Category: Health Care Reform

Kentucky Medicaid is a Mess.

Slow-Payments or No-Payments for medical care.

A week ago I was pretty tough on a possibly hypothetical physician who was said at a Frankfort hearing to have abandoned two child patients because one of the three new Kentucky Medicaid Managed care vendors had not paid him for three months. What is not hypothetical is that the Medicaid system is now in shambles. There are now four independent Medicaid managed care systems in Kentucky plus original Medicaid itself to deal with. Each of these has its own bureaucracy and unique systems. Thats a lot of different hoops for physicians and other healthcare providers to jump through. I have no doubt all are pulling their hair out. By all accounts, all three new vendors are in the pay-slow, pay-low mode. Cynics will point out that this is an easy way for an insurer to make a profit. After all, even Kentucky government uses the gimmick of paying healthcare providers late as a way to balance the books and make it look like they have actually been doing their jobs.

It is easy to assume that the three new managed care companies are to blame. That does not easily explain why all three seem to have failed at the same time, or why they appear successful in other states in which they work. When I worked in Kentucky Medicaid in the 1990s during my first-ever sabbatical and later as a faculty fellow, it was clear to me that there were major inadequacies in the state’s Medicaid computer systems and their ability to transfer and analyze information. I hope things have improved since then. Remember that all information about eligible beneficiaries, hospitals, and other providers has to be transferred to the managed care companies and continually updated so they know who to pay and for what. The three vendors have been silent publicly, but I will bet a martini in your favorite Louisville bar that internally they are struggling to interface with the state’s system. When you consider that each hospital and doctor’s office may also have their own computer system, it is no surprise that Kentucky Medicaid is staggering under its own weight and complexity. I hope we can pull out of this death spiral of cost and confusion. I still expect the state and providers to hold patients harmless, but that cannot continue infinitely. What a mess! Continue reading “Kentucky Medicaid is a Mess.”

Loss of Medical Privacy? Is that OK?

Yesterday, Phil Galewitz reported for Kaiser Health News (reprinted in USA Today) on a practice that is one of my biggest disappointments in our health care system, the sale of our personal health information for the benefit of someone else.  I do not mean the use of de-identified medical information to improve public health, medical quality, enhancement our ability to treat disease, or even for law enforcement.  I am talking about the use of your individual health information to try to sell you something else that you may or not need.  Did you ever wonder why all of a sudden you started getting ads for diabetes supplies?  Or why ads for erectile dysfunction started arriving in your mailbox as well as your email?  It is because your personally identifiable medical information is being shared to improve the bottom lines of those who have access to your medical records.  The story highlighted the practices of hospitals that use information from their medical records to peddle other services to their current or former patients  Partnering with mass marketing companies, your hospital knows a lot more about you than is present in their records.  For example, if you smoke, you get a directed ad for lung cancer screening.   Believe me, when you come in for a “screening,” something can almost always be found that ”needs” to be done.    Screening can be a hospital’s or doctor’s best friend.  It all depends on how ethical or financially strapped the provider is that determines how far evidence-based scientific medical practice will be stretched.  Examples of abuse are easy to find. Continue reading “Loss of Medical Privacy? Is that OK?”

Archbishop Fights Health Plan Policy.

I have been trying to find the time to branch out to other topics on this policy blog, but material related to issues of the recently failed merger/acquisition of University of Louisville Hospital by Catholic Health Initiatives keeps rolling in. Yesterday it was reporting by Peter Smith in the Courier-Journal on local Catholic Archbishop Joseph Kurtz’s tough talk about the new federal law requiring employers offering health insurance to cover birth control pills, morning-after pills, and certain other basic necessary health services related to reproductive and womens’ health. The Catholic Church equates contraception to murder, although even the large majority of American Catholics and most of the rest of us do not agree.

The coverage requirements do not apply to churches or other purely religious communities such as convents, although presumably some (but not all) of the covered services would not be missed in such institutions. The new law only extends to entities such as hospitals and universities in the public marketplace that would hire non-Catholic employees.

Bishop Kurtz complains that, “People of faith cannot be made second-class citizens,” and that his religious ancestors did not come to these shores “only to have their posterity stripped of their God-given rights.” He complains further that the new law “has cast aside the first amendment … denying to Catholics our nation’s first and most fundamental freedom, that of religious liberty.” The Bishop apparently fails to see any irony that by forcing employees or patients in hospitals like University Hospital to follow his religious dogma, that he is guilty of violating the freedoms of others, god-given or otherwise! Reverend Simmons, a minister and teacher of medical ethics in of Louisville says it better, “that the only freedom being cast aside is the “liberty to enforce their opinions on others.” Continue reading “Archbishop Fights Health Plan Policy.”

Exaggeration, Unethical, or Just Plain Despicable?

Today’s Courier-Journal reported on a legislative hearing in Frankfort concerning the struggling implementation of our new Medicaid Managed Care companies in Kentucky. The focus was on slow payments to providers and difficulties arising from having to interact with the systems of three different providers, although there were apparently also problems in obtaining timely authorizations for treatment or prescriptions. None of this should have been completely unexpected given the relative speed at which rather drastic changes were made to the Medicaid program of Kentucky. Most of the state just went from unbridled fee-for-service care to the more closely supervised system we call managed care. I am certainly not surprised! What is more important is how this vital healthcare system reacts and repairs itself. Time will tell.

What did surprise and more-than-disappoint me was the report of the behavior of an unnamed psychiatrist in Kentucky who is said to have refused to continue to treat two of his current patients who are children because “he has not been paid since Nov 1.” Why is this not abandonment and a cause for disciplinary action by the Medical Licensure Board, or if there are any damages, in a civil court? My friends in the Medical Licensure Board, what does it take for you to investigate this accusation? You may consider this a complaint. The safety of two children is in jeopardy, or the good image of physicians has been sacrificed to make a better story for our legislators. Either alternative begs for clarification and resolution. Reports like this, when true, make me ashamed on behalf of my profession. Continue reading “Exaggeration, Unethical, or Just Plain Despicable?”