I have to actually cut and paste the article because I am afraid it may disappear. Yet again, an article is posted TODAY, I make a comment on it and it is no longer on the front page of the Chicago Tribune. It has to make me wonder why. This is twice that I have posted a comment about the truth in medical treatment for stroke survivors in Illinois after they have lost their job and Medicaid cuts them off. The article is pulled from the front page as soon as I bring it to light. I have posted the link to the article above and will cut and paste the article below with my comment so it can be read.
Time to move on Medicaid spending
When Gov. Pat Quinn spoke Wednesday about the state of the state, he gave a brief nod to the groaning cost of Illinois' single biggest operating expense: Medicaid.
The state expects to have about $1.7 billion in unpaid Medicaid bills on hand at the end of fiscal 2012. That backlog will balloon to $21 billion in just five years if the state doesn't overhaul Medicaid spending.
That will be a diaster for the 2.7 million Illinoisans who depend on Medicaid, for taxpayers and for medical providers. More doctors are likely to stop accepting Medicaid patients because they won't get paid remotely close to on time.
Quinn's budget address is Feb. 22. That's when we should learn the details of how he proposes to curb Medicaid spending.
Here's what he needs to do:
• Speed the switch to managed care. Half of Illinois' Medicaid patients are supposed to be moved into managed care by 2015. The overarching strategy is to improve health care for Medicaid patients and save the state tens of millions of dollars. Managed care generally means patients are assigned a "medical home" — a doctor (it could be an HMO-style clinic) who oversees their care. Doctor and hospital fees are geared to delivering better health care, not just more of it.
So far, only about 40,000 patients have been switched to managed care. The state needs to dramatically pick up the pace of this vital program. The faster patients move to managed care, the better the care, and the more the state saves in cost.
• Accelerate the move of residents from obsolete and expensive institutions for the developmentally disabled to community-base care. Quinn's on the right track here with his plans to shut down two state institutions. The residents will get better care and the state will save money. But Illinois still lags far behind many other states in making this transition. Last year, Quinn proposed that several state facilities be shut. He needs to keep the state on course to reach that goal.
• End Illinois Cares Rx. That's a prescription drug program that supplements coverage for seniors. But the feds don't help pay for it. Eliminating it will save $54 million.
Illinois Department of Healthcare and Family Services director Julie Hamos is expected to deliver a wide-ranging list of Medicaid cost-cutting options to a bipartisan committee of state lawmakers later this month. The goal: Save as much as $2.7 billion in the $14 billion Medicaid budget.
"Everything has to be on the table to keep the program solvent," Illinois Sen. Heather Steans, D-Chicago, tells us.
Nothing's final yet. But we like what we're hearing.
The state could save big, for instance, by capping how much it will pay per patient for so-called "optional services." That includes dental work and prescription drugs. The idea: Patients should be allowed to choose from those services, but the state would set a cap on how much it will spend for each patient.
Another good idea: Require a co-payment from Medicaid recipients for emergency room visits that aren't emergencies. That could save millions by cutting down on expensive visits to the ER.
Providers also need to be in the savings mix. For Medicaid to thrive, hospitals need to reduce costly readmissions. Illinois has the highest rate of such readmissions in the nation, according to a 2010 study by the Center for Health Care Strategies Inc. The state should offer hospitals incentives to cut that rate, and penalize hospitals that fail.
Those are just some of the ways to save money while delivering quality care. There are many more.
Let's also remember that the state's Medicaid program will add up to 800,000 people beginning in 2014, when the federal health care overhaul kicks in. The feds will fully reimburse the state for those beneficiaries ... for three years. Then Illinois will be stuck with a slice of that bill.
Bottom line: Illinois needs to curb Medicaid spending dramatically starting now. Copyright © 2012, Chicago Tribune
History Teacher Lady at 11:21 AM February 4, 2012
"The state could save big, for instance, by capping how much it will pay per patient for so-called "optional services." That includes dental work and prescription drugs. The idea: Patients should be allowed to choose from those services, but the state would set a cap on how much it will spend for each patient."
I love this. Prescriptions are considered optional services. Tell this to a stroke survivor, like Senator Kirk, who is on 16 medications. Maybe the physical and occupational therapies are optional too. You know the things you need to learn how to walk and function again.
Medicaid seems to think that when you suffer a debilitating stroke you have too large of an income with disability to qualify for Medicaid. Let's not forget that you do not qualify for Medicare until 24 months after your stroke because of your age. Now all of your 16 prescriptions are paid out of pocket (+$600 a month) and you can no longer get your blood thinner levels monitored every month as they need to be. Yeah, those pesky optional blood thinners that were prescribed to PREVENT the clots running the length of your leg to get bigger and cause another stroke. Yeah, let's make sure none of that is monitored because Medicaid is paying for all of that optional life saving treatments.
This just makes me sick.
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