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Archive for Thursday, October 6, 2011

Colyer: Medicaid changes won’t narrow eligibility

October 6, 2011

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— A plan for overhauling Kansas' Medicaid program will push to cut the state's nursing home population and reorganize agencies, but won't narrow eligibility requirements to reduce the number of people covered, Lt. Gov. Jeff Colyer said Thursday.

Colyer, a surgeon and former state senator, is leading a Medicaid task force for Gov. Sam Brownback's administration. The Republican governor has said he wants to reduce the costs associated with medical care for the needy while improving services, and Colyer said the administration will release its plan by the end of October.

The lieutenant governor discussed the broad outlines of the Medicaid plan during an interview with The Associated Press, saying it will be designed to tackle a "fragmented" system for providing care for the elderly and disabled and poor families. He said Brownback's administration will ask the federal government for a "global waiver" of Medicaid rules to give the state as much flexibility as possible.

Administration critics have worried Brownback will try to make it tougher for Kansans to qualify for Medicaid coverage or reduce the payments to doctors, clinics and hospitals that provide services to program participants. Colyer said any payment reduction to health care providers is "a last resort."

"We are not going to cut people off of Medicaid," Colyer said. "Secondly, we are not looking at giant across-the-board rate cuts."

The state's Medicaid program covers about 330,000 people, a figure that's been rising in recent months. Overhauling Medicaid is a major initiative for Brownback's administration because the program's costs, now approaching $2.8 billion, have increased 48 percent during the past eight years, stressing the state's budget.

The federal government, which oversees states' programs, typically has picked up about 60 percent of the cost. Colyer said the Brownback administration anticipates big cuts in federal spending to help close the federal budget deficit and reduce the federal debt.

Colyer didn't provide specifics about the overhaul plan, saying its release remains several weeks away. But he said it will include proposals for seeing a greater number of elderly and disabled Kansas residents receive services in their homes rather than in nursing homes, which tend to be more expensive. He said the state may even work to get nursing homes themselves to provide such services.

"We want to keep people in their own homes," Colyer said. "We can do that and save money."

Comments

Paul R Getto 3 years, 3 months ago

"But he said it will include proposals for seeing a greater number of elderly and disabled Kansas residents receive services in their homes rather than in nursing homes," === Much of this effort, I suspect, is really intended to deny services to the poor, but this is actually a good idea.

tabitha013 3 years, 3 months ago

One of they ways they intend to do this is through the use of telehealth, which is a daily monitoring program that helps make people more aware of their condition(s) and also gives their doctors' an accurate look at how they are actually doing, for example in regards to blood pressure. Telehealth can help keep people out of nursing homes and out of the emergency room, which will reduce the amount of money needed for the care of each person, by actually increasing their care.

Kendall Simmons 3 years, 3 months ago

But didn't the State just eliminate the free Internet service that, among other things, allowed for telemedicine to rural areas?

tabitha013 3 years, 3 months ago

Telehealth is different from telemedicine. Telemedicine is generally done via videoconferencing. Telehealth is a daily monitoring system that involves a remote monitor, generally referred to as a telestation and periphial equipement, such as a blood pressure machine, pulse oximeter or scale. These devices wirelessly transmit the readings to the telestation, which then transmits the data either via phone line or an e-cellular device to a nurse who checks the vitals every day to see if they are within the parameters set by the doctor. They also get life counseling about their diagnoses, which can help them understand how to control their condition.

designdiva 3 years, 3 months ago

Who will be reimbursed for telehealth monitoring? I should point out that telemedicine also includes patient to physician phone calls and, soon, e-mail. There are rigid requirements before a phone call or e-mail between patient and physician can be considered telemedicine. As the telemedicine system currently works, patients who are nursing-home bound are monitored by nursing home staff. When the patient condition changes for the worse, warrenting a phone call to the patient's physician, the physician can spend several cummulative minutes or hours on the phone with nursing home staff and family members during the course of the day or week. While this time can be billed, it is never reimbursed by insurance companies, and furthermore, insurance companies prohibit billing the patient for these services.
As I see it, the vital signs, weight, bood pressure, etc. of telehealth patients will be monitored by someone, but ulitmately the responsibility will fall on the patient's physician, as is the current practice. In the interest of reducing the "waste" seen in the Medicaid system, without reducing service to patients, I anticipate Colyer and his team will recommend that physicians "relieve" nursing homes of the monitoring duty. And I guarantee there will be no reimbursement to physicians for this service. Ergo, physicians will cease and desist seeing Medicaid patients. This is already happening in the Medicare realm. Don't beleive me? Ask your elderly parent, neighbor, spouse. See how hard it is to find a physician willing to take a new to the physician patient who has Medicare. If and when the predicted 30% cut to Medicare reimbursement happens in Jan 2012, physicians may refuse to see established Medicare patients too.
Currently, the average Medicare reimbursement for a normal office visit is $57.64. With the proposed cuts the reimbursement level will fall to $40.34 for the same service.

tabitha013 3 years, 3 months ago

Reimbursment goes to the company providing the telehealth services. Let me re-iterate that telehealth IS different from telemedicine. Telemedicine can be all encompassing and can include almost any service that can be provided via videoconferencing. Telehealth is a self directed daily assessment and measurement of certain vital signs pertinent to your diagnoses or health needs. The monitoring is done by the company providing the service. The physicans do not do the monitoring. This increases the level of care, as well as the overall satisfaction of the patient.

designdiva 3 years, 3 months ago

I am well aware of the difference between "telehealth" and "telemedicine", which I argue does not have to involve vidoeconferencing at all. As I stated, telemedicine can involve a telephone call or an e-mail. What I am arguing is that telemedicine does not reimburse a physician for time spent on the phone "assessing, diagnosing, and treating a patient". What does this mean to the average person? I wake up sick with a sore throat, productive cough with thick, tenacious sputum, myalgias, and febrile. I call my personal physician who offers me an appointment. I really can't afford my $40 co-pay in addition to whatever prescription my physician may deem appropriate, so I lie, tell my physician I am too sick, too busy, can't get off work, whatever. He treats me over the phone. His practice has provided a service for me that will not be paid for by my insurance company or I. My physician has assumed the liability for a correct diagnosis and correct treatment, without ever having laid eyes or hands on me, for absolutely no financial gain. This practice is abused in, I would wager to say, 100% of practices multiple times a day.

I am suggesting that "telehealth" instances will be handled the same way. Some company will offer 24 hour monitoring, receiving payment from the patient's insurance company, or the patient themselves, while the physician, who is responsible for the decision making and liability, will not be paid a bloody red cent.

I assume you are in support of telehealth. I am not sure what your connection to the health care system is, but if I were you, I would prepare for this idea to not go over well with physicians. The result could likely be that physicians refuse to take care of patients (regardless of insurance) who can't physically make it into the office on their own two feet.

As it is, there are many LOCAL private practice physicians who, due to falling insurance company reimbursements and lack of ability to pay by non-insured individuals, are barely keeping the doors open. The days of a private physician are nearly over.

I would be very interested in knowing what your thoughts about the healthcare reform act are. How do you see that playing out?

tabitha013 3 years, 3 months ago

The physicians are not involved in the telehealth health. The company providing the services employ RNs that do the daily monitoring. The physicians actually encourage their patients to use telehealth as it gives them more accurate information to help their patients. Telehealth is a service that is provided in addition to doctor's visit, not in replacement of.
If you are going to comment, then get all of your facts so that you don't mislead other people who may not have any background on the subject. Ignorance is not always bliss.

Kendall Simmons 3 years, 3 months ago

If the way that SRS handles payments is any indication, they seem to have no problem delaying contracted payments for no reason whatsoever except "we're really busy", resulting in our tax dollars being spent on late free and penalties rather than on providing those contracted services.

63BC 3 years, 3 months ago

A fifth-generation Kansan, Jeff Colyer was raised in Hays, where his father worked as a dentist.[2] He graduated from Thomas More Prep High School before enrolling at Georgetown University, where he earned undergraduate degrees in economics and pre-med in 1981. After receiving a Master's degree in International Relations from Cambridge University in 1982, he obtained his Doctor of Medicine degree from the University of Kansas in 1986.[1]

Colyer had residency training in general surgery at the Washington Hospital Center (1986–1988, 1989–1991); in plastic surgery at the University of Missouri–Kansas City (1991–1993); and in craniofacial/pediatric plastic surgery at the International Craniofacial Institute in Dallas, Texas (1993–1994).[1] In 1988, during his residency in at the Washington Hospital Center, he was named a White House Fellow and served in the Executive Office of the President and Agency for International Development under Presidents Ronald Reagan and George H.W. Bush.[3]

Kendall Simmons 3 years, 3 months ago

The State has long had its own random clusters of ridiculous rules and administrative hurdles with no real end...and, since they've actually added more under Brownback, one has to wonder if that waiver is just so that the State can take those Medicaid dollars and spend them on faith-based initiatives and rich friends.

meggers 3 years, 3 months ago

While they may not reduce the number of people covered, they could certainly limit the number of services those people qualify for- sort of like the tinkering they've been doing with mental health services.

Interesting that he's calling it a "Global Waiver" instead of the Medicaid block grant Brownback has been pushing for. If they try to compare it to Rhode Island's Global Waiver, don't be fooled.

http://www.cbpp.org/cms/index.cfm?fa=view&id=3428

'In recent months, proponents of converting Medicaid into a block grant have cited a Medicaid waiver demonstration project in Rhode Island as evidence that a block grant would produce substantial federal and state savings while giving states greater flexibility over their Medicaid programs. [1] These claims, however, are off the mark. The Rhode Island waiver was a “sweetheart deal” between the Bush Administration — in its final week of office — and the Republican governor of Rhode Island, in which the federal government effectively unloaded additional federal money on the state and gave Rhode Island federal funds beyond what it would receive under the regular Medicaid program, in return for the state accepting a cap on its Medicaid expenditures at an inflated level that it never expected to reach anyway. Such a deal would be impossible to replicate under proposals to convert the Medicaid program to a block grant; such proposals are designed to cut federal Medicaid funding by tens or hundreds of billions of dollars, the opposite of what happened in Rhode Island.'

Kendall Simmons 3 years, 3 months ago

"tinkering" - such a refined way to refer to what they've been doing with mental health services recently. The last 6+ months have been horrible.

meggers 3 years, 3 months ago

Yes, it was definitely an understatement.

ThePilgrim 3 years, 3 months ago

Colyer will be our governor in less than 18 months when Brownback rides one of the Repub's coat tails into Washington in the new administration's Cabinet.

JayhawkFan1985 3 years, 3 months ago

This is part of the radical right's "cultural revolution." They say they are going to "reform" a program that provides services to our poorer neighbors and friends. What this is really about is reducing spending on people who they think don't count. Brownback and his ilk think corporations are people, but they don't recognize poor people as people.

In response to ThePilgrim, there is no current Republican candidate who as of today could beat Obama. That could change, of course, as the election is over 1 year away. If Brownback does somehow become VP, we should all move to Canada. His view of America is to become a fundementalist Christian version of Taliban Afganistan. I don't want to live in Afganistan. I wish he would move to Afganistan instead.

chootspa 3 years, 3 months ago

What I heard is that they're going with a "managed care" model, meaning that they've figured out a way to give more money to cronies in private industry and hide the cuts in services.

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