As the Supreme Court begins hearing arguments on the Affordable Care Act, Tell Me More continues the conversation about state reactions to the law. Guest host Jacki Lyden speaks with Florida Senate President Mike Haridopolos, about opposition to the Affordable Care Act in his state.
via A Florida Lawmaker Critiques Health Care Law : NPR.
Nearly a year after lawmakers approved moving to a statewide Medicaid managed-care system, the Agency for Health Care Administration last week sent another round of detailed information to federal officials about how the plan would be carried out.
The information, in a document dated Friday, indicates that the number of beneficiaries enrolled in HMOs and another type of managed-care plan is expected to double — and possibly triple — by the end of 2014.
Also, with the state divided into 11 Medicaid regions, it says beneficiaries would move into managed-care plans in a “staggered” fashion and that timelines would be developed for each county.
via Agency details Medicaid plan | The News-Press | news-press.com.
Tens of millions of people every year decide they can’t afford or simply won’t buy health insurance. Some are out of work or underemployed. Many are young and early in their working careers, self-employed or without access to large group plans through work.
The Obama administration wants to cover 30 million more people by providing incentives for nearly everyone to buy insurance. The Affordable Care Act expands government programs such as Medicaid, offers subsidies for lower-income people and imposes a penalty for those who don’t sign up with a private, employer-based or government plan.
Now the individual mandate to buy insurance is in the cross hairs of a challenge to the law by Florida, 25 other states and business groups before the U.S. Supreme Court. Among other objections, opponents say forcing people to purchase insurance or pay a penalty is a step too far, an unconstitutional overreach by the government.
The court’s decision, expected as a landmark ruling in June or July, could uphold the law, strike it down or perhaps kill the mandate while leaving other parts intact.
But if the law and the mandate survive, there’s still a fundamental problem with incentives, said Bruce Vogel, associate professor in the Department of Health Outcomes and Policy at the University of Florida’s College of Medicine.
via Experts see few barriers to stop people from buying health-care coverage only when sick.
Hillsborough County has joined an ongoing dispute over health care costs for its poorest residents.
The Hillsborough County Commission on Wednesday unanimously backed a lawsuit challenging the constitutionality of a plan to collect local Medicaid payments before billing. It approved spending $5,000 for legal costs in the Florida Association of Counties lawsuit to be filed soon in Leon County Circuit Court.
via Hillsborough joins Medicaid lawsuit | TBO.com.
The state budget and an implementing bill signed this week by Gov. Rick Scott would delay the phasing in of Medicaid managed care plans for dentistry, but Scott made clear he would support the plans in the future.
The language would require the agency to continue allowing dentists to bill for Medicaid patients under the traditional fee-for-service system in areas outside Miami-Dade County, but would expire in July 2013. The Agency for Health Care Administration announced it was delaying the statewide implementation of the managed care system after the language was approved by the Legislature.
via Budget would delay statewide Medicaid managed care for dentistry | The Florida Current.
Medicaid remains the black sheep of the health care reform litigation. Before the six-and-a-half hours of oral argument at the end of March, commentators focused primarily on whether Congress may require a minimum level of health insurance coverage. Even the number of amicus briefs filed about 23 on the Medicaid issue versus about 78 on the “individual mandate” indicates lack of attention to the spending question in Florida v. US Department of Health and Human Services. Both Solicitor General Donald Verrilli and Paul Clement referred to Medicaid as Medicare, a blunder that may be natural after three days of arguments. But, such stumbles suggested a lack of understanding of both spending doctrine and the Medicaid expansion and do not bode well for the Courts decision-making processes.
via JURIST – Forum: Medicaid in the Supreme Court: Small Errors, Big Problems.
Perhaps ObamaCare will be remembered as the breaking point for top-down planning. There is not enough information available for the government to micromanage a system as complex as health care, which represents more than 15% of the economy. Austrian economist Friedrich Hayek wrote some 50 years ago about the “pretence of knowledge,” meaning the conceit that planners could know enough about complex markets to dictate how they operate. He warned against “the belief that we possess the knowledge and the power which enable us to shape the processes of society entirely to our liking, knowledge which in fact we do not possess.”
via Crovitz: Complexity Is Bad for Your Health – WSJ.com.
The test uses a chemical called florbetapir, known by the brand name Amyvid, which is a radioactive agent that tags clumps of a sticky substance called an amyloid. Amyloid proteins are hallmarks of Alzheimer’s disease. The chemical, which costs $1,600 per dose, then is detected using a brain imaging technique called positron emission tomography, known as PET scans.
For patients who already have some symptoms of cognitive decline, a positive scan suggests that moderate to frequent amyloid plaques are present in the brain, which is consistent with Alzheimer’s disease.
via FDA Approves Alzheimer’s Test Developed by Eli Lilly – WSJ.com.
The Obama administration’s budget proposal to cut defense spending, in part, by increasing the cost of health care for retired service members has riled veterans groups and members of Congress.
via TRICARE fee increases: Hikes in cost of veterans health care draw fire – POLITICO.com.
Although this article addresses the historical issue of debtors, debtors prisons, and Bankruptcy, I find it interesting as the Health Care System evolves. The Number One reason for personal bankruptcy is health care bills
As Health Care restructures its delivery system, watch large health care systems work their way through bankruptcy. This may seem far fetched at this time. However with the significant Medicaid and Medicare budget cuts major cash flows will be altered. Large Health Care Providers which have made large capital outlay to capture what was in the past a major cash flow will experience financial distress.
A cut of 60.5 million a year will effect Florida Nursing Homes in a big way. These cuts are effecting how the Nursing Homes are paid by Medicaid for those residents that have not paid there bills. There is an a way that the Nursing Home industry can add the bad debt to their cost of doing business, which will effect the rate medicaid will pay. Under a new law this will be changed.
A new Avalere Health analysis detailing the negative impact on Skilled Nursing Facilities (SNFs) resulting from so called “bad debt” provisions passed in the Middle Class Tax Relief and Job Creation Act of 2012 finds facilities in Florida, Ohio, Illinois, Pennsylvania, North Carolina, Louisiana, Indiana, Tennessee, Georgia and New Jersey will absorb the largest Medicare funding cuts. Nationally, the provision will cut SNF payments by at least $3 billion over the FY 2012-21 budget window.
Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care (AQNHC), pointed out that the phrase “bad debt” is a complete misnomer. The federal government itself, he said, prevents SNFs from collecting as much as 90 percent of SNF bad debt. “SNFs have no legal recourse to collect ‘bad debt’ from state Medicaid agencies — and is more accurately described as ‘uncollectible debt’ as mandated by federal law,” he stated. He noted the U.S. SNF sector, America’s second largest health facility employer, faces yet another $8-9 billion in cuts between FY 2012-21, resulting just from the looming sequestration threat
On April 2 2012 Alex Sink speaks on the future of florida and Florida
Next.
According to a Kaiser Family Foundation poll .pdf released last week, the Medicaid expansion provision in the Affordable Care Act has 70 percent approval from Americans.
The poll also found that most provisions in the law have considerable support from the public, except for the individual mandate, which bottoms out with a 32 percent approval rating.
via Poll: 70 percent like Medicaid expansion in health care reform law | Florida Independent.
“It is absolutely not sustainable. If we do nothing, this line will bankrupt our state,” Scott said at a news conference
via Florida Challenges Medicaid Spending ‘By Force’ : NPR.
The Financial State Of Florida’s Medicaid | HealthyState.org – Florida Health News.
University of South Florida Public Radio Reporter, David Gulliver has written one of the best analysis of the funding of Medicaid. In great detail he describes the two billion dollar cuts to Medicaid that only saves the state of Florida 442 million. To understand the scale of the Medicaid Program and the programs impact to the state economy, Gulliver reports, that medicaid represents 21.2 billion of Florida total budget of 70 billion. The cuts represent less than a 10 percent cut.
David Gulliver also drives home the point that in tough economic times the Medicaid enrollment grows. From 2003 to 2008 Medicaid caseload was flat. As the recession impacted Florida, over 1 million people joined the Medicaid rolls.
The article ends by looking at the future of Medicaid reform and the pilot program that privatized Medicaid in five Florida counties. It is still unknown if real savings are achieved by this approach. David Gulliver cites the two studies done at the University of Florida and Georgetown University.
Great Reporting.
Over the strong objection of Florida counties and tea party activists, Gov. Rick Scott on Thursday signed a bill that will force the local governments to make good on nearly $300 million worth of unpaid Medicaid bills.
via Scott Signs $276 Million Medicaid Bill | TheLedger.com.
Miller – McCune has a great article about the politics of the Supreme Court. As the Supreme Court considers the Affordable Care Act and Medicaid today, they must do so with great respect for their opinion to be honored. However the backlash will be great what ever decision they will make. It is my prediction that the Supreme Court will not render a decision until after the Presidential election this fall.
If the smear of partisan decision-making tars the unelected U.S. Supreme Court after these decisions, the fundamental legitimacy of the institution may become precarious.Why exactly is legitimacy so important?Legitimacy means that an institution has the right to make decisions, and, because those decisions are fairly, impartially, and procedurally properly made, citizens are under the obligation to accept those outcomes, even when they disagree with them. So, in this sense, legitimacy is for losers — those on the losing side of the issues the Supreme Court decides.
via Can the Supreme Court Survive a Health-Care Decision? – Miller-McCune.
U.S. Tells States How to Expand Medicaid in Health Law – WSJ.com.
Regulations on the expansion of the federal medicaid program are issued to the dismay of many states. Oral Arguments in the Supreme Court of the United States are less than 10 days away. This WSJ article is well written and informative.
The Miami Herald reports:
A controversial measure that would shift $300 million in disputed Medicaid bills to counties has been received by Gov. Rick Scott’s office, triggering the 15-day window for him to either sign or veto the legislation. If Scott does neither by the March 29 deadline, it becomes law automatically.
via Clock ticking for governor to sign controversial Medicaid legislation | Naked Politics.
Some of questions asked by the Federal Government to the State of Florida regarding the transition to managed care for those on Medicaid. In a recent article some of these questions have been revealed. If you were the State of Florida how would you answer them.
“The State must ensure that plans maintain a network of providers in sufficient number, mix, and geographic distribution to meet the needs of Medicaid beneficiaries,” one part of the list said.
“What are the standards that will be used by the state to ensure access to Medicaid services and to which managed care plans will be held accountable? How have these standards been vetted? Describe the ongoing oversight and review that will be in place to ensure plans maintain a sufficient network.”
via Feds Question Florida on Medicaid | TheLedger.com.
Florida Medicaid shift could take longer than expected | The News-Press | news-press.com.
Well written article, about the shift to managed care for seniors on medicaid and how the state and federal governments still do not understand how it will all work. The need for independent advice on choices and care seems manifest for seniors and their families as these changes in the medicaid program are put in place.
A very good basic Frequently Asked Questions is provided by the Washington Post on the upcoming oral arguments in the Supreme Court over the Affordable Care Act.
FAQ: The Supreme Court and health reform – The Washington Post.
The Miami Herald editorial page reviewed the Florida legislature 2012 session with a judgmental tone. The editorial staff at the Herald were concerned that the legislature failed Neglected Elders and meaningful reform of the Medicaid Program.
NEGLECTED ELDERLY
Gov. Rick Scott and lawmakers talked a good game, calling for major reforms to improve assisted living facilities in the state. In the end, however, only the Senate was willing to impose serious reforms to help vulnerable ALF residents. But with no willing partners in the House and little leadership from the governor — who swore that this issue was a priority — ALF reform went nowhere this session. Shameful.
MEDICAID CUTS ON FAST TRACK
Jackson Health System dodged a bullet from the governor’s original proposal, which sought to cut a quarter billion dollars in Medicaid funding. Instead, the Legislature’s formula trimmed Jackson’s Medicaid allotment by about $47 million, with the ability to recoup about $12 million of that amount and possibly more through expected federal revenue.But even so, the Legislature forced Florida hospitals to absorb a cut of more than 5 percent in Medicaid funding in a state that already covers far less than what it costs to care for sick, indigent patients.Most maddening: The Legislature rejected $440 million from the feds to improve Medicaid reimbursement rates to physicians, money designed to encourage more doctors to serve the poor and disabled. This is all politics, designed to show displeasure over the Obama administration’s Affordable Health Act, but it winds up hurting Florida’s neediest.
via Missed opportunities – Editorials – MiamiHerald.com.
Forbes is reporting Long Term Care Issues are not a top issue for presidential candidates. An exception is Newt Gingrich. Forbes reveals:
Gingrich, who has shown real interest in long-term care issues in the past, was typically provocative though sometimes contradictory and often not specific. The former speaker used the survey as a platform to renew his calls for repealing the 2010 Affordable Care Act, turning Medicare from a guaranteed federal benefit into a defined contribution program, and replacing the existing Medicaid system with a federal block grant.
Gingrich said consumers should be able to use tax-advantaged Health Savings Accounts and Flexible Savings Accounts to buy long-term care insurance. This is somewhat curious since Gingrich has also proposeda flat income tax system that would seem to effectively end HSAs and FSAs.
Still Gingrich also said he’d “promote new models of care” that focus on primary medical care and home care. He also embraced the use of new assistive devices, though he didn’t say how consumers would pay for them.
In addition, Gingrich said Medicare should cover training for family caregivers. This is a very interesting idea through it is not clear how such a mandate would be implemented once Gingrich shifts Medicare to a largely private insurance model.
via Long-Term Care Services: Forgotten By Most Presidential Candidates – Forbes.
Local and County governments are on the hook for more cost sharing for Medicaid patients. Currently at stake is over 300 million dollars in disputed Medicaid billings. These funds owed are over a three year period.
p>The state wants to get that money, as well as future Medicaid payments, by withholding revenue sharing dollars from counties. That in an unfair burden on local governments that will hurt taxpayers, the Tea Party says.
“This is going to require counties to cut services or raise taxes to pay for what the state is mandating for the counties,” said Henry Kelley of Ft. Walton Beach, the Tea Party Network’s legislative liaison.
via Tea Party defends counties in Medicaid billing dispute | Naked Politics.
As Courts interpret Medicare and Medicaid laws, they ponder the language that the public policy is described in the laws. In todays Wall Street Journal JOE PALAZZOLO, writes about the difficulty in understanding the plain meaning of the enabling laws.
James Madison warned in the Federalist Papers about laws "so voluminous that they cannot be read, or so incoherent that they cannot be understood."
If only he had lived to see the Medicare and Medicaid programs.
via Here's a Funny Idea: Medicare Laws That Are Easy to Read – WSJ.com.
As goes Florida so does Kansas.
Medicaid in Kansas has grown by 7.4% annually over the last decade, and Mr. Brownback would reform it by contracting with managed-care organizations to oversee and coordinate care. His plan would also provide monetary incentives for insurers and providers to improve quality and use health-care dollars more economically.But heres the rub. To execute most of these Medicaid changes, Mr. Brownback needs Health and Human Services Secretary Kathleen Sebelius to issue a global waiver, which frees the state from most Washington strictures in return for a cap on federal funding. George W. Bush granted Rhode Island a global waiver that has had excellent results, but Ms. Sebelius is a former Kansas Governor and may not want to give her party rival the power to succeed.
via Review & Outlook: Whats Right With Kansas – WSJ.com.
What’s it show? It’s the hospitals — the hospitals that are behind the unchecked growth in state Medicaid spending, even though their rates have been cut and they’ve cried “crisis” year after year.
Florida’s one of only 10 or 11 states that pays hospitals a per-diem rate rather than a per-service rate. The hospitals themselves must submit cost reports to the state Agency for Healthcare Administration, and each hospital’s per-deim rate is set according to a complex formula.”
What’s behind Florida’s Medicaid spending surge: It’s the hospitals | On Call with Stacey Singer.
The Wall Street Journal reports on new resources for caregivers.
Home Instead Senior Care has started training its home-care workers in new techniques and strategies to improve care for dementia patients—and is starting to offer the same instruction at no cost online and in person to family caregivers.
“Families need help keeping their loved one safe and mentally engaged and stimulated, and managing difficult behaviors,” says Jeff Huber, Home Instead’s president.
To that end, Home Instead developed a life journal, designed to collect information about a patient’s history “to create a much more effective caring experience,” he says.
[Gov.] Scott said the reimbursement “adjustment” would create a flat rate for hospital groups using average costs. “No program has grown as fast and as much as Medicaid, and we must find a way to control the cost. If we do nothing, this program will bankrupt our state,”
via Florida plans to slash Medicaid funds ahead of health reform | Government Health IT.
In the Gainsville Sun Attorney Anne Swerlick writes “The Florida Legislature has an opportunity to address these problems. The state pays billions of dollars to mostly private-for-profit HMOs to care for some of the most vulnerable Floridians. It is imperative that these health plans provide Medicaid patients, their physicians and the public a transparent process by which health care decisions are made. This is especially important now as more Medicaid patients will be required to enroll in HMOs and other managed care plans.”
via Anne Swerlick: Will the Legislature protect Florida’s most vulnerable? | Gainesville.com.
The Tampa Tribune Editoral makes the point “Continued deep cuts will compromise Floridians’ care.”
via Medicaid goes under the knife | TBO.com.
RCPALM Editorial Page points out ‘Here’s what is particularly insidious about the Legislature’s proposed cuts to Medicaid: At the same time Florida lawmakers are planning to reduce vital health care services for hundreds of thousands of state residents, both chambers have approved state budgets that continue to offer overly generous health insurance premiums for high-ranking state officials. The governor, lawmakers and other powerful elites would remain eligible for health insurance premiums at significantly reduced rates — $8.34 a month for single coverage; $30 a month for family coverage. (By contrast, rank-and-file state employees pay $50 a month for single coverage and $180 for family coverage.)”
Fred Grimm in the Miami Herald writes “If the Senate version prevails over a less Draconian appropriation in the House, 34 percent of the mental health funding, and 25.5 percent of the money for substance abuse, would disappear. Some 140,000 patients would be tossed from their community treatment programs. A number of these non-profit programs would shut down. (Even without the Negron cuts, the Department of Children & Families has admitted that it hasn’t been able to provide services to 170,000 adults and 40,000 children with serious mental illnesses.)”
The state [of Florida] has been fighting with the feds for sometime now over implementation of its plan to privatize most of its Medicaid program.
via Florida legislators passing ceremonial bills denouncing health care reform | Florida Independent.
The Tampa Bay Times reports use of a Yacker Tracker at Tampa Bays two veterans hospitals. A Yacker Track “is a testing device that measure the decibel level on inpatient wards. Placed at nursing stations and looking like a red light signal, the device flashes red when the noise exceeds levels set by the hospital.”
VA hospital officials, it is reported, understand that noise can delay recovery and healing. Look for signs in the hospital that state “Quite please Patients healing.”
My research has always revealed that health care follows the money. So I was not surprised that the Insurance Company industry is profiting from the Health Law Mandate. This is not a “bad profit” if coverage has high quality of care and high quality of life.
Bloomberg reports
The industry that was the loudest, most persistent critic of this law, the industry whose analysts and executives predicted it would suffer immensely because of the law, has thrived,” Gosselin said. “There is a shift to government work under way that is going to represent a fundamental change in their business model.
The Justice Department had filed its first brief on Friday in the US Supreme Court. The Court is being asked to define questions about Congress’s power. This will have huge impact in Florida if the Law is upheld and the state is forced to comply. A watchful eye on this issue is needed. For more information please follow the link below.
Panel Wrestles with Federal Rules for Health Funding
“The issue centers on a $1-billion-a-year program known as the Low Income Pool, which sends extra money to hospitals and other providers statewide that care for large numbers of poor and uninsured patients. The so-called “LIP” program was created as part of the pilot, which is controversial primarily because it requires most Medicaid beneficiaries in five counties to enroll in managed-care plans.
Federal officials agreed in December to extend the pilot through June 2014 but placed strings on how $50 million of the LIP money could be used. Those strings call for taking money that otherwise could go toward hospital services and requiring that it be spent on new or beefed-up programs to improve quality of care.”
http://www.sunshinestatenews.com/story/panel-wrestles-federal-rules-health-funding
CNN is reporting that with Medicare reforms Doctors are going broke. As a counter point, accountable care organizations start this month, Doctors may seek shelter in these practices. ACO may offer more compensation to those providers if they can keep patients from needing expensive care. This is part of great effort to rewrite our social contract of care. If all the doctors roll into ACOs and this approach fails then we will start to head in a single provider system. We will need to keep an eye on this.
From PR Newsletter:
JACKSONVILLE, Fla., Jan. 5, 2012 /PRNewswire via COMTEX/ — Blue Cross Blue Shield of Florida (BCBSF) and the AmeriHealth Mercy Family of Companies (AMFC) today announced an agreement to enter into a joint venture to bring best-in-class Medicaid managed care and services to Florida beginning in mid-2012.
The joint venture, called Florida True Health, Inc., will be an equal partnership between BCBSF and AMFC. Both companies will share in the startup costs, financial risk and risk-based capital, among other business practices. Florida True Health will be responsible for Medicaid member enrollment, claims processing, provider network development, utilization management, quality management, customer service, community outreach, marketing, finance, actuarial and public affairs.
“This joint venture with AmeriHealth Mercy enables us to enter the Florida market with competitive capabilities from day one,” said Steve Booma, executive vice president of strategy and diversified business. “AmeriHealth’s exceptional operations and strong history in serving Medicaid members, combined with BCBSF’s 67-year history serving the health care needs of all Floridians, creates a unique organization dedicated to serve the state’s Medicaid population.”
Michael A. Rashid, President and Chief Executive Officer of the AmeriHealth Mercy Family of Companies said, “It is a privilege to bring our proven care management expertise to Florida. Our medical management and outreach programs have improved the health of our members for nearly 30 years. We look forward to working with the providers, community partners, the state and our BCBSF partner to make a positive difference in the lives of Floridians in need.”
Florida True Health will be headquartered in Florida, although the specific location of its offices has yet to be determined. Florida True Health will enter Medicaid as soon as state approvals are obtained.
About Blue Cross and Blue Shield of Florida
Blue Cross and Blue Shield of Florida (BCBSF) is a leader in Florida’s health industry. Since 1944, the company has been dedicated to meeting the diverse needs of all those it serves by offering an array of choices. BCBSF is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, FL, BCBSF is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information concerning BCBSF, please see its website at www.bcbsfl.com .
About AmeriHealth Mercy
The AmeriHealth Mercy Family of Companies is one of the nation’s leaders in health care solutions for the underserved. AmeriHealth operates in 11 states and serves more than 4 million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services, and other administrative services. Headquartered in Philadelphia, AmeriHealth Mercy is a mission-driven company with more than 25 years of experience serving low-income and chronically ill populations. AmeriHealth Mercy’s divisions include:
Keystone Mercy Health Plan, a Medicaid managed care health plan servicing over 321,000 members in five southeastern Pennsylvania counties;
AmeriHealth Mercy Health Plan, a Medicaid managed care health plan servicing 108,000 members in 15 Pennsylvania counties;
Select Health, a Medicaid managed care health plan serving 214,000 members throughout the State of South Carolina;
MDwise Hoosier Alliance, a Medicaid managed care health plan serving 133,000 members throughout the State of Indiana;
PerformCare/CBHNP Behavioral Health Services, servicing almost 1.1 million members in Pennsylvania, New Jersey, Indiana, and South Carolina;
Perform Rx, a pharmacy benefits manager servicing over 1.8 million members.
The AmeriHealth Mercy Family of Companies also provides other administrative services in New Jersey and Kentucky.
SOURCE Blue Cross Blue Shield of Florida
Copyright (C) 2012 PR Newswire. All rights reserved
Health Care Reform has been attempted by seven presidents. Obama’s administration with the Affordable Care Act, has put forth meaningful change. Even it’s detractors will state that it is legislation that is significant and can’t be ignored. There is strong argument that this is a mixed public policy debate on how to spend limited resources and survive in the political arena.
Whoever provides medical care or pays the costs of illness stands to gain the good will of the sick and their families. The prospect of these good-will returns to investment in health care creates a powerful motive for governments to intervene in the economics of medicine. Political leaders since Bismarck . . . have used insurance against the costs of sickness as a means of turning benevolence to power. Similarly, employers often furnish medical care to recruit new workers and instill loyalty to the firm. Unions have used the same means to strengthen solidarity. To be the intermediary in the costs of sickness is a strategic role that confers social and political as well as strictly economic gains. Paul Starr, The Social Transformation of Medicine
The quote above is a bit stale in today’s marketplace of medicine. Health Care services will always follow the streams of payment from whatever sources are available. With state governments unable to afford federal matching funds for entitlement programs the infrastructure of our community’s health care structure is truly at risk.
As the true cost of this health care infrastructure becomes more of a local government issue, limited funding may cause consolidation at the Hospital Level. Special Taxing Districts may increase to fund Hospitals. As the debate becomes more local a closer look a medical outcomes and cost of care will be fought at our doorsteps. We need to be watchful of this issue.
In the Tampa Bay Times, Sue Brody the CEO of Bayfront Health System, has written an excellent editorial on health care reform. She states, “health care is experiencing a paradigm shift unrivaled in the last 25 years.” According to Ms Brody providers have a tough mandate from the community and the government. While noting that “providers are re-engineering processes to make way for increased access and improved quality at lower costs”, she warns of risks to the community’s quality of care due to drastic cuts from the state budget. Large amounts of government money provide the funding for the poor who need specialized medical care. This enables private insurance and their insureds to access medical specialist at their local hospital who were made available due to Medicaid funding. click here
Michael Porter a Harvard professor on strategy looked at Health Care financial waste and suggested that only a few centers of excellence exist and redundant facilities of care be closed. There are more choices in the public debate, but we need to keep our eyes on this one.
On March 23, 2011, Governor Rick Scott established a commission to review whether government-run hospitals are in the best interest of taxpayers. He was motivated by a Florida Tax Watch report. This report show the rapid growth in hospital special taxing districts to pay for indigent care.
The Commissions draft report does highlight how concerned hospitals are over the medicaid reform approach the state is taking. The report did not suggest that public hospitals are not in Florida’s best interest. Here is the pull quote from the report. It
The Legislature has also established timeframes for the Medicaid program to move to managed care for the vast majority of its recipients. This is to be completed for the individuals receiving Medicaid long term care services beginning July 1, 2012 and completed by October 1, 2013; and for Medical services by October 1, 2014—Implementation begins January 1, 2013.
In a managed care environment, health plans and hospitals will negotiate a rate. They are not tied to the Medicaid rate, but the Medicaid rate is normally used in the negotiations as a reference or starting point. Sometimes, it ends up being the negotiated rate. If the state moves to DRGs, questions will occur as to how this may affect the health plans/hospital negotiation and establishment of a rate, as well as how local contributions may be affected.
Health plans will be required to contract with “essential providers” that offer services that are not available from any other provider within a reasonable access standard. Statutory teaching hospitals, hospitals that are trauma centers, hospitals located at least 25 miles from any other hospital will be included in this group.
It will be essential that managed care companies selected by AHCA in the competitive procurement process for the new managed care programs receive a fair portion in the capitation payment for the cells that represent the hospital component for each individual. Providing a system where managed care companies and hospitals receive fair compensation is a major challenge that will need continued monitoring and development by the Agency and the Legislature. It has been a somewhat contentious battle between hospitals and managed care companies surrounding the rate issues. Hospital rate increases should not be implemented without coordination of the managed care rate for the new program to be a success.
Taking both reports together, it would seem likely that property taxes may increase to fund local indigent care in the public hospitals. Keep an eye on this issue.
