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(Governing)   Federal government penalizes Florida for implementing its alternative to Obamacare: legally declaring that people on Medicaid don't get sick more than six times a year   (governing.com) divider line 51
    More: Interesting, Medicaid Services, obamacare, federal government, emergency room visits, primary care physicians, social security act, managed care  
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1538 clicks; posted to Politics » on 04 Mar 2014 at 11:57 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2014-03-04 11:28:46 AM  
That sounds like a good way to handle the problem. Why don't they just legislate that everyone only gets sick once a year? That would save even more money.
 
2014-03-04 11:58:36 AM  
Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.
 
2014-03-04 11:59:25 AM  
Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.
 
2014-03-04 12:01:26 PM  

ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.


Its the portion that can be alotted for admin costs theyre withholding.
 
2014-03-04 12:02:14 PM  
I guess he wasn't kidding:

i1.ytimg.com
 
2014-03-04 12:02:28 PM  

Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.


Jesus fark, their solution really is "Poor people should die."
 
2014-03-04 12:02:54 PM  

Summercat: ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.

Its the portion that can be alotted for admin costs theyre withholding.


And yet, somehow, I think those admin costs are going to be found in the "After you've paid your own drug tests" foodstamp fund.
 
2014-03-04 12:03:06 PM  
'Good' cat.jpg
 
2014-03-04 12:03:40 PM  

Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.


I thought using Emergency Rooms instead of being insured was a feature of the system, not a glitch?
 
2014-03-04 12:09:34 PM  

ikanreed: Summercat: ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.

Its the portion that can be alotted for admin costs theyre withholding.

And yet, somehow, I think those admin costs are going to be found in the "After you've paid your own drug tests" foodstamp fund.


Which would be another violation.

I would expect that if there is gross incompetance or some other major failure there is a procedure for tempoarily taking management away.

But that would be sane.
 
2014-03-04 12:12:00 PM  
Headline should read "its alternative." "its." No apostrophe. Cripes.
 
2014-03-04 12:12:18 PM  
It's. Its.
 
2014-03-04 12:13:28 PM  
Not at all mean spirited...
 
2014-03-04 12:13:44 PM  
[hurls an apostrophe at menschenfresser's head and shakes impotent fist]
 
2014-03-04 12:14:02 PM  

ikanreed: Summercat: ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.

Its the portion that can be alotted for admin costs theyre withholding.

And yet, somehow, I think those admin costs are going to be found in the "After you've paid your own drug tests" foodstamp fund.


drug testing for ER visits?  They got the pee bottles right there and everything.
 
2014-03-04 12:15:12 PM  

menschenfresser: Headline should read "its alternative." "its." No apostrophe. Cripes.


Irregardless, we all know what subby is inferring.
 
2014-03-04 12:16:38 PM  

Bloody William: Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.

Jesus fark, their solution really is "Poor people should die."


Well, Gov. Deal of GA has already said he would like to see the EMTALA law 'revisited' (read: repealed), so is it such a big surprise?
 
2014-03-04 12:17:57 PM  
FTA: Florida has been limiting Medicaid patients to six emergency room visits a year even though federal officials consider such a cap illegal.

You know, honestly, if "Get" reviewing cases where a patient has visited the ER that many times. Maybe at 4 visits a case worker reviews your ER visit history and seeks to help you resolve whatever issue you are having, be it transportation or need for a primary doctor. But just drawing a line in the sand legally is stupid..
 
2014-03-04 12:21:03 PM  

Prank Call of Cthulhu: [hurls an apostrophe at menschenfresser's head and shakes impotent fist]


I feel bad now; in retrospect, it was pretty obnoxious to call that out in public.
 
2014-03-04 12:23:23 PM  
We had an alternative? I missed that memo.
 
2014-03-04 12:24:29 PM  

mrshowrules: ikanreed: Summercat: ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.

Its the portion that can be alotted for admin costs theyre withholding.

And yet, somehow, I think those admin costs are going to be found in the "After you've paid your own drug tests" foodstamp fund.

drug testing for ER visits?  They got the pee bottles right there and everything.


No, he's talking about the reqt that in order to qualify for welfare you need to take a drug test. That has been shot down though.
 
2014-03-04 12:24:36 PM  
These people know you don't go to the emergency room for general aches and pains and are guaranteed treatment, right? EMTALA doesn't say "if someone asks for treatment at an emergency room you must cure them", it says "if someone arrives at the emergency room with need for emergency treatment they must be stabilized.

If someone is visiting an emergency room every other month they have SIGNIFICANT medical concerns anyway, not just "someone too lazy to get a real doctor."
 
2014-03-04 12:25:20 PM  

BMulligan: menschenfresser: Headline should read "its alternative." "its." No apostrophe. Cripes.

Irregardless, we all know what subby is inferring.


For all intensive purposes it got the message across.
 
2014-03-04 12:29:59 PM  
It sure seems like GOP legislation is just plain mean spirited. do they do it just because they want to know in their hearts that they've screwed someone over?
 
2014-03-04 12:31:18 PM  
This wouldn't be too much of a problem if Scott had expanded Medicaid but he didn't so poor people can't afford to see a regular doctor.
 
2014-03-04 12:32:53 PM  

jst3p: BMulligan: menschenfresser: Headline should read "its alternative." "its." No apostrophe. Cripes.

Irregardless, we all know what subby is inferring.

For all intensive purposes it got the message across.


I'll post this anyway, but it's probably a mute point.

img.fark.net
 
2014-03-04 12:33:35 PM  

Grungehamster: These people know you don't go to the emergency room for general aches and pains and are guaranteed treatment, right? EMTALA doesn't say "if someone asks for treatment at an emergency room you must cure them", it says "if someone arrives at the emergency room with need for emergency treatment they must be stabilized.

If someone is visiting an emergency room every other month they have SIGNIFICANT medical concerns anyway, not just "someone too lazy to get a real doctor."


You would think so.

My ex-wife took the kids to urgent care for just about everything. Popcorn kernel in the kids ear, rolled ankle that could have waited, eczema rash.
My co-pay for a doctor visit was $25 but for urgent care it was $80. When I started demanding that she cover 50% of co-pays, as our divorce decree states, she started making doctor appointments.

/not saying I agree with what Florida is doing here
 
2014-03-04 12:59:03 PM  
I realize they want people to visit primary care physicians instead of going to the ER. While that's a good idea, there's a problem with expecting people to do this, that being a shortage of primary care physicians not just in Florida, but across the nation. Some don't take Medicaid patients, and the ones that do often aren't accepting new patients. This obviously leaves people without a primary care physician so they end up going to the ER instead.


Of course, there will always be those who have primary care physicians, but choose to use the ER instead.
 
2014-03-04 01:07:52 PM  

Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.


Seriously?  The GOP Party's solution is to fight the ACA Act by banning ER Room visits?
How will they learn? Maybe the National NFL Football League can threaten them like Arizona.
 
2014-03-04 01:29:24 PM  

Bathia_Mapes: Some most...the vast majority, don't take Medicaid patients, and the ones that do often aren't accepting new patients.


FTFA
 
2014-03-04 01:38:14 PM  

Bloody William: Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.

Jesus fark, their solution really is "Poor people should die."


That's their economic plan too.

//well, after "tax cuts for the wealthy", of course.
 
2014-03-04 01:51:01 PM  

Bathia_Mapes: I realize they want people to visit primary care physicians instead of going to the ER. While that's a good idea, there's a problem with expecting people to do this, that being a shortage of primary care physicians not just in Florida, but across the nation. Some don't take Medicaid patients, and the ones that do often aren't accepting new patients. This obviously leaves people without a primary care physician so they end up going to the ER instead.


Of course, there will always be those who have primary care physicians, but choose to use the ER instead.


FDR resolved a critical shortage of physicians by giving the physicians a choice: Quadruple the number of students in medical schools or I'll use the national emergency to draft you, pay you Army wages, and quadruple the number of medical students you have to teach.
Worked like a charm.
 
2014-03-04 02:04:40 PM  

Geoff Peterson: Bathia_Mapes: Some most...the vast majority, don't take Medicaid patients, and the ones that do often aren't accepting new patients.

FTFA


Really?

theincidentaleconomist.com

/image is hotlined to article discussing Medicaid access
 
2014-03-04 02:26:07 PM  

demaL-demaL-yeH: Bathia_Mapes: I realize they want people to visit primary care physicians instead of going to the ER. While that's a good idea, there's a problem with expecting people to do this, that being a shortage of primary care physicians not just in Florida, but across the nation. Some don't take Medicaid patients, and the ones that do often aren't accepting new patients. This obviously leaves people without a primary care physician so they end up going to the ER instead.


Of course, there will always be those who have primary care physicians, but choose to use the ER instead.

FDR resolved a critical shortage of physicians by giving the physicians a choice: Quadruple the number of students in medical schools or I'll use the national emergency to draft you, pay you Army wages, and quadruple the number of medical students you have to teach.
Worked like a charm.


Sometimes it's easy to be a dictator.
 
2014-03-04 02:40:18 PM  

Serious Black: Geoff Peterson: Bathia_Mapes: Some most...the vast majority, don't take Medicaid patients, and the ones that do often aren't accepting new patients.

FTFA

Really?

[theincidentaleconomist.com image 749x402]

/image is hotlined to article discussing Medicaid access


That's a nice graph. It does not disprove my statement. At all.
 
2014-03-04 03:11:48 PM  

kidgenius: mrshowrules: ikanreed: Summercat: ikanreed: Too bad the penalties only end up hurting people at the bottom more, as asshole politicians move that budget away to pay it.

Its the portion that can be alotted for admin costs theyre withholding.

And yet, somehow, I think those admin costs are going to be found in the "After you've paid your own drug tests" foodstamp fund.

drug testing for ER visits?  They got the pee bottles right there and everything.

No, he's talking about the reqt that in order to qualify for welfare you need to take a drug test. That has been shot down though.


I was facetiously implying extending it to ER visits
 
2014-03-04 03:32:24 PM  

Bloody William: Satanic_Hamster: Problem:  People using ER rooms as a regular doctors office.

Solution:  Just outlaw ER room visits.

Jesus fark, their solution really is "Poor people should die."


No, not die. Just be billed out the ass as a non-insured person despite having coverage.

You know. Like the rest of us.
 
2014-03-04 03:41:32 PM  

Geoff Peterson: Serious Black: Geoff Peterson: Bathia_Mapes: Some most...the vast majority, don't take Medicaid patients, and the ones that do often aren't accepting new patients.

FTFA

Really?

[theincidentaleconomist.com image 749x402]

/image is hotlined to article discussing Medicaid access

That's a nice graph. It does not disprove my statement. At all.


I doubt there's any evidence I could provide that you would accept as disproving your statement. The backfire effect is a biatch. But whatever, trudge on we must!

The rate of PCPs accepting new patients on Medicaid is not significantly different from the rate of acceptance for new patients on private capitated plans. The rate of pediatricians accepting new patients on Medicaid is significantly higher than the rate of acceptance for new patients on private capitated plans. The rate of OB/GYNs accepting new patients on Medicaid is significantly higher than the rate of acceptance for new patients on private capitated plans. Those are the most important doctors we want to accept Medicaid patients because it has primarily been a program for children and pregnant women, and it will likely continue that way in the future even after the expansion. Source data here.

Beyond that, what's the number one reason why a doctor won't accept Medicaid patients? Money. Specifically, doctors don't accept Medicaid patients because their reimbursements are for too little money in their judgment. ObamaCare increases Medicaid reimbursement rates so they look more like Medicare's. And if you look at the link I submitted above, Medicare has virtually identical acceptance rates for new patients with PCPs as private non-capitated plans.
 
2014-03-04 04:04:45 PM  

jigger: demaL-demaL-yeH: Bathia_Mapes: I realize they want people to visit primary care physicians instead of going to the ER. While that's a good idea, there's a problem with expecting people to do this, that being a shortage of primary care physicians not just in Florida, but across the nation. Some don't take Medicaid patients, and the ones that do often aren't accepting new patients. This obviously leaves people without a primary care physician so they end up going to the ER instead.


Of course, there will always be those who have primary care physicians, but choose to use the ER instead.

FDR resolved a critical shortage of physicians by giving the physicians a choice: Quadruple the number of students in medical schools or I'll use the national emergency to draft you, pay you Army wages, and quadruple the number of medical students you have to teach.
Worked like a charm.

Sometimes it's easy to be a dictator.


Dictator? The  Burke-Wadsworth Act  gave him the authority to do this.

(Lincoln wasn't a dictator, either.)
 
2014-03-04 04:12:25 PM  
I think Florida should be fined for this, but taking away even more money from Medicaid doesn't seem like the brightest way to do this. Even if the idea is to limit the fine to admin costs, that probably isn't how it's going to trickle down. Instead, hit states where it really hurts. Penalize their road funds.
 
2014-03-04 04:14:43 PM  
Serious Black:
Beyond that, what's the number one reason why a doctor won't accept Medicaid patients? Money. Specifically, doctors don't accept Medicaid patients because their reimbursements are for too little money in their judgment. ObamaCare increases Medicaid reimbursement rates so they look more like Medicare's. And if you look at the link I submitted above, Medicare has virtually identical acceptance rates for new patients with PCPs as private non-capitated plans.

Both of your cites are from the same source. I find this curious. I have no cites aside my own experience in the healthcare field. I know some physicians who are members of larger medical organizations are required to accept medicaid and have specialty practices to accommodate it. Occasionally an independent PCP may accept medicaid, but by and large they don't. Do they say they don't take medicaid? Of course not, but they "aren't accepting new patients at this time", or "we can't get you in until 2016". Why? because as you said, it's money. We're on the same page, but different paragraphs, methinks.
 
2014-03-04 04:22:26 PM  

Geoff Peterson: Serious Black:
Beyond that, what's the number one reason why a doctor won't accept Medicaid patients? Money. Specifically, doctors don't accept Medicaid patients because their reimbursements are for too little money in their judgment. ObamaCare increases Medicaid reimbursement rates so they look more like Medicare's. And if you look at the link I submitted above, Medicare has virtually identical acceptance rates for new patients with PCPs as private non-capitated plans.

Both of your cites are from the same source. I find this curious. I have no cites aside my own experience in the healthcare field. I know some physicians who are members of larger medical organizations are required to accept medicaid and have specialty practices to accommodate it. Occasionally an independent PCP may accept medicaid, but by and large they don't. Do they say they don't take medicaid? Of course not, but they "aren't accepting new patients at this time", or "we can't get you in until 2016". Why? because as you said, it's money. We're on the same page, but different paragraphs, methinks.


The Incidental Economist is primarily run by health economists, doctors, and stats geeks. They reference professional journals in their work, they don't shy away from complex explanations of issues, and they are careful to limit the impact of their personal biases and focus on what the evidence tells them is true. Small wonder an analytic type like myself would love their stuff.
 
2014-03-04 04:33:42 PM  

Serious Black: The Incidental Economist is primarily run by health economists, doctors, and stats geeks. They reference professional journals in their work, they don't shy away from complex explanations of issues, and they are careful to limit the impact of their personal biases and focus on what the evidence tells them is true. Small wonder an analytic type like myself would love their stuff.


Don't misunderstand me, I wasn't knocking the source, and my limited perusal it doesnt appear to be biased in one way or the other, but I didnt look at it too hard. Regardless, I think we can agree that a medicaid patient is not going to have the choice a private patient has and will have to endure more inconvenience than a private customer (i.e. longer trip, longer wait times, etc.)
 
2014-03-04 04:40:18 PM  

Geoff Peterson: Serious Black: The Incidental Economist is primarily run by health economists, doctors, and stats geeks. They reference professional journals in their work, they don't shy away from complex explanations of issues, and they are careful to limit the impact of their personal biases and focus on what the evidence tells them is true. Small wonder an analytic type like myself would love their stuff.

Don't misunderstand me, I wasn't knocking the source, and my limited perusal it doesnt appear to be biased in one way or the other, but I didnt look at it too hard. Regardless, I think we can agree that a medicaid patient is not going to have the choice a private patient has and will have to endure more inconvenience than a private customer (i.e. longer trip, longer wait times, etc.)


Actually, wasn't that your entire previous argument?  You stated that Medicaid patients will be overlooked by private physicians, usually by stating they aren't taking any new patients at the time.  I can tell you from experience that if a doctor isn't taking new patients, it's due to already being at capacity for what they can handle, not in any way due to how someone can pay for their visits.

But you go right on believing that it's all about how they are being paid.  There may be some specialists that pull that kind of crap (or a lot of loudmouth doctors who worry more about their income, and less about their patients), but it's the exception, not the rule.
 
2014-03-04 04:48:02 PM  

AurizenDarkstar: Actually, wasn't that your entire previous argument? You stated that Medicaid patients will be overlooked by private physicians, usually by stating they aren't taking any new patients at the time. I can tell you from experience that if a doctor isn't taking new patients, it's due to already being at capacity for what they can handle, not in any way due to how someone can pay for their visits.


Well, I was willing to meet in the middle (you know, where the truth usually lies). What, pray tell, makes your experience more valid than mine?
 
2014-03-04 04:58:32 PM  

Geoff Peterson: AurizenDarkstar: Actually, wasn't that your entire previous argument? You stated that Medicaid patients will be overlooked by private physicians, usually by stating they aren't taking any new patients at the time. I can tell you from experience that if a doctor isn't taking new patients, it's due to already being at capacity for what they can handle, not in any way due to how someone can pay for their visits.

Well, I was willing to meet in the middle (you know, where the truth usually lies). What, pray tell, makes your experience more valid than mine?


I work in the medical field, and know that when it comes to the patients that a doctor sees, they are usually audited each year.  If that audit shows that they are excluding a group of people based on how they will pay, it will come with the threat of losing access to Medicare money as well (and a lot of doctors take care of many of the elderly, so that does add up).

That's why I say, usually when it DOES happen, it tends to be specialists or doctors who want to 'stick it to the man', so to speak.  It's not as widespread as you make it out to be.
 
2014-03-04 05:00:43 PM  
However, they CAN turn away patients if they have no way (or cannot prove a way) to pay for the services rendered.  That's pretty much the only legal way that a doctor can turn away a patient.
 
2014-03-04 05:00:53 PM  

Geoff Peterson: Serious Black: The Incidental Economist is primarily run by health economists, doctors, and stats geeks. They reference professional journals in their work, they don't shy away from complex explanations of issues, and they are careful to limit the impact of their personal biases and focus on what the evidence tells them is true. Small wonder an analytic type like myself would love their stuff.

Don't misunderstand me, I wasn't knocking the source, and my limited perusal it doesnt appear to be biased in one way or the other, but I didnt look at it too hard. Regardless, I think we can agree that a medicaid patient is not going to have the choice a private patient has and will have to endure more inconvenience than a private customer (i.e. longer trip, longer wait times, etc.)


They could in some cases. They might not in others. Private plans have networks that limit coverage to a list of various doctors. These networks vary from one plan to another. My insurance plan could include in the network a large number of PCPs but none are accepting new patients. My insurance plan could cover only a couple of PCPs who all are willing to accept new patients. It's nowhere near as simple as private always provides better choices and more convenience than Medicaid.
 
2014-03-04 05:05:06 PM  

Serious Black: Geoff Peterson: Serious Black: The Incidental Economist is primarily run by health economists, doctors, and stats geeks. They reference professional journals in their work, they don't shy away from complex explanations of issues, and they are careful to limit the impact of their personal biases and focus on what the evidence tells them is true. Small wonder an analytic type like myself would love their stuff.

Don't misunderstand me, I wasn't knocking the source, and my limited perusal it doesnt appear to be biased in one way or the other, but I didnt look at it too hard. Regardless, I think we can agree that a medicaid patient is not going to have the choice a private patient has and will have to endure more inconvenience than a private customer (i.e. longer trip, longer wait times, etc.)

They could in some cases. They might not in others. Private plans have networks that limit coverage to a list of various doctors. These networks vary from one plan to another. My insurance plan could include in the network a large number of PCPs but none are accepting new patients. My insurance plan could cover only a couple of PCPs who all are willing to accept new patients. It's nowhere near as simple as private always provides better choices and more convenience than Medicaid.


Pretty much this.  The government keeps lists of participating doctors that accept Medicaid as payment and gives that information to those covered.  Much like any other insurance coverage does.
 
2014-03-04 06:19:09 PM  

Prank Call of Cthulhu: It's. Its.


... Mon-tee Py-thon's Fly-ing cir-cusss...

(cue "The Liberty Bell March")
 
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