Medicaid Waiver Presents Structuring Challenges
By year’s end, health care providers across Texas will have submitted proposals to state leaders to transform the way they care for the poor and uninsured. They have been spurred by a Medicaid waiver Texas officials sought and received in 2011 from the federal government, one that ties financing to cooperation, cost efficiency and better patient outcomes.
“We’re at a real turning point, some would call it a crisis, on how much money we’re spending on health care,” said state Rep. Lois Kolkhorst, R-Brenham, the chairwoman of the House Public Health Committee. “It is incumbent upon us ...
Comments (6)
Frank Kenisky via Texas Tribune on Facebook
The distribution of money in the hands of elected officials here in Texas where it has been redistricted to create a one sided majority. This distribution? Think about it. Care for the poor and uninsured is paramount to peoples health and well being. It makes them stronger and more able to work and get out of their poverty. We are sadden by the death of children at school by a gunman, but we don't care about the kids in schools slowing dying from lack of medical care. What kind of society do we live in?
Healthy Texan
Lois Kolkhorst is likely to be the biggest roadblock to bettering our health delivery system. If state "leaders" like Kolkhorst continue to bow at the trough of the medical associations and continue taking their orders from them, there is no way we can make our system better and provide good care for all of our citizens. Thousands of qualified providers, nurse practitioners, are ready and able to provide high-quality primary care, providing cost savings to the patient and to the system, yet Kolkhorst refuses to bring state regulations into the 21st century. It is really very sad. If we continue policies that artificially limit our provider supply, we will continue to drive up the cost and will continue seeing patients flock to the ER because of the severe lack of access. Great job Lois.
Miguel Berry
The proposal for Regional Health Partnership #20, which includes Webb, Zapata, Starr, Maverick, and Jim Hogg counties appears to have some glaring inconsistencies. Following are the comments I submitted:
The summary of Category 1-2 proposed projects for the Regional Health Partnership #20 for the Medicaid 1115 Waiver raises several questions:
DSRIP Incentive allocations for DY2-5 allow 33.4% to Border Region Behavioral Health and in terms of outcomes the OD-2 Preventable Admissions, IT-2.4 Behavioral Health/Substance Abuse Admission Rate is cited. How was this determined and why is this allocation and outcome prioritized over prevalent health risks such as cardiovascular, complications from diabetes, etc.?
In Category 1 Infrastructure Development, the Border Region Behavioral Health project involves establishing telemedicine service in Starr County. According to the plan document, Starr County is not included in RHP#20. Why is funding allocated to Starr County?. Also, in the follow-up Category 2 Program Innovation and Redesign, the project aims to "identify clients with co-morbid conditions and provide integrated primary and behavioral services", but does not mention Starr County. Why?
Camino Real Community Services is located in Lytle, TX and, according to its website, serves Maverick, Zavala, Dimmitt, Frio, LaSalle, McMullen, Atascosa, Karnes, and Wilson Counties. Its services are described as mental health, developmental disability, and early childhood. In its Category 2 project, however, it is to "co-locate primary care and behaviroal health care services..." How is this organization, which does not have a presence in RHP 20, co-locating in the region with primary services it does not provide?
The Laredo Medical Center is allocated a total of $8,725,010 for producing outcomes in OD-6 Patient Satisfaction, IT-6.1 Percent Improvement over Baseline. What commitments is LMC making toward this project when the listings for LMC in the Hospital Compare website at HHS.gov are mostly "no information available"? Also, who will be conducting the patient satisfaction surveys? If these are administered at the hospital, there is a substantial risk of bias. Moreover, unless there is a longer-term follow up, meaningful observations of post-treatment impacts by patients will not be obtained. There is a risk of a "self-serving" formulation of performance in this area.
The UT Health Science Center-San Antonio project is to "develop a mechanism to deliver epilepsy care." What is the incidence of epilepsy in RHP 20 and why does this outweigh other population health conditions?
The Summary of Community Needs cites #4 RHP 20 Health Assessment as a primary source. Is this document available for public review?
The Texas Department of State Health Services lists 10 conditions as "potentially preventable" hospitalizations. Were these used in evaluating community needs in RHP 20?
Item 13 on the Webb County Commissioner's Court Agenda for December 10, 2012 describes a proposal to increase the professional services contract with Larry Tonn & Associates by $100,000. Was a Request for Proposals issued for the original contract? What is the scope of services of the contract and why is an increase requested?
Christine Lund
How about simple problems like not having the money for a filling and losing $14,000 of dental work because of it. I still owe the money but have nothing to show for it. They wanted $60 for a simple filling. You go to the hospital in pain and agony with rotten teeth and they turn you away. Sorry Charlie. Now, if they'd helped me with a filling or two, I wouldn't have lost ten more teeth and now I need a lower denture and new upper partial. They pay for that. Crazy!
Christine Lund
Oh did I mention that they had to perform oral surgery twice, just about giving me a panic attack each time and losing ten pounds each time. Don't you think a filling would have cheaper?
David Spratt
Not to worry,, Obama is taking over come this year and all will be well. Kathleen and her minions are hard at work on your behalf. They have written over 14 thousand pages of regulations and rules and have only gotten started. This is all designed to insure you recieve the finest care possible. There could be well over 100,000 pages by the time they feel confident they have covered every possible aspect. Rest assured they will stay on top of developments and this process will never end. These cube monkeys are looking out for you.
Thousands of IRS agents are being trained to ferret out people who have means but refuse to purchase insurance. They will insure the money is collected one way or the other. So there should be no shortage of money. As well all of us who have insurance will be paying more. If more money is needed there is always Medicare to steal from or we can just simply print MO MONEY MO MONEY MO MONEY.
Just be patient,,, Obama is not superhuman and unlike Santa Claus or the Easter Bunny he cannot do all this in one day. .