Help Wanted
I recently wrote about the Medicaid trainwreck that is unfolding for Utah. I've received some input since then and have come up with a few areas of targeted improvement -- further privatization of administration (and, as an incentive, sharing the savings with the companies we contract with) and reduction in frivolous utilization.
I heard a staggering figure. One private company manages 55,000 medicaid recipients in Utah. Of those, just 220 recipients are responsible for HALF the total emergency room costs (220 out of 55,000 rack up half the expense to taxpayers). And these are not catastrophic cases; they are things like 15 ER visits a month for some users, none of which merits hospitalization (drug seeking), or repeated visits for the sniffles. To reduce those ER visits, we need to figure out how to minimize outright abuse of the system and, perhaps, how to improve access to a primary care physician.
Also, an ER doctor told me compelling stories about the effect that potential litigation has on the services he provides. While he knows, in some cases, that one test is sufficient (and that is all most non-Medicaid patients would receive in those cases), he orders (and taxpayers pay for) several other expensive tests, as defensive medicine in the event there is a lawsuit. When we debate the effect of malpractice lawsuits, we often focus only on actually litigated cases and neglect the steep costs of defensive medicine.
In some cases, Medicaid provides Cadillac services that the taxpayers who financially support those services could never afford for themselves. Meanwhile, as a result of wasting our money through such poor prioritization, reimbursement rates suffer for other basic services, such as those provided by specialists, to the point that service providers won't accept Medicaid patients. Medicaid patients are people like you and me, our family members, neighbors, and our friends. The people have decided that Government should provide some medical services for those lacking financial resources. But I don't think anyone intended the current mess or would call the system superlative, as it currently stands.
Rep. Brad Last (House Chair of Health and Human Services) and I will hold informal meetings with interested parties to get a better feel for the problems and possible solutions. If you have ideas, bring 'em on.
I heard a staggering figure. One private company manages 55,000 medicaid recipients in Utah. Of those, just 220 recipients are responsible for HALF the total emergency room costs (220 out of 55,000 rack up half the expense to taxpayers). And these are not catastrophic cases; they are things like 15 ER visits a month for some users, none of which merits hospitalization (drug seeking), or repeated visits for the sniffles. To reduce those ER visits, we need to figure out how to minimize outright abuse of the system and, perhaps, how to improve access to a primary care physician.
Also, an ER doctor told me compelling stories about the effect that potential litigation has on the services he provides. While he knows, in some cases, that one test is sufficient (and that is all most non-Medicaid patients would receive in those cases), he orders (and taxpayers pay for) several other expensive tests, as defensive medicine in the event there is a lawsuit. When we debate the effect of malpractice lawsuits, we often focus only on actually litigated cases and neglect the steep costs of defensive medicine.
In some cases, Medicaid provides Cadillac services that the taxpayers who financially support those services could never afford for themselves. Meanwhile, as a result of wasting our money through such poor prioritization, reimbursement rates suffer for other basic services, such as those provided by specialists, to the point that service providers won't accept Medicaid patients. Medicaid patients are people like you and me, our family members, neighbors, and our friends. The people have decided that Government should provide some medical services for those lacking financial resources. But I don't think anyone intended the current mess or would call the system superlative, as it currently stands.
Rep. Brad Last (House Chair of Health and Human Services) and I will hold informal meetings with interested parties to get a better feel for the problems and possible solutions. If you have ideas, bring 'em on.
posted by steve u. at 3/24/2005
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1 Comments:
I've often wondered why hospitals don't have a non-emergency clinic with extended hours attached to the hospital so that when non-emergency cases show up at the ER for treatment they can ship them across the parking lot, minimizing expenses and keeping the ER free to handle true emergencies. This should also translate into savings in the goverment funded programs as treatment for non-emergencies are channeled into a less expensive service network. ER rooms become the treatment arena for choice because you don't have to make an appointment and they won't turn you away. If there was a viable, inexpensive alternative conveniently located next to the ER room, I think it would work. Just a thought.
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