This conversation has been much too civil - Franky (@GunsOfFrankEaton) can you explain this one to me?
ACA - Things that are working, things that arent...
- Thread starter davidallen
- Start date
Not a disagreement at all fundamentally. Charge inflation has gotten out of control for good and bad reasons.
I work for a not for profit so I will only speak to how our bottom line is impacted. We rely on our operating and investment revenue to make capital investments into our ability to keep up with technology and service lines. The not for profits aren't without fault as we are typically very top heavy management-wise. Not for profits have had to finally make adjustments to management structures to maximize dollars spent on caregivers in the recent past (great thing).
The latest round of Medicare cuts imposed by the ACA has caused an emphasis on reducing costs in supplies (sorely needed) and in labor cost management. The strategies that have been implemented to improve labor efficiency and cost (furloughs for low census and call back systems) have indeed helped to control labor costs, but have also created a labor market where clinical staff look for opportunities that are less subject to furloughs and have had a negative staffing impact on the types of service lines that are more susceptible to large variations in patient census. This has led to staffing shortages that require large premiums to get staff off their ass in times of high census, which negates the cost savings realized by the low census furloughs. Patient care providers are smart and figured out long ago how to maximize their income.
Medicaid patients are notoriously wasteful as they experience zero financial disincentive to be good stewards of healthcare dollars. Medicaid patients are more likely to use the emergency department for primary care than any other payer demographic. The ACA was touted as a way to increase "access" to reduce ED visits, but that has yet to materialize. In fact, ED visits have continued to increase in that demographic due to the lack of primary care providers who accept Medicaid and nothing on the reimbursement side to provide incentive to physician providers to accept them. Besides, that demographic typically doesn't like the answer of an appointment scheduled in 3 days or longer. Medicaid reimbursement is a loser for all provider types.
Of course this is anecdotal, but I have no motive for dishonesty on the subject and our experience is certainly not unique. My ambulance service has a Medicaid patient population that we routinely transport to the ED for no other reason than Medicaid pays for it, literally to the tune of 3 or more times per week (usually seeking narcotic relief for all that ails them). Of course "Medicaid pays for it" actually translates to doesn't actually cover the cost for service in most cases. Of course we could refuse to transport them, but this particular population will continue to call 911 until somebody gives. We've tried to address it through Medicaid (what do you want us to do, revoke their eligibility for fraudulent use? No way!) and other means (case management "but they might sue" and law enforcement "not my problem").
Expansion of Medicaid was a great way to expand coverage, but with zero disincentive for abuse and zero incentives for providers, it's become the smoke nobody wants to investigate for actual flames. Simple Medicaid reforms likely would have produced at least some of the needed revenue for expansion, but would have been very politically unpopular in that voting bloc. Expanded coverage has only led to increased abuse and decreased availability of the holy Medicaid dollar.
Had no idea... ambulance for transport to an appointment essentially? Have not heard of this. That is outrageous.
In your opinion would an HSA style account incentivize better behavior for Medicaid?
Not an ambulance transport to an appointment. An ambulance transport to an emergency department for a chronic/maybe even nonexistent problem because calling a taxi/Uber requires payment up front and appointments with primary care/specialists might cost out of pocket money.
Requiring some financial responsibility in any form would incentivize better "behavior" in the Medicaid population just like it does in the Medicare and insurance populations. Medicaid has literally zero copay or other financial investment from the patient for ambulance service and/or ED visits.
A blog post from someone credible in my book. You can look at the "Medicaid cost sharing" directly from medicaid.gov.
http://www.kevinmd.com/blog/2014/01/medicaid-patients-emergency-department-primary-care.html
Ambulance utilization from 2011. There are more recent statistics but I'm too sleepy to look them up. The Medicaid usage of ambulance transport has increased steadily since this publication.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196627/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196627/
again it's not you or your insurance or the credits you pay
it's the 40#'s you haul around that i don't want to pay for.
there's a big drain in the sky
we are in the healthcare system with all its associated costs and who pays for it together
and it doesn't hit you like that i'm sure because your healthcare insurance costs haven't gone from auto insurance equivalent to another mortgage payment
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012.Aug 27, 2015
can you comprehend the costs associated with childhood obesity?
it's lifestyle choices that increase costs which increase wealth distribution
from your end it seems to be i write a check and i'm good with it
