http://www.arktimes.com/ArkansasBlog/archives/2013/02/06/medicaid-cost-growth-down-dramatically-is-reform-effort-the-cause Comments On: Medicaid cost growth down dramatically — is reform effort the cause? by David Ramsey en-us Copyright 2013 Arkansas Times. All rights reserved. This RSS file is offered to individuals, Arkansas Times readers, and non-commercial organizations only. Any commercial websites wishing to use this RSS file, please contact Arkansas Times. robert@arktimes.com (Arkansas Times Webmaster) Mon, 20 May 2013 00:00:01 -0500 Mon, 20 May 2013 03:45:00 -0500 Foundation http://blogs.law.harvard.edu/tech/rss
I certainly have no opposition to trying something different. But the reality is that when government (state or local) is controlling prices in half the health care economy, you're going to cause convolutions in the markets that drive prices for everyone else higher.

The point is that a dollar saved by Medicaid is just transferred (AKA as "cost-shifted") to the private half of the economy, or a corresponding decline in services will occur in the government half. There really isn't any way around this fundamental fact.

Tinkering with payment arrangements to gain efficiency is a good thing; but it must be recognized for what it is -- working around the margins of the core problem which is a government run program doing its best with what it has to work with. Until we come to our senses as a nation and privatize both Medicare and Medicaid, we will continue to see costs spiral out of control unless the quality of services are cut for government beneficiaries (this is already happening in many physicians offices, where fine medical professionals, but still lesser qualified ones, are seeing patients instead of physicians).
Posted by David Ray]]> Thu, 07 Feb 2013 11:02:18 -0600 Arkansas Times
Two quick points regarding your concerns. The Payment Improvement Initiative features BOTH positive and negative incentives, so it's not a reimbursement cut. Most providers will get the same or higher reimbursements. Also, for what it's worth, there are quality checks built in to the initiative in addition to efficiency checks. There is no doubt that there are many unnecessary or duplicative procedures/tests/etc. under the fee for service model. There is also no doubt that improved coordination between providers would likely cut unnecessary costs. That said, obviously, in an efficiency push there is also the risk that things will get cut that actually are medically necessary. The quality checks are meant to guard against that, as is the fact that the cost tests come over the course of a year, not for a given patient or incident. Whether this successfully mitigates against concerns about quality of care remains to be seen.

Another thing to note is that SEPARATE from the Initiative, there are flat cuts to provider reimbursements because of the shortfall. DHS does not want to make these cuts but they believe they have no choice because of the shortfall. In fact, they are especially reluctant to make those cuts since it could interfere with provider buy-in to the Initiative just as it's getting off the ground. In fact, the effort to control costs long term is precisely in reaction to their budget woes. I am pretty confident that if the Initiative works and they see more slowing of cost growth, one of the first places those savings would go would be toward eliminating the cuts to provider rates.

What we MIGHT be seeing is that providers are now looking for and working toward efficiencies more aggressively than they have before and that that alone MIGHT lead to slowing the long-term cost growth of the Medicaid program.
Posted by David Ramsey]]> Thu, 07 Feb 2013 10:37:16 -0600 Arkansas Times
Here's the deal with them. Ray started working as a teenager stocking new Wal-Mart stores when Wal-Mart was dinky. He was as serious as cancer when we were kids and worked like a demon no matter how hard the job. As I recall and I might be wrong because it was 40 years ago, I think maybe at first Ray skipped college to go to work for Wal-Mart full time, maybe he did some college on the side. Anyway, these were the early years where Wal-Mart was expanding like wildfire.

They sent him all over this part of the country opening little regular Wal-Mart stores, didn't matter to him what Podunk town they sent him too, he was at work early and ready to get after it. All that hard work paid off because Ray rose in the company like a helium balloon.

Ray was off on a Wal-Mart trip when Debbie went into labor and delivered a baby with unbelievable problems. Sam Walton sent his airplane to airlift her and the child to the hospital, I forget where and miraculously the baby lived though he still has very serious problems. As I recall Sam Walton paid for everything and rightly so because Ray had lived and breathed Wal-Mart every second for at least a decade by then.

Ray went on to become a Vice President of Wal-Mart for many years when being a VP really meant something and became very very wealthy. As I've said many times....money changes people and this thread would indicate that the Debbie Hobbs I once knew as a sweet young girl has changed.....and perhaps not for the better if she's picking on poor folks trying to walk the thin line it takes to make sure their kids have health insurance.

I wish growing up and growing older wasn't so damn sad. My generation was a wonderful bunch of kids before we got old enough to be greedy and started into hating and fearing and trash talking others. God this makes me sad!
Posted by DeathbyInches]]> Thu, 07 Feb 2013 01:16:05 -0600 Arkansas Times >Hobbs said. "So in my mind, I'm thinking if you worked that extra day, you could afford to pay insurance for your child and probably have a little extra money too."

Another perfect example of why YOU NEVER WANT a Republican running any economy.

There's such a thing as diminishing returns. One day of labor could put her maid $5 over the line to qualify and send the child to the "free market" which would cost more than a month's income.

They should never be allowed to run any economy. Never. They never understand numbers. Ask Curtis Coleman, Bradley Gitz.
Posted by eLwood]]> Thu, 07 Feb 2013 00:42:41 -0600 Arkansas Times
And it takes even longer to recognize the effect of the cost-shift to private insurance, which drives up the premiums of those who buy their own coverage. We often conveniently ignore this factor, but the government price controls of Medicare and Medicaid are the principle reason insurance costs spiral higher. It often takes a year or two for these consequences to be seen.

Simply put, there is no free lunch. While Medicaid administrators may see one, what they do not see is the effect on the overall health care system of cutting reimbursements to providers. In the end that means lower quality care, higher premiums to those who pay their own ways, or both.
Posted by David Ray]]> Wed, 06 Feb 2013 23:27:39 -0600 Arkansas Times Posted by plainjim]]> Wed, 06 Feb 2013 23:01:15 -0600 Arkansas Times
That's what I was thinking. I bet the cleaning lady couldn't buy insurance for the amount an extra day would pull in. Hobbs is living in total unreality when it comes to the working poor, obviously.
Posted by rablib]]> Wed, 06 Feb 2013 22:37:33 -0600 Arkansas Times What. A. Bitch.
Posted by the real any*mouse but login hates me]]> Wed, 06 Feb 2013 21:59:26 -0600 Arkansas Times Posted by Max Brantley]]> Wed, 06 Feb 2013 21:40:20 -0600 Arkansas Times
Good news indeed - unless the result is a significant decline in quality of care. It will take a while to find out. But let's be optimistic.
Posted by radical centrist]]> Wed, 06 Feb 2013 21:12:43 -0600 Arkansas Times
God help the people she represents!
Posted by Salieri]]> Wed, 06 Feb 2013 20:35:11 -0600 Arkansas Times Posted by Silverback66]]> Wed, 06 Feb 2013 20:25:37 -0600 Arkansas Times