think we all know that a decent bit of it is. And my understanding is that they have a substantial staff at every VA to deal with that aspect of things. Again not saying its a complete waste but some of it is.

Not sure. Again that is another reason why it can't be compared to medicare which is not responsible for grading and paying disability checks. Nobody openly audits private hospital waste which would be a borderline fair comparison except of course you have to account for the health administrative costs of delivering a simultaneous insurance benefit.

It just bothers me when people **** on the VA because it is obvious they have never worked in one and seen the care it delivers for the types of patients it has.

 

[nimbus]

Not sure. Again that is another reason why it can't be compared to medicare which is not responsible for grading and paying disability checks. Nobody openly audits private hospital waste which would be a borderline fair comparison except of course you have to account for the health administrative costs of delivering a simultaneous insurance benefit.

It just bothers me when people **** on the VA because it is obvious they have never worked in one and seen the care it delivers for the types of patients it has.

I rotated through our local VA for several months during residency. The low productivity was astonishing. 2 total hips was considered a full day. If the 2nd case couldn’t be started before noon, it was cancelled because it was likely to go past 3pm and there was no mechanism for overtime. The patients were sick but the hours were super cush.

But I agree all the administrative tasks the VA does need to be included.

 

[chessknt]

I rotated through our local VA for several months during residency. The low productivity was astonishing. 2 total hips was considered a full day. If the 2nd case couldn’t be started before noon, it was cancelled because it was likely to go past 3pm and there was no mechanism for overtime. The patients were sick but the hours were super cush.

But I agree all the administrative tasks the VA does need to be included.

Well when you pay Ortho surgery 200k/yr that is what you get...

 

[VA Hopeful Dr]

I rotated through our local VA for several months during residency. The low productivity was astonishing. 2 total hips was considered a full day. If the 2nd case couldn’t be started before noon, it was cancelled because it was likely to go past 3pm and there was no mechanism for overtime. The patients were sick but the hours were super cush.

But I agree all the administrative tasks the VA does need to be included.

Same, as a 3rd year student I never stayed past noon as that's when the ORs shut down.

 

[VA Hopeful Dr]

Not sure. Again that is another reason why it can't be compared to medicare which is not responsible for grading and paying disability checks. Nobody openly audits private hospital waste which would be a borderline fair comparison except of course you have to account for the health administrative costs of delivering a simultaneous insurance benefit.

It just bothers me when people **** on the VA because it is obvious they have never worked in one and seen the care it delivers for the types of patients it has.

Slightly tangential but Medicare is also the main driver of administrative bloat in hospitals these days.

 

[chessknt]

Slightly tangential but Medicare is also the main driver of administrative bloat in hospitals these days.

I think that is part of it but hard to blame as the primary driver. The confusing private payor requirements, JAHCO bull****, seemingly endless administrative people managing every random aspect of the hospital to comply with various rules are all independent of medicare. Our ICU has 3 nurse managers that didnt do **** during the pandemic when we were ratioed 5:1 except send encouraging emails. They didnt even venture out of their fancy glass windowed corner office in the ICU to help. I doubt these people were serving some crucial medicare role but the hospital paid them more than the RNs who were actually taking care of patients. I have no love for CMS and their asinine infliction of arbitrary rules but the hospitals do perfectly fine at wasting money on their own without them.

 

[VA Hopeful Dr]

I think that is part of it but hard to blame as the primary driver. The confusing private payor requirements, JAHCO bull****, seemingly endless administrative people managing every random aspect of the hospital to comply with various rules are all independent of medicare. Our ICU has 3 nurse managers that didnt do **** during the pandemic when we were ratioed 5:1 except send encouraging emails. They didnt even venture out of their fancy glass windowed corner office in the ICU to help. I doubt these people were serving some crucial medicare role but the hospital paid them more than the RNs who were actually taking care of patients. I have no love for CMS and their asinine infliction of arbitrary rules but the hospitals do perfectly fine at wasting money on their own without them.

JAHCO is because of CMS. We have an entire department of over 100 people (and we're not a huge hospital system) whose only job is making sure we stay compliant with everything CMS expects us to do.

The various rules you mention are majority CMS rules. The ones that aren't are an off-shoot of Medicare since that was the first payer to really get into quality measures.

I'm not absolving the insurance companies (why should I have to do a PA for a $5 medication the patient has been taking for 10 years?) or the hospitals (I have an MBA cousin who makes over twice what my physician wife and myself make overseeing surgery centers and while I like him I'm super angry about that massive disparity profiting off of physician work), but CMS is a much bigger problem on a regular basis for me than any private payor or hospital system.

 

[Beeftenderloin]

You sure about your statement Texas is the only privately owned power grid? Maybe the only not regulated by the fed. I’m pretty sure most are privately owned but regulated by the govt.

Look no further than the formula shortage to determine that yes govt is horrible at running things. Biden said he didn’t know until April this would be an issue. They’re the ones who shut down the manufacturing plant (rightly so) and yet can’t predict a catastrophic shortage?

On further investigation you appear to be correct. I guess it’s just Texas/ERCOT that sucks.

 

[maxxor]

This is the most accurate portrayal of the waste and admin situation. Most of the regulations in hospitals (i.e. admin bloat) is driven by Medicare and CMS requirements. No JCAHO certification = no CMS money = hospital goes out of business.

The same applies for EMRs. EPIC and others have to be approved by CMS to be used for billing. The complicated process for their security and HIPAA standards is mandated by CMS. This is the reason that smaller EMRs are not allowed to come and make things easier for us all and there's no integration across platforms at all. Lots more admin there with the IT support and added "training" and we all have to do for it.

Credentialing is another big thing. Every single hospital has a massive credentialing department, which comes directly from state and federal requirements to be allowed to bill for services. Is there any real reason why a hospital needs to recapitulate every requirement that was submitted for state licensure, just to credential a physician to work there? I know of one (main) reason: CMS/Medicare.

JCAHO isn’t required. My prior job covered a hospital that used DNV.

On their website it says they have 50+ other hospitals in my state. Maybe competition might be good?

Search Hospitals

From multi-hospital systems to community hospitals; from major teaching institutions to regional medical centers . . . hospitals across the US are choosing DNV Healthcare for a new approach to accreditation. One that focuses on quality, innovation and continual improvement.

www.dnvhealthcareportal.com

 

[OptionOffense]

It just bothers me when people **** on the VA because it is obvious they have never worked in one and seen the care it delivers for the types of patients it has.

People **** on the VA for good reason. THe VA merits it's reputation and then some. They are another corrupted fraudulent , federal bureacracy that keeps on getting bigger by the year and produce worse results.

 

[chessknt]

People **** on the VA for good reason. THe VA merits it's reputation and then some. They are another corrupted fraudulent , federal bureacracy that keeps on getting bigger by the year and produce worse results.

You sound like a crazed libertarian loon. I'm sure there is a place where anarchy and no taxes exists, feel free to relocate there.

 

[OptionOffense]

You sound like a crazed libertarian loon. I'm sure there is a place where anarchy and no taxes exists, feel free to relocate there.

You sound like a grow government at all costs lib t a r d

 

[chessknt]

JAHCO is because of CMS. We have an entire department of over 100 people (and we're not a huge hospital system) whose only job is making sure we stay compliant with everything CMS expects us to do.

The various rules you mention are majority CMS rules. The ones that aren't are an off-shoot of Medicare since that was the first payer to really get into quality measures.

I'm not absolving the insurance companies (why should I have to do a PA for a $5 medication the patient has been taking for 10 years?) or the hospitals (I have an MBA cousin who makes over twice what my physician wife and myself make overseeing surgery centers and while I like him I'm super angry about that massive disparity profiting off of physician work), but CMS is a much bigger problem on a regular basis for me than any private payor or hospital system.

Oh I don't disagree that they are responsible for a lot of problems in US healthcare but they are a product of our dysfunctional political system and expansive nonsensical healthcare laws. The sad thing is we could fix a lot of the costs and redirect people performing pointless invented tasks in to more productive efforts if there was any political will to do so but it isn't sexy and headline grabbing so it never happens. The proverbial waste that gets bantered around is hard to actually identify because it is dressed up as pretend quality metrics that everyone agrees we need but nobody can actually figure out what they are and (crucially) how they should be implemented. Directing resources to figure that out would be an excellent use of the legions of office drones doing pointless paper pushing but instead CMS farms that out to medical societies that are run by academics who infrequently operate in the real world and have strong political motivations to court favor with CMS.

As an example in critical care CMS was upset by the number of CLABSIs and instituted punitive measures for when they occurred. This was actually a good move because it spurred a rigid adoption of sterile technique and drove CLABSI rates way down so they actually achieved quality with this metric. But then stupid JAHCO pushed it further and now we have to have industry-sponsored special expensive dressings change every X days and a damn checklist with a idiotic sign hanging outside the door saying STERILE PROCEDURE, a silly sealable box to transport reusable equipment across the hallway to be processed for sterilization etc etc none of which accomplishes anything but adds bloat and extra metrics to be checked. It is so big now though I dont think anyone knows hot to fix it 🙁

 

[kidthor]

Oh I don't disagree that they are responsible for a lot of problems in US healthcare but they are a product of our dysfunctional political system and expansive nonsensical healthcare laws. The sad thing is we could fix a lot of the costs and redirect people performing pointless invented tasks in to more productive efforts if there was any political will to do so but it isn't sexy and headline grabbing so it never happens. The proverbial waste that gets bantered around is hard to actually identify because it is dressed up as pretend quality metrics that everyone agrees we need but nobody can actually figure out what they are and (crucially) how they should be implemented. Directing resources to figure that out would be an excellent use of the legions of office drones doing pointless paper pushing but instead CMS farms that out to medical societies that are run by academics who infrequently operate in the real world and have strong political motivations to court favor with CMS.

As an example in critical care CMS was upset by the number of CLABSIs and instituted punitive measures for when they occurred. This was actually a good move because it spurred a rigid adoption of sterile technique and drove CLABSI rates way down so they actually achieved quality with this metric. But then stupid JAHCO pushed it further and now we have to have industry-sponsored special expensive dressings change every X days and a damn checklist with a idiotic sign hanging outside the door saying STERILE PROCEDURE, a silly sealable box to transport reusable equipment across the hallway to be processed for sterilization etc etc none of which accomplishes anything but adds bloat and extra metrics to be checked. It is so big now though I dont think anyone knows hot to fix it 🙁

One of my hospitals has armies of uninformed clipboard-holding box-checkers that misinterpret CMS and JC "requirements" into completely bizarre and meaningless metrics. It's too much work to counter and combat the crazy new things they come up with, so everyone has become complacent and will just appease them.

A couple times I took a deep dive into figuring out where they're getting some of the odd metrics and it usually comes from a series of misinterpretations that then become a hospital policy that then can't be easily fixed. Often the metrics actually induce harmful behavior contrary to what the source material intends.

This is the new normal sadly. I think it's by design.

Lisa Rosenbaum has three articles in NEJM over the past couple months on this topic. To quote her "Decades into the quality improvement movement in U.S. health care, the fix for the system has become a massive, cumbersome, time-consuming, demoralizing system in its own right — and we don’t even know whether it is improving care."

 

[rakotomazoto]

One of my hospitals has armies of uninformed clipboard-holding box-checkers that misinterpret CMS and JC "requirements" into completely bizarre and meaningless metrics. It's too much work to counter and combat the crazy new things they come up with, so everyone has become complacent and will just appease them.

A couple times I took a deep dive into figuring out where they're getting some of the odd metrics and it usually comes from a series of misinterpretations that then become a hospital policy that then can't be easily fixed. Often the metrics actually induce harmful behavior contrary to what the source material intends.

This is the new normal sadly. I think it's by design.

Lisa Rosenbaum has three articles in NEJM over the past couple months on this topic. To quote her "Decades into the quality improvement movement in U.S. health care, the fix for the system has become a massive, cumbersome, time-consuming, demoralizing system in its own right — and we don’t even know whether it is improving care."

Thanks for sharing the linked article. I hadn't seen it yet and it was a great read.

 

[VA Hopeful Dr]

Oh I don't disagree that they are responsible for a lot of problems in US healthcare but they are a product of our dysfunctional political system and expansive nonsensical healthcare laws. The sad thing is we could fix a lot of the costs and redirect people performing pointless invented tasks in to more productive efforts if there was any political will to do so but it isn't sexy and headline grabbing so it never happens. The proverbial waste that gets bantered around is hard to actually identify because it is dressed up as pretend quality metrics that everyone agrees we need but nobody can actually figure out what they are and (crucially) how they should be implemented. Directing resources to figure that out would be an excellent use of the legions of office drones doing pointless paper pushing but instead CMS farms that out to medical societies that are run by academics who infrequently operate in the real world and have strong political motivations to court favor with CMS.

As an example in critical care CMS was upset by the number of CLABSIs and instituted punitive measures for when they occurred. This was actually a good move because it spurred a rigid adoption of sterile technique and drove CLABSI rates way down so they actually achieved quality with this metric. But then stupid JAHCO pushed it further and now we have to have industry-sponsored special expensive dressings change every X days and a damn checklist with a idiotic sign hanging outside the door saying STERILE PROCEDURE, a silly sealable box to transport reusable equipment across the hallway to be processed for sterilization etc etc none of which accomplishes anything but adds bloat and extra metrics to be checked. It is so big now though I dont think anyone knows hot to fix it 🙁

Even when I was in residency (2010-2013) if we coded something as iatrogenic we'd get a delightful call from the coding people to ask if we were SURE it wasn't pre-existing. We had a team of nurses who did full body skin checks on admission to make sure we caught any skin problems so we wouldn't be blamed for decubitus ulcers.

 

[nimbus]

One of my hospitals has armies of uninformed clipboard-holding box-checkers that misinterpret CMS and JC "requirements" into completely bizarre and meaningless metrics. It's too much work to counter and combat the crazy new things they come up with, so everyone has become complacent and will just appease them.

A couple times I took a deep dive into figuring out where they're getting some of the odd metrics and it usually comes from a series of misinterpretations that then become a hospital policy that then can't be easily fixed. Often the metrics actually induce harmful behavior contrary to what the source material intends.

This is the new normal sadly. I think it's by design.

Lisa Rosenbaum has three articles in NEJM over the past couple months on this topic. To quote her "Decades into the quality improvement movement in U.S. health care, the fix for the system has become a massive, cumbersome, time-consuming, demoralizing system in its own right — and we don’t even know whether it is improving care."

Quality=checkbox on ePreop.

 

[TeslaCoil]

As Biden administration leans toward $10,000 in student loan forgiveness, advocates push back

Advocates expressed anger and disappointment on Friday in response to news that the Biden administration is leaning toward $10,000 in student loan relief.

www.cnbc.com

I am curious as to where most of left of center and far-left of center SDN members feel about this topic. Many of you would not receive any forgiveness while residents and students may get $10K.

Of course, I am right of center and think this is a bad idea period. Even though I would benefit from this forgiveness I oppose it on principle.

I agree despite having over 400k to pay back myself. I already refi’ed into a low interest private loan while the rates were ridiculously low. What I do think is that student loan lending practices need to be curbed. There is so much predatory lending to students. Its practically criminal. And schools just keep jacking up the tuition to take advantage of the loose practices. Its a vicious cycle that has gotten out of hand, and I think it is part of why many people are demanding forgiveness etc.

 

[kidthor]

What I do think is that student loan lending practices need to be curbed. There is so much predatory lending to students. Its practically criminal. And schools just keep jacking up the tuition to take advantage of the loose practices. Its a vicious cycle that has gotten out of hand, and I think it is part of why many people are demanding forgiveness etc.

Yep - and yet none of the politicians want to talk about this root cause! They'd rather give out free money and let the gravy train keep flowing eternally.