RSS Articles and Information
  • Third Party Free Medical Practice Case Studies March 28, 2015
    Dr. Kathy Brown, Jack Brown, and Dr. Keith Smith speak at the 69th Annual Meeting of AAPS, September 2013. http://www.oregonderm.com/ & http://surgerycenterok.com
  • A Tale of 2 Prices…or 3?‏ March 27, 2015
    by Ralph Weber About a year and a half ago, Perry Hunt needed a hip replacement. He had been in constant pain for years and owned a construction company, and could not afford to take the 6 months off that …
  • Tisha Casida interviews Ralph Weber: Free Market Solutions to Healthcare March 25, 2015
    Tisha Casida with Rebellion.life interviews CEO of MediBid, Ralph Weber, about his work educating the public and the government about common sense health care solutions. MediBid is an online marketplace with true transparency, listing not only prices, but qualities and …
  • Small Business Coverage Uncertain Future with Association Health Plans March 23, 2015
    For the last 20 years, small businesses in Washington state have relied heavily on associations and trusts to provide healthcare insurance for their workers at lower cost than in the open market. The system is popular and works well, a …
  • Outpatient Surgery Saves Patients Time and Money March 20, 2015
    The death of Joan Rivers after a routine procedure has some asking about the safety of outpatient surgical centers. First off, it is important to make sure to know if you are a good candidate for surgery and what to …
  • Study Finds Hormones Can Help Younger Women Through Menopause March 18, 2015
    Hormone replacement therapy used to only be given to women who had completed menopause, relieving hot flashes, sleeplessness, and other symptoms. In 2009, about 8 million women used HRT, most over the age of 60. A recent Cochrane review finds …
  • Retail Health Care Clinics Multiply with Increasing Demand March 16, 2015
    Integrated care facilities offer primary care, specialty services, labs, and diagnostics all under one roof. These clinics follow a model common in Latin America. This consumer-focused type of providing medical care is gaining in popularity and increasing in number since …
  • Avoiding Caregiver Burnout March 13, 2015
    Over 43.5 million Americans care for older parents, grandparents, spouses, or other loved ones. Most family caregivers are spouses or children. The demands of caregiving can be overwhelming and can take a toll on your health, relationships, and sanity – …
  • It is Safe to Assume They Lie March 11, 2015
    by G. Keith Smith, MD I laugh every time I see headlines bragging about the number of people enrolled in “Obamacare.”  What choice to people have, after all?  ”Buy this crappy insurance plan (that you wouldn’t buy unless you were …
  • FinalHayes1 March 11, 2015
  • Physician Burnout – What To Do March 9, 2015
    Signs of physician burnout can range from decreased enthusiasm for work, increased cynicism and a low sense of accomplishment.  Where at one time the physician may have felt a burning passion for medicine, he may feel that “light” burning out, perhaps …
  • Increasing Wait Times for Hip Surgery Ruin Patients’ Lives March 6, 2015
    Frustrated patients in British Columbia are in constant pain as their wait times for hip replacement surgeries increase. Wait times for joint replacements have increased in most Canadian provinces despite promises from the government to address the problem. B.C. is …
  • Staying Physically Active: How Much Exercise is Right for You? March 4, 2015
    by Adrienne Snavely Everyone knows that the key to keeping a healthy body is a combination of a healthy diet and regular physical activity. What is considered “regular” differs from person to person. The Dietary Guidelines for America (DGA) first …
  • Supreme Court to Hear New Obamacare Case This Week March 2, 2015
    Later this week, the Supreme Court will hear arguments in King v. Burwell, the results of which could affect the future of Obamacare. This case addresses if consumers who buy health insurance at HealthCare.gov are eligible to receive tax credits …
  • How to Fight and Prevent Sugar Cravings February 27, 2015
    The average American consumes about 16 teaspoons more sugar per day than what is recommended. Sugar causes the brain to release serotonin, creating a natural high, and the endorphins leave us wanting more. Kicking a sugar addiction can be tough, …
  • Hospital Closures Bring “New Day” in Healthcare February 25, 2015
    Hospitals are operating with fewer beds or closing, as patients seek more affordable medical care at clinics and outpatient surgery centers. A low occupancy rate makes for a high-priced facility, which is not competitive. These closures are due to the …
  • Do Your Part to Protect Your Heart – February Special February 23, 2015
    February is Heart month. Protect the health of your heart, preventing heart disease and stroke, with a simple blood test. Below are the February specials from DirectLabs. Lipid Profile – $19 (Regular Price $29, $98 Retail) Test includes: Cholesterol, Total …
  • The Various Dimensions of Mammogram Screening February 20, 2015
    by Adrienne Snavely Every year, over 200,000 women in the U.S. are diagnosed with breast cancer and about 40,000 will die from it. When breast cancer is detected early, it is easier to treat. Forty million mammograms are performed each …
  • Crashing the Free Market Party February 16, 2015
    by G. Keith Smith MD Riding in to rescue the victims of Obamacare and other government healthcare schemes are guess who? The legislators? The regulators? Don’t make me laugh. It is the growing group of healthcare free marketeers. The celebration …
  • Dark Chocolate is Good For You and Your Valentine February 13, 2015
    Dark chocolate is loaded with nutrients, one of the best sources of antioxidants, and can improve health and lower risk of heart disease. Dark chocolate is very nutritious. It contains a fair amount of soluble fiber and is full of …

Some States are Limiting Hospital Coverage for Those Medicaid Patients Whose Lives Depend on it

Obamacare won’t allow insurance companies from denying people with pre-existing conditions coverage, but certain states are having to limit Medicaid coverage for those with critical illnesses requiring excessive hopsitalization due to its unafordablity. These expenses are going to fall on hosptitals and privately insured patients, as well as restricting health care access to those whose lives depend on it. Other states have taken steps to cut costs by eliminating things like vision coverage, adult day care, and dental exams/prodedures.

By Phil Galewitz

KHN Staff Writer

Oct 24, 2011

This story was produced in collaboration with USA Today

In the latest sign of how desperate they are to control rising Medicaid costs, a small but growing number of states are sharply limiting hospital coverage — to as few as 10 days a year.

Advocates for the poor and hospital executives say the moves will restrict patients’ access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients.

 States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funding this summer – funds that had helped prop up Medicaid, the state-federal health insurance program for the poor.

Arizona, which last year received national attention for stopping coverage of certain transplants for several months, plans to limit adult Medicaid recipients to 25 days of hospital coverage a year, starting as soon as the end of October.

Hawaii is going even further. In April 2012, it plans to cut Medicaid coverage to 10 days a year — the fewest of any state, experts say.

Both efforts are pending federal approval, which state officials consider likely because several other states already restrict hospital coverage, among them Alabama (16 days), Arkansas (24 days), Florida (45 days), and Mississippi (30 days). Last year, Massachusetts started a 20-day per stay limit.

Private health insurers generally don’t limit hospital coverage, according to America’s Health Insurance Plans, a trade group.

In Alabama, which has had a 16-day limit for more than decade, hospitals have billed patients for days not covered by Medicaid, said Larry Gardella, director of advocacy at Legal Services Alabama. Because poor patients often are unable to pay, the hospitals typically must pick up the cost, he said.

Another problem: Patients may also delay seeking elective services if they’ve already reached the coverage limit, Gardella said.

Rosemary Blackmon, executive vice president of the Alabama Hospital Association, said “for the most part hospitals do what they can” to provide care to Medicaid patients despite the limits.

In Arizona, hospitals won’t discharge or refuse to admit patients who medically need to be there, said Peter Wertheim, spokesman for the Arizona Hospital and Healthcare Association. “Hospitals will get stuck with the bill,” he said.

While the coverage limits affect only a small percentage of Medicaid patients, they are often are some of the sickest in the program. About 4,000 of Arizona’s 1.3 million Medicaid recipients were in hospitals for more than 25 days from July 2009 to July 2010.

Hospital coverage limits are just one of the strategies states are using to control rising Medicaid costs. Driven by higher enrollment and rising medical costs, total spending on Medicaid was projected to increase by an average of 11 percent in fiscal 2011, according to the National Association of State Budget Officers.

For the 2012 fiscal year that began in July, the association estimated state Medicaid spending would rise 19 percent, largely because of the end of the federal stimulus dollars.

To deal with the higher costs, states are requiring more Medicaid recipients to enroll in managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors, and reducing benefits.

The federal health law requires states to maintain Medicaid eligibility and enrollment standards through 2013. But states are still free to cut optional benefits, which include drugs, vision care and visits to certain providers such as chiropractors and podiatrists.

Within those restrictions, many states have enacted benefit cuts in fiscal 2012, digging deeply into their Medicaid programs for savings. This month, Nebraska began limiting the number of adult diapers it pays for to 180 a month. In July, Colorado stopped covering circumcisions and Tennessee ended coverage of adult acne medicine.

Other steps:

  • California plans to eliminate adult day care coverage and limit Medicaid patients to seven doctor visits per year beginning in November.

 

 

  • Connecticut in July cut the number of dental exams covered for adults on Medicaid from twice a year to once a year.

 

 Matt Salo, executive director of the National Association of Medicaid Directors, said the hospital coverage limits reflect how states are “desperately looking for any and all levers to reduce Medicaid costs,” without violating the law.

The federal Centers for Medicare and Medicaid Services refused to comment on the hospital limits proposed by Arizona and Hawaii, saying they are under review.

CMS is working with states to “provide them with flexibility to run their Medicaid programs and reduce their costs,” Medicaid director Cindy Mann said in a statement. At the same time, “we must also ensure the Medicaid program continues to meet the health care needs of the children, people with disabilities and the elderly whom it serves.”

Brian Turney, CEO of Kingman Regional Medical Center in northwestern Arizona, estimates the hospital coverage limit will cost his 235-bed rural hospital more than $1 million a year. “We can’t kick out patients if they need care from a medical standpoint,” he said. “We are going to just get stuck eating the cost as uncompensated care.”

Turney said hospitals will try to shift costs to private health plans.

The limit will also hamper hospitals’ ability to transfer patients to rehabilitation hospitals because those types of hospitals will be covered by the coverage limit.

Turney said hospitals are especially upset by the limit because it comes as hospitals already are being hit by a 5 percent Medicaid reimbursement cut and the state is taking steps to reduce by the number of people eligible for the program.

Advocates for the poor also are crying foul.

“We do not think people who need medical care should be denied hospitalizations,” said Ellen Katz, director of the Morris Institute for Justice, an advocacy group for the poor based in Phoenix. She said the state is wrong to impose the coverage limit because it penalizes the sickest patients.

The inpatient limit excludes burn units, transplants and inpatient psychiatric care, Arizona Medicaid spokeswoman Monica Higuera Coury said.

Arizona estimates the coverage limit will save a total of $94 million in Medicaid spending in fiscal 2012, including $30.7 million in state funds. Coury said the limit and other cuts to the program are needed to help the state balance its budget.

“The 25-day limit is a cost savings measure and is part of a larger effort to address the $800 million shortfall created by the end of the federal stimulus program,” she said.

 



At MediBid, we restore market forces to medical care. Doctors get to set their own rates based on their training, experience, and outcomes, and patients get to shop for medical care across state lines and international borders. Many times with MediBid, you will find procedures that are more effective than procedures allowed, or covered by health plans. Transparency and competition are the only way to achieve reasonable costs. Many of our employer clients offering group health insurance through MediBid save $5,000 per employee per year. Those are substantial savings. Patients are saving an average of 48% vs. insurance discounted rates, or 80% vs. retail. Contact us for more information.
Share

Comments

This entry was posted in Business and Medicine, Cost of Health Care, Health Care News, Health Law and Legislation, Hospital Bills, News and tagged , , . Bookmark the permalink.
More Affordable Insurance AlternativeCategories
Bulk Email Sender