Showing posts with label medicaid. Show all posts
Showing posts with label medicaid. Show all posts

Saturday, May 7, 2011

Florida Legislature Passes Medicaid Reform | Sunshine State News

Florida's Medicaid program will likely undergo fundamental and historic changes in the coming years, as the state Legislature passed a comprehensive reform package Friday, the last day of the legislative session.

 

The bill shifts Medicaid recipients from the government-centered program that provides health care to low-income families by paying providers for services, and into managed-care companies that are contractually obligated to provide services and meet cost-reduction goals.

 

The bill is largely based on a five-year-old pilot program in Broward County and four other North Florida counties, but the statewide move to managed-care companies is unprecedented among the other states.

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Saturday, April 23, 2011

Patients Are Not Consumers - NYTimes.com

Earlier this week, The Times reported on Congressional backlash against the Independent Payment Advisory Board, a key part of efforts to rein in health care costs. This backlash was predictable; it is also profoundly irresponsible, as I’ll explain in a minute.

But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to “make government health care programs more responsive to consumer choice.”

Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

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Friday, April 15, 2011

Centers for Medicare & Medicaid Services

CMS Programs & Information

CMS Programs & Information-->
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Friday, April 1, 2011

Cuts Leave Patients With Medicaid Cards, but No Specialist to See - NYTimes.com

Eight-year-old Draven Smith was expelled from school last year for disruptive behavior, and he is being expelled again this year. But his mother and his pediatrician cannot find a mental health specialist to treat him because he is on Medicaid, and the program, which provides health coverage for the poor, pays doctors so little that many refuse to take its patients.

Michael Stravato for The New York Times

Dr. Rachel Chatters, right, with Ana Smith, says she begs specialists to see Medicaid patients.

Michael Stravato for The New York Times

Ms. Smith said she has tried for more than a year to find a psychiatrist to treat her son Draven, 8, who is on Medicaid.

The problem is common here and across the country, especially as states, scrambling to balance their budgets, look for cuts in Medicaid, which is one of their biggest expenditures. And it presents the Obama administration with a major challenge, since the new federal health care law relies heavily on Medicaid to cover many people who now lack health insurance.

“Having a Medicaid card in no way assures access to care,” said Dr. James B. Aiken, an emergency physician in New Orleans.

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Thursday, March 17, 2011

Don't cut Medicaid, fund it better - CNN.com

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist.

(CNN) -- You can't turn on the news these days without hearing about our budget crisis. We've also been told, over and over, that it's a problem with spending -- we're doing too much of it.

There's truth in that. Even if taxes were to be raised, it's nearly impossible that we can begin to tackle the deficit without addressing the spending on Social Security, Medicare and Medicaid. Together, they total well over a trillion dollars in spending.

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Monday, March 14, 2011

Hospitals Could Save Millions By Eliminating Five Hospital-Acquired Conditions

An average 200-bed hospital could save approximately $2 million annually if it eliminates common but high-cost hospital-acquired conditions among inpatients, according to the Healthcare Management Council, Inc. (HMC), a Needham, MA-based company focusing on hospital and healthcare performance improvement.

The information was compiled using federal Agency for Healthcare Research and Quality (AHRQ) indicators and recent proprietary cost-benchmarking information, according to Shelley Burns, HMC's director of knowledge management. HMC has reviewed the performance of hundreds of facilities ranging in size from 75 beds to more than 800 beds.

"The cost of quality is what we call it, but bringing that number [together] for our folks to see lets us align the financial side of the house and the clinical side of the house so they can work together [on this issue]," Burns says

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Monday, February 28, 2011

Governors: Medicaid More A Budget Buster Than Ever : NPR

The federal government and the states have shared the cost of Medicaid, the health insurance program for some 60 million low-income Americans, since it was created in 1965.

They've shared something else almost that long — arguments about who should foot how much of the ever-escalating bill.

"Medicaid cost growth has been a problem for time immemorial," says Alan Weil, executive director of the National Academy for State Health Policy.

But this time, he says, things are different.

For one thing, "the program is bigger, so growth on a larger base is more real dollars that's harder to find."

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Saturday, February 26, 2011

Medicaid chief: Single payer may be better than ‘devil-may-be’ market

A senior Patrick administration health care official said Friday that a single payer system may work more effectively and efficiently than Massachusetts’s existing insurance market, a high-profile endorsement that raised eyebrows at a legislative hearing.

“I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,” said Terry Dougherty, director of MassHealth – the state-run Medicaid plan that insures nearly 1.3 million Massachusetts residents – when lawmakers asked for his “personal view” on a single payer system.

Dougherty’s comment, made during a budget hearing at the Boston Public Library, prompted his boss, Secretary of Health and Human Services JudyAnn Bigby, to interject: “That’s his personal opinion.”

Dougherty noted that MassHealth, by far the largest program in state government, spends just 1.5 percent of its $10-billion-a-year budget on administrative costs – compared to about 9.5 percent by the private market, according to studies by the state Division of Health Care Finance and Policy. That figure won plaudits from several lawmakers on the panel, including some who have supported implementing a statewide single payer system.

After his remarks, Dougherty told the News Service that he’s learned to appreciate “elements of single payer” during his 30 years in health care.

“It’s got to be better than this devil-may-be marketplace,” he said. “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth ... who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.”

A single payer system would replace the state’s patchwork of nonprofit and private insurers with a single, public insurer through which all health care dollars would flow to hospitals, doctors and other health care providers. Supporters say it would eliminate administrative waste and ensure that all residents receive adequate coverage.

But while supporters point to single payer models used by other countries and tout the idea as a cost saver, critics warn the system would result in government bureaucrats deciding what services to cover and how to pay for them, would reduce the quality of care and would disrupt relationships between doctors and patients.

Hundreds of thousands of Massachusetts residents have endorsed the approach. In fact voters in 14 House districts –including five that backed Scott Brown for U.S. Senate – voted overwhelmingly last year to support a non-binding ballot question that asked, “Shall the state representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”

A similar question passed in 10 other House districts in 2008.

Although last session 50 members of the Legislature supported a single payer model, the issue has lacked support from the upper echelons of the Legislature and the Patrick administration.

A single payer plan would scrap Massachusetts’s landmark health care system, which relies on the private insurance marketplace, and that backers have credited with helping insure about 98 percent of the population. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the state’s Connector Authority, an exchange that pairs consumers with private plans, or through MassHealth.

This session, only 32 members signed on to the single payer proposal, although the sponsors include several high-ranking lawmakers: Rep. Stephen Kulik, vice chair of the Ways and Means Committee; Rep. Martha Walz, assistant vice chair of the Ways and Means Committee; Reps. Ellen Story and Byron Rushing, members of Speaker Robert DeLeo’s upper leadership team; and eight House committee chairs. The bill’s lead sponsors are Rep. Jason Lewis (D-Winchester) and Sen. James Eldridge (D-Acton). Last session’s lead sponsor, Rep. Matthew Patrick (D-Falmouth) was ousted at the polls by Republican David Vieira.

Benjamin Day, executive director of Mass Care, a single payer advocacy group, noted that only six of the lawmakers in the 14 House districts whose voters endorsed single payer health care signed onto the bill. He asserted that many members of state government’s health care hierarchy support single payer health care but keep it to themselves.

“Everyone is making political considerations, tactical considerations,” he said.

Day said supporters of a single payer system are eyeing Vermont, which recently elected a Democratic governor who ran on a platform that included a single payer system.

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Tuesday, February 22, 2011

Obama administration asks states to cut costs without dropping Medicaid coverage

By Marilyn Werber Serafini
Kaiser Health News
Tuesday, February 22, 2011; 12:58 PM

The Obama administration is deploying squadrons of in-house experts to help budget-strapped states figure out how to save money on Medicaid, the health program for the poor that has been a source of rising tensions between state capitals and Washington.

In recent weeks, both Democratic and Republican governors have been pressing the administration to be flexible in enforcing a requirement in the new health-care law that bars states from tightening eligibility for the program between now and 2014, when an additional 16 million people will be eligible for the program. Some states want to tighten eligibility now to curb spending.

Health and Human Services Secretary Kathleen Sebelius has a difficult balancing act. The former governor of Kansas wants to improve relations with the governors, who are due Saturday in Washington for a big meeting. But she also wants to expand Medicaid, not shrink it.

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Thursday, February 3, 2011

CMS Initiative Will Link Incentives With Reduced Infections, Readmissions - California Healthline

CMS is planning a "major multi-year financial commitment" involving Medicare, Medicaid and private insurers that aims to curb hospital-acquired infections and readmissions, according to a confidential draft of a CMS document, Inside Health Reform reports.

The so-called National Patient Safety Initiative -- which is being developed by CMS' innovation center -- would link $70 billion in Medicare funds across 10 years to hospitals' ability to achieve new standardized performance metrics. Under the plan, 6% of hospitals' Medicare payments will be contingent on reporting errors and meeting safety measures, with the proportion of payments increasing to 9% by 2015.

By hiring state contractors, CMS will develop measures and monitor progress, and then use results to determine payments.
Medicaid and private insurance plans that chose to participate in initiative also will link a larger portion of payments to patient safety goals, affordability and patient-centered care.

The innovation center also will fund studies that aim to determine how to disseminate best practices data, and support states and health systems that develop networked learning projects, Inside Health Reform reports (Inside Health Reform, 1/26).

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Friday, January 7, 2011

More young people are winding up in nursing homes - Yahoo! News

Adam Martin doesn't fit in here. No one else in this nursing home wears Air Jordans. No one else has stacks of music videos by 2Pac and Jay-Z. No one else is just 26.

It's no longer unusual to find a nursing home resident who is decades younger than his neighbor: About one in seven people now living in such facilities in the U.S. is under 65. But the growing phenomenon presents a host of challenges for nursing homes, while patients like Martin face staggering isolation.

"It's just a depressing place to live," Martin says. "I'm stuck here. You don't have no privacy at all. People die around you all the time. It starts to really get depressing because all you're seeing is negative, negative, negative."

The number of under-65 nursing home residents has risen about 22 percent in the past eight years to about 203,000, according to an analysis of statistics from the Centers for Medicare and Medicaid Services. That number has climbed as mental health facilities close and medical advances keep people alive after they've suffered traumatic injuries. Still, the overall percentage of nursing home residents 30 and younger is less than 1 percent.

Martin was left a quadriplegic when he was accidentally shot in the neck last year by his stepbrother. He spent weeks hospitalized before being released to a different nursing home and eventually ended up in his current residence, the Sarasota Health and Rehabilitation Center. There are other residents who are well short of retirement age, but he is the youngest.

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Sunday, December 26, 2010

Guides help recovering patients find long-term care | The Salt Lake Tribune

An uncomfortable truth for anyone facing disability for a year or more: If you go into a nursing home, you might never get out.

Under patchwork Medicare provisions, says Utah Commission on Aging Director Maureen Henry, it is more convenient for hospitals to discharge patients to nursing homes than to figure out how they might live in their homes and communities.

But what looks like the easy solution can be costly. Nursing home bills may drive more people onto Medicaid, which costs taxpayers more, and the move can unnecessarily disrupt the community and impoverish the lives of patients, Henry says.

“You’re shifting residence; you’re shifting family structure out of the community and into the nursing facility,” she says.

Now, with the help of a $700,000 grant from the federal Administration on Aging, the Utah commission is linking hospital discharge staff with “options planners,” who help guide patients and their families through a complicated array of choices for extended care.

The way Medicare and Medicaid law works, people are guaranteed care in nursing homes. But there is no similar guarantee of coverage for care outside an institution, meaning family finances may limit the choices.

“People have the right to decide where and when they receive long-term care,” Henry says. “Our objective is to try to catch people before they are scrambling in a crisis, stop giving people the runaround.”

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Thursday, December 2, 2010

Arizona Cuts Financing for Transplant Patients

Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.

“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”

Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.

Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.

He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list.

“I know times are tight and cuts are needed, but you can’t cut human lives,” said Mr. Felix’s wife, Flor. “You just can’t do that.”

Such high drama is unfolding regularly here as more and more of the roughly 100 people affected by the cuts are becoming known: the father of six who died before receiving a bone marrow transplant, the plumber in need of a new heart and the high school basketball coach who struggles to breathe during games at high altitudes as she awaits a lung transplant.

“I appreciate the need for budget restraints,” said Dr. Andrew M. Yeager, a University of Arizona professor who is director of the Blood and Marrow Transplantation Program at the Arizona Cancer Center. “But when one looks at a potentially lifesaving treatment, admittedly expensive, and we have data to support efficacy, cuts like this are shortsighted and sad.”

State Medicare officials said they recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.

“As an agency, we understand there have been difficult cuts and there will have to be more difficult cuts looking forward,” said Jennifer Carusetta, chief legislative liaison at the state Medicare agency.

The issue has led to a fierce political battle, with Democrats condemning the reductions as “Brewercare,” after Gov. Jan Brewer.

“We made it very clear at the time of the vote that this was a death sentence,” said State Senator Leah Landrum Taylor, a Democrat. “This is not a luxury item. We’re not talking about cosmetic surgery.”

The Republican governor has in turn blamed “Obamacare,” meaning the federal health care overhaul, for the transplant cuts even though the Arizona vote came in March, before President Obama signed that bill into law.

But a top Republican, State Representative John Kavanagh, has already pledged to reconsider at least some of the state’s cuts for transplants when the Legislature reconvenes in January. Mr. Kavanagh, chairman of the Appropriations Committee, said he does not believe lawmakers had the full picture of the effect of the cuts on patients when they voted.

“It’s difficult to be linked to a situation where people’s lives are jeopardized and turned upside down,” he said in an interview. “Thankfully no one has died as a result of this, and I believe we have time to rectify this.”

Across the country, states have restricted benefits to their Medicaid programs, according to a 50-state survey published in September by the Kaiser Commission on Medicaid and the Uninsured. But none have gone as far as Arizona in eliminating some transplants, which are considered optional services under federal law.

Before the Legislature acted, Arizona’s Medicaid agency had provided an analysis to lawmakers of the transplants that were cut, which many health experts now say was seriously flawed. For instance, the state said that 13 of 14 patients under the state’s health system who received bone marrow transplants from nonrelatives over a two-year period died within six months.

But outside specialists said the success rates were considerably higher, particularly for leukemia patients in their first remission.

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