New Medicaid: "Rewards for good patients"

[dajoki]

WP
http://www.msnbc.msn.com/id/13266267/

States reshape Medicaid program
New restrictions aim to save money

By Amy Goldstein

Updated: 1 hour, 4 minutes ago

After winning greater freedom from federal Medicaid rules, states are moving aggressively to transform the nation's largest public health insurance program, adding fees, restricting benefits and creating incentives for patients to take responsibility for their health.

The changes are just beginning in several states that are being watched closely by governors nationwide. Those changes are reshaping Medicaid, which covers 55 million poor and disabled Americans, so that the program more closely resembles private insurance, rather than a social welfare system run with a strong, central government hand.

Starting July 1, West Virginia will phase in a redesigned form of Medicaid that requires patients to sign a "member agreement," promising that they will keep doctors' appointments, take prescribed medicine and not overuse hospital emergency rooms. Patients who refuse to sign or to follow the rules will be eligible for less care.

Kentucky is dividing its Medicaid patients into four categories, depending on their health and their age, with different benefits for each group. Most adults will face higher co-payments for medical services and new limits on prescription drugs. But patients who sign up for a "disease management" program eventually will be able to earn credits toward extra "get-healthy benefits," such as eyeglasses or classes to quit smoking.

Florida, meanwhile, will privatize part of its Medicaid system in September, directing patients in Jacksonville and Broward County to pick from 19 health plans, each offering different services. In a departure from how states have reimbursed doctors or health plans, Florida health officials will rate the health of every Medicaid patient in the two communities and pay for only as much care as officials predict they should need

<<snip>>

The Bush administration is encouraging states to embrace the altered view of Medicaid. "We are trying to be as supportive as we can," said Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services. His agency has been coaching states on the changes they can make -- and swiftly approving states' revisions. When West Virginia's Medicaid commissioner, Nancy V. Atkins, sent the federal agency the proposal for the state's redesigned program on April 26, she was startled that it was approved one week later.

Rewards for good patients
Other states are not far behind the leading edge. South Carolina's governor has been pushing for changes that would include health savings accounts and rewards for being a good patient. Oklahoma's legislature has just passed a bill that would allow the state to pay health plans a defined amount depending on a patient's health. And a recent Missouri law calls for the current Medicaid system there to be abolished in 2008; its replacement is being designed.

[MercutioATC]

1. I worry about the application, but the theory is sound. N/T

[Warpy]

5. The application will run into trouble because you can't get

Medicaid unless you are destitute and pretty well disabled. That means patients who don't follow the rules because of mental retardation, sensory or motor problems, or just because nobody explained it all to them properly will be penalized by having even worse care.

The application will be rigid, trust me, brought to you by the kind of bureaucrat who came up with "zero tolerance."

[dajoki]

7. Agreed!!

[ThoughtCriminal]

9. My wife's doctor's advice for severe abdominal pain

Sleeping pills (Ambien).

He did not order any tests or scans. She refused the prescription and went to a different doctor who ordered tests, diagnosed and treated her infected colon. If we were on Medicaid, I imagine this would have classified her as difficult and uncooperative.

[undergroundpanther]

20. Yes it would have

This legislation is about screwing the poor.
And some people hate the poor and wish they'd all die,they believe the poor ask to be poor and blame the poor for causing their own poverty . This is the most insidious evil brought to society by the"fortunate ones".

Fuck the fortunate ones..sucess is not it's own rationale for action and the means never justify the ends.

[undergroundpanther]

19. The theory is about CONTROL

Controlling others and finding excuses to discriminate don't you GET that?
You cannot apply this kind of rule based discrimination because there will always be some asshole bigot in some high place with a wonderful plan to push people to comply with his little fetish for a grand society,and cracks will open up in the system and people will be hurt or discriminated against for no good reason...
And don't even get me started on greedy administrators who exploit the state programs,the petty psychopaths,who hurt vulnerable people to line their own pockets,who discriminate because they get off on a sick power trip,I have seen it myself.
I am on medicaid and I shower everyday..I got all my teeth..There are BIGOTS in the system.And they are the type of brownnosing psychopath bully scum that can ruin a system from the inside..

[Kutjara]

2. "Good patient" my ass.

Who decides what constitutes a 'good patient'? Are there extra points given for docility and taking whatever medicine your doctor pushes on you? Is seeking a second opinion indicative of being 'bad'? What about missing appointments because you have three kids to look after and a job to hold down? Do 'bad patients' have any rights of appeal against doctors who label them as such just to get them off their books? Will wanting an abortion make you a 'bad' patient? How about seeking treatment for an STD?

Where in the fucking Hipporcatic Oath does it say, "Seek to relieve suffering, but only those of whose lifestyles you approve"?

[jaxx]

4. How about just dying and getting it over with.

A good patient never needs anything.

[undergroundpanther]

15. Thank you

I HATE THE HEALTH NAZI'S TOO..
Fuck!!How DARE these bean counting nazis force me to comply to pogroms and not think for myself,how dare they tell me conform to their ideal human models and "norms" or else..,How dare they demand I take whatever they say, even when they fuck me over, hurt me or I cannot comply due to MY limitations, or die!!
I have had dumb ass doctors almost KILL me for my own good.They were ignorant of things like med clashes and they had"issues".
A doctor can be a psychopath too. Don't believe me? than you haven't had a psychopath in charge of your treatment.. yet,Well I have..And it is harrowing..

Fuck you BUSH. I hope you get cancer and DIE all alone.HATED in Pain.IN a gutter.Because you are not a "good patient" you fucking nazi asshole.

[Stinky The Clown]

3. VERY slippery slope to 'lifestyle' demerits

Everyone knows gay people all have AIDS from going to gay orgies where indiscriminate sex is the norm. :sarcasm:

And more seriously ... is sickle cell an issue that will result in higher deductable for 'some people'?

[MaraJade]

6. For twenty-two years, I worked for rate setting in PA Medicaid. . .

The number one complaints of providers everywhere was the failure of Medicaid patients to follow medical
advice. The low fees weren't the problem. The patient-related problems were.

Most pointedly, I remember a case where a mom was asked NOT to put her one-year-old to bed with a bottle
full of sugar-water because that was causing the primary teeth to decay. She ignored this advice for a
couple of years, as the child graduated from a bottle full of sugar-water to a bottle full of soda every
night.

As a result, when the permanent front teeth of her daughter came in, they were decayed. This resulted in
the child losing her permanent front teeth. Of course, the mom wanted the state to intervene and provide
cosmetic help, but cosmetic repair (outside of accident or catistrophic injury) is rightly prohibited
by the state as it is (rightly) believed that making people "beautiful" is a misuse of taxpayer dollars.

I also heard many complaints from physicians who wouldn't take Medicaid patients because they were
belligerent (true) or unhygenic (also true).

Current Medicaid patients should consider where they fall out in all of this and change accordingly.

[dajoki]

8. Many generalizations...

"I also heard many complaints from physicians who wouldn't take Medicaid patients because they were
belligerent (true) or unhygenic (also true)." Do you you mean ALL medicaid patients?

[MercutioATC]

10. You're going to take some heat for this, but I agree.

I have two very good friends who are E.R. nurses and my ex-wife is a dental assistant.

They all have similar tales.

[undergroundpanther]

16. Bigots ..even on DU

Listen to this jerk unwashed masses ..I'm just waiting to hear..Useless eater outta this pig's mouth.

Hey you bigots get your arrogant ass off of du and go to free republic with the rest of the poor haters ok?
I am on medicaid and I am damn belligerent and I got my reasons.I had the shit exploited out of me when I had blue cross. I ain't gonna go through that shit again with medicaid...You ever ask those dirty people you stick your nose up at their reasons? Get some empathy..Jeezus..

If you do ask and their stories are all the same couldn't it mean there is a PROBLEM with this society? A problem of bigots bullies and control freak snot balls like YOU being an elitist fuck wad and being oblivious to how fucking discriminatory you are..? I hate people like you it's a crying shame people even have to trust snots like you out-ta desperation. You don't like poor people QUIT YOUR FUCKING JOB with medicare..and go work for someone else dick wad. Oh,I forgot you'll keep that job,you like feeling better than the poor AND the state gives workers benefits and job security the private sector doesn't anymore.. regardless of your bad attitudes and bigotry..Shame you need to be fired if you hate who you help and treat them with disdain.Wish I was your boss I'd make sure you never work with disadvantaged populations again..

[ebayfool]

11. Medicaid patients are dirty & belligerent? BULLSHIT!

I'd venture that is a justification used because most docs don't want to deal w/medicaid patients for the lower pay they are reimbursed for them!

You make the pronouncements of 'true' & 'right' so glibly - I gather you had direct patient contact in order to be so very sure of your condemnation, yes?

Unfuckingbelievable stereotyping, in my fucking unwashed opinion.


Oops! Am I being belligerent?

[undergroundpanther]

18. Be MORE Belligerant..

Thanks..

"One of the great delusions of our time is that a service system can produce care. All kinds of systems steal this human word.In doing that, they put the mask of love on the face of control."
-- John McKnight

"The professionals are always sitting around saying,
'Now how can we motivate Ms. Client to do XYZ?'
The simple answer is to ask Ms. Client if she wants to do XYZ.
If she says 'No, I don't want to do that,' then you don't have to worry about motivating her."
-- Peg Englebert

"We will no longer attempt to prove how reasonable we can be. We will go before them, face to face, to fight for our freedom.We will not be held hostage to their administrative efficiency. We will not keep to our place. We will never again be put away.We are freedom fighters now.
And this is war."
-- Mouth Magazine

Grrrowoorwrwrrr..
Don't push me...I am belligerant I demand equal respect,and I will chew a bigot up and spit them on the floor for giggles and shits .. Because I will not be cowed by the likes of any elitist..I don't care what anyone thinks..Grrrrr..

I want your help, but I don’t want your help changing my mind or my liffestyle..What part of this Don't the control freaks understand??!!

"..it does not require a majority to prevail, but rather
an irate, tireless minority keen to set brush fires in
people's minds.." --Samuel Adams

[jbnow]

17. Besides the sweeping

generalizations made in your post...

missing front teeth are not just about "making people "beautiful"".
It will affect the placement of all of her teeth, making for a very bad bite which can lead to other problems. It will affect her eating and speech. The longer it goes the harder it will be to ever correct.

It will cause huge problems with self esteem and how others treat her. It will affect even her future employment.
Yes, it was the mother's fault. So the sins of the mother should "rightly" be visited on the child?

I had a client on Medicaid who was just starting a new job. His dentist told him he had to get his teeth pulled, they couldn't be saved. The dentist took many extra steps. She fought medicaid to have him get some immediate dentures before being fitted for the final ones for the very reason that he had to work and going toothless in public would be very bad for his self esteem. Perhaps it eventually worked because he had a psychiatric disorder.
She also contacted me and asked about setting up a meeting with patients who took psychiatric medications and those at CMH who prescribed them or worked with the patients. She wanted to explain the extra steps that had to be taken to take care of the teeth with those meds, even brought samples of artificial saliva.

I've had many clients on Medicaid. Most had older clothes and cheaper haircuts, but they were clean and wanted the best for their kids. Transportation could be an issue in getting where they needed to go, but it wasn't indifference.

Some were dirtier and with worse attitudes, just like some of my clients not on medicaid. Those poor enough to be on medicaid have to work harder to get anything done. I don't equate poverty with bad hygiene or bad attitudes.

There are sometimes underlying psychiatric conditions that do cause these issues, including depression.

Good patients, bad patients? Try being sick and depressed and having to take 3 busses in bad weather to get to the doctor and see what a good patient you are.

[underpants]

24. I believe you but this smells of finding reasons to boot people off

the system.

Less people less money the system needs. Less money less taxes, right? Maybe not less taxes for YOU but less taxes aren't you against taxes? What, whose taxes look lets not get off the subject are you FOR taxes or AGAINST taxes? Okay that is what I thought now run along....

What you say is very believeable but I know how these people operate and this reaks of "shrinking the beast" so the uber riche pay less taxes.

[nannah]

12. medicaid goes to TANF recipients or people w/ permanent, total disability.

Peope who receive Temporary Aid to Needy Families (TANF) also get Medicaid medical coupons for themselves and their children. Also children of families with limited incomes may be eligible for medicaid coupons. The other group of people who use medicaid coupons are people who suffer permanent, total disability defined by being unable to do any work in the national economy and have incomes less than @$650.00 a month.

Medicaid coupons provide health care services for gravely or chronically ill adults and children who rely on competent medical care to survive: children with progressive neurological impairments or birth defects; adults with life threatening heart disease, cancer, or progressive neurological disease.

Medicaid coupons are used by people whose lives are disrupted by mental illness or cognitive impairments, health problems that affect how people interact with their health care providers.

Medicaid coupons are used by many people during their end of life care and final illness.

Medicaid coupons provide health care to millions of children.

By what measure are these people targeted for draconian tightening of health care expenses?

[REP]

21. Those on SSD Usually Qualify for Medicare, Not Medicaid

Medicare is a different program, and those with permanent diability almost always qualify for it (generally speaking, most adults who have enough quarters to qualify for SSD also have enough for Medicare). Some Medicare patients may also qualify for Medicaid due to income, but it's not automatic that a disabled person is on Medicaid.

[OzarkDem]

22. Cancer patients will really get screwed

They're usually the first ones hurt, kicked out of the system because their care is expensive.

[nannah]

25. I used the income figure of below $650.00 to distinguish medicaid

recipients. That would include those whose SSD payments are below the SSI threshhold. For those who receive medicare the problems can be very complex as they get caught in "spend down" programs in order to get help with their medical bills.

[WildClarySage]

13. So if, as a resident of WV,

my doctor tells me (as she did last week) to take Tylenol PM to help me sleep (without considering that it's contraindicated for lactating moms because of the antihistimane properties affecting milk supply), and I refuse to take it, I can be considered a bad patient? I've discovered that I have to be responsible for doing the research and making choices for me and my family for our health and that I can't just blindly go along with what she says.

And if a laboring mom decides for herself that she doesn't want an epidural, episiotomy or non-emergency c-section, is she being a bad patient who can be put on report? Where does patient empowerment fit into this???

[MountainLaurel]

23. Sing it, Sage

My grandmother is one of those Medicare patients in WV. She doesn't drive, has never driven. Her doctor's office is in the county seat, several miles away. She generally relies on family members to get her to the doctor. I hate to think that medical care will be denied to her because my aunt had an emergency at the last minute and couldn't take her to the doctor.

:grr:

[undergroundpanther]

14. This is WRONG.

Because sometimes doctors are wrong. Ever been to a state doc?
One that sees you for ten minutes and hands out drugs?

Sometimes those drugs have side effects,and if it takes a month or longer to SEE the doc,what are you to do take a medicine that makes you sick?

What are they gonna do DISCRIMINATE like for profit health insurances do?

This is Bad,very very bad. Those of you who do not see it or are not on state insurance,or never had to deal with a bad system screwing you up..,I wish you'd get your heads out-ta the do good-er fantasy land and realize this change is not motivated by a desire to help people it's motivated by a desire to control or worse.I can't believe how trusting you are of legislation that is so restrictive and controlling.I really AM scared for this country and it isn't just the right I'm scared of anymore..Shiver..

[dajoki]

26. We ALL should be scared n/t