August 10, 2005

Other Southern States Attempt to Curb Medicaid Costs

A recent article in The Augusta Chronicle documented the ways in which Georgia and South Carolina are dealing with the rising costs of Medicaid in the face of impending Federal cuts. Even without Congressional cuts, many states would still be facing a financial crisis due mainly to the costs of prescription drugs and long term care. These cuts have forced states to develop innovative ways to address the rising needs of individual's health care and less money to fund the programs.

South Carolina has implemented a program that calls for Medicaid recipients to be given personal health care accounts to pay expenses. Patients could then choose an option that they feel would give them the best service for their needs. The South Carolina plan also hopes to slow the growth of the costs of the program by promoting competition among companies offering different plans.

Patients who spend their money wisely could be rewarded by giving them some of the money back or receive some sort of a gift certificate. But this still raises questions about people who do not spend their account well, or still have expenses beyond what they were provided. This system could also encourage people to ignore potentially serious health concerns so that they can keep some money from their account.

Georgia's plan is similar to a Florida model, and turns to managed care program. The state's Department of Community Health selected companies to enroll the state's more than one million Medicaid and PeachCare for Kids patients into the program. The program has divided the state into 6 regions, with each region serviced by a couple different companies that have experience running managed care programs. The state hopes to save tens of millions of dollars by paying the companies a flat rate per patient, but it remains to be seen whether those savings will materialize. The program will stress preventive care and provide primary care physicians, and attempt to educate patients to seek treatment before their illness becomes critical and more costly to treat.

Neither of these programs is perfect, but both make attempts to address this critical issue. The fact remains that something must be done, because the status quo will be inadequate to address the nations healthcare needs in the future.

August 09, 2005

Louisiana Looks to Study Nursing Home Fines

A recent article in The Times-Picayune has addressed the issue of nursing home sanctions in Louisiana.

Louisiana has long been considered to be lax in its enforcement of federal regulations for health care. Louisiana's homes, which often rank toward the bottom on key quality of care indicators, are far less likely to be fined for violations, even those that cause serious injury or death, than their neighboring states. For example, in the last four years, Louisiana's 309 licensed nursing homes have been fined a total of approximately $1.2 million. Over that same time period, Mississippi's 204 homes were fined $3 million, and Texas's 1,137 homes were fined around $7.4 million.

Some officials in Louisiana are beginning to investigate whether more stringent penalties will lead to better quality of care. Governor Blanco's Health Care Reform Panel spent months studying the state's long term health care program, and recommended that sanctions be increased and that the issue receive more study.

The study will be headed by the state's ombudsman for long term care, Linda Sadden. The group will also include state health regulators, representatives from the nursing home industry, advocacy groups and elderly and disabled people receiving long term care. Sadden has said that they will look at other states for guidance and see if the increased sanctions lead to an increase in the quality of care.

Sadden has said that while relatively little research has been done on the relationship between penalties and quality of care, the few studies that have been conducted suggest that strict sanctions serve as a motivator for nursing homes to improve. In California, for example, the maximum penalty was raised to $25,000 in 1999, and then again to $100,000 in 2001. Following these increases, the number of homes cited for serious violations has dropped from 30 percent to 6 percent in the last six years.

Some have cautioned against stricter penalties, suggesting that higher fines levied will reduce the monies available to provide a high quality of care. Others have countered that if the home is already providing a high quality of care, the increased sanctions will not be an issue.

The group meets for the first time on August 18. It will be interesting to see if this study leads to any dramatic changes in enforcement in Louisiana.

August 07, 2005

Random Bits Learned From The IDR Process

First, if you are doing your own IDR rebuttal, make sure that every page from a resident's chart (even if it is a back page) has the resident's name and a date on it. Second, make sure the names and dates are legible.

Many times, a facility's defense to treatment issues is the fact that the resident or responsible family members refused treatment or diagnostic tests. This defense will not fly unless you are able to demonstrate informed consent on the part of the resident or responsible family members. Thus, if the resident refuses labs that may, for instance, detect problems with dehydration--it is important that the physician clearly informs the resident or family members of the risks of refusing such labs.

If you are trying to administer medication , and he says "I don't want it", inform him of the possible consequences of not taking is medication. Then document the chart with the information and his response.

If you don't have this sort of information in the chart, you won't win on this issue.