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Nearly 35% of all the imaging costs ordered for 2,068 orthopedic patient encounters in Pennsylvania were ordered for defensive purposes, according to study presented recently at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
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A woman suffering from personal problems and the subsequent unexpected death of her son was involuntarily committed to a behavioral health center by a psychologist allegedly following a telephone conference in which the woman expressed suicidal ideation. The physician failed to document the specifics of the conversation on the records required for an involuntary commitment.
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If a cutting an optional service saves Medicaid $5 million, will this cause costs to increase by $5 million in another area of the program?
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Major Medicaid reform legislation signed by Illinois Governor Pat Quinn in January 2011 is projected to save $624 million to $774 million over five years, reports Theresa Eagleson, administrator of the Division of Medical Programs for Illinois' Medicaid agency.
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It is the broad inclusion of all services that makes Illinois' managed care expansion unique, according to James Parker, deputy administrator for medical programs at the Illinois Department of Healthcare and Family Services.
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While opportunities for cost savings exist in the Patient Protection and Affordable Care Act, some states will be unable to take advantage of these due to severe budget shortfalls, according to Stan Rosenstein, principal advisor at Health Management Associates in Sacramento, CA, and former California Medicaid director.
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Adults with mental illnesses in the Cash and Counseling program had higher satisfaction, both with their quality of life and with their paid caregivers, compared to those receiving traditional Medicaid services, according to an April 2010 study done for the Substance Abuse and Mental Health Services Administration, Self-Directed Care in Mental Health: Learnings from the Cash & Counseling Demonstration Evaluation.
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The federally funded increase in Medicaid primary care reimbursement rates, which requires providers to be reimbursed at parity with Medicare rates in 2013 and 2014, presents states with both challenges and opportunities, according to a January 2011 brief from the Hamilton, NJ-based Center for Health Care Strategies (CHCS), Increasing Primary Care Rates, Maximizing Access and Quality.
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Leadership and the convening of stakeholders, payment incentives, support for infrastructure, information feedback and monitoring, and certification and recognition are key factors for successful delivery system reforms, according to a December 2010 report from The Commonwealth Fund.
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Medicaid programs now have a new option to offer "health homes" to enrollees with chronic conditions, included in the Affordable Care Act (ACA). "The main reason we will see strong interest is that this is a population that is very high-cost, and often goes without needed care," says Jocelyn Guyer, co-executive director of Georgetown University's Center for Children and Families in Washington, DC.
