* Gov. Pat Quinn said this week that Medicaid has to be cut by $2.7 billion. According to the AP, Quinn’s administration has prepared a “menu” of doable Medicaid cuts totaling $1.9 billion, plus options for reducing provider payments by as much as 9 percent, which would save $825 million…
The list includes some items that probably seem reasonable to people covered by private insurance plans: Limiting the number of eyeglasses paid for each year, for example, or eliminating coverage of chiropractors. The current Medicaid program has no annual limit on eyeglasses or chiropractors.
The menu includes limiting — or eliminating entirely — dental care for adults and “durable medical goods” such as walkers and wheelchairs. It includes axing smaller programs for sexual assault victims, people with hemophilia and refugees who’ve been victims of torture. Obesity surgery is on the list for limits or elimination. […]
The list also include more drastic cuts, such as changing eligibility rules for nursing homes and at-home help so that some incontinent elderly people who can’t prepare their own meals would be denied state-financed care… Also on the menu is excluding illegal immigrant children from the All Kids program. […]
The list states that a 9 percent reduction in payments to hospitals, doctors and pharmacies would reduce state and federal Medicaid spending by $825 million next year. A 6 percent rate cut would reduce spending by $550 million, according to the list.
* Chief Financial Officer Dave Storm of St. Anthony’s Memorial Hospital in Effingham lays out his case…
(I)f Medicaid is looked at historically, it’s not necessarily the costs that are major factors in funding, but the number of patients eligible for Medicaid, Storm said.
As the state increases eligibility for everything from Medicaid to education programs, more people are taking part in the assistance. However, funding hasn’t followed the furnishings.
“But they haven’t done anything to allocate more dollars for those programs. It’s the growth enrollment side of it,” Storm said, adding the cuts go deeper for St. Anthony’s than just losing a portion of Medicaid payments.
The hospital, as well as others in the state, already pay into the hospital assessment program, totaling about $900 million a year from those in Illinois that contribute. Approximately $770 million, is federally reimbursed through Medicaid.
* Another provider speaks…
Dr. Paul DeHaan of Crystal Lake, an orthopedic surgeon with Mercy Health System in McHenry, said Medicaid already is in crisis, and that Quinn’s plan will make things worse.
“Access for Medicaid patients to get in to see a doctor is limited,” DeHaan said. “There are only a small number of practices that will accept new Medicaid patients. Too many doctors won’t or can’t see new Medicaid patients.”
“Private practices are small businesses, just like any small business,” DeHaan added. “They’re strangling under the financial burden of the Medicaid system as it already exists.”
DeHaan, who was in private practice in McHenry for 20 years before joining Mercy Health System six years ago, said Medicaid payments are less than the cost of providing services.
And health-care providers are paid “very, very late. It creates a cash-flow problem for doctors. They cannot make a profit.”
* And another…
Patricia Comstock, executive director of the Springfield-based Health Care Council of Illinois, a group representing long-term care facilities, said reimbursement rates for Medicaid nursing home patients were $120 per day for 24-hour care.
“The funding the state of Illinois provides for our residents is already last in the nation,” she said. “It is impossible for us to think of doing what we are required to do with anything less.”
The providers are well-organized, well-funded and well-represented in Springfield. They’re also right that Illinois has kept reimbursement rates relatively low. Medicaid recipients have no high-powered lobbyists, aren’t all that organized and aren’t well-funded. In some ways, their interests coincide with the providers. In others, not so much.
- Cindy Lou - Friday, Feb 24, 12 @ 11:54 am:
So what is the replacement plan for feeding homebound elderly unable to make their own meals?
- Danny - Friday, Feb 24, 12 @ 12:13 pm:
ouch. I’m glad we’re at least having this discussion, though. I’d like to hear more specifics about the numbers…I mean, of course folks on Medicaid shouldn’t be getting 2 pairs of eyeglasses each year. But we all know cutting chiropractors and eyeglasses ain’t gonna add up to $2.7 billion.
It’s the stuff that hurts…programs for tortured refugees, care for our disabled elderly…That’s where the real money (and human suffering) probably is and I want to know just how much we’re talking here.
- Irish - Friday, Feb 24, 12 @ 12:17 pm:
The thing that irks me is the lack of thought that goes into some of these ideas. Quinn says he wants to close state human services institutions and put people into local care programs. Then he says he wants to eliminate coverage for people who are being assisted at home at the local level. Is there no one that looks at that and says “now wait a minute , do you realize what you are saying?”
- Aristotle - Friday, Feb 24, 12 @ 12:18 pm:
“…many doctors won’t or can’t see new medicade patients.”
I have never understood this argument. If the governement can require, lets say a cab, to pick up a fare that may cost more than the the fare charged as a condition of keeping their operating licese, why can’t the legislature require a doctor or other healthcare provider to see a medicade patient as a condition of licensure? There are many more examples, but I like the modest cab driver struggling to make ends meet.
- Irish - Friday, Feb 24, 12 @ 12:28 pm:
Aristotle @12:18 - I believe it has to do with the rate of reimbursement and/or the lack of reimbursement.
The cab driver might have to pick up any fare but he still has the ability to charge the fare full price for the ride. The health provider taking in Maedicaid patients has to accept what ever the state says the going rate is for medicaid reimbursement. Providers who have too many medicaid patients cannot afford to stay in business as they actually lose money. This is true of pharmacies, also. Many operate on close profit margins and can lose a lot of money on prescriptions especially when a doctor prescribes one of the very expensive specialized drugs.
- Aristotle - Friday, Feb 24, 12 @ 12:33 pm:
Irish, 1st please excuse my earlier typos, but like the health provider, the govt sets the cabs fare rate. A cab company must dispatch a cab to pick up a fare even to the most remote corners of its service area and the customer may only require a short trip; thus costing the operator more than the fare in fuel, lost opprtunity, etc. This cost is imposed as a cost of doing business. I believe my analogy remains sound.
- Peggy R/Southern - Friday, Feb 24, 12 @ 12:36 pm:
From what I read in the papers and the links here, it looks like Medicaid is the only component of public assistance that is on the table for cutting. (eg, housing subsidies, SNAP, etc, monthly stipends for poor) I hope not.
I do agree with the St Anthony’s CFO that too many people are enrolled in Medicaid. Eligibility should be restricted further. Several hospitals in central-southern IL are run by the Hospital Sister of 3rd Order of St. Francis. The 2 hospitals in Bville are plotting expansion/relocation to O’Fallon, where pop is growing due to Scott AFB growth. I am curious as to their revenue expectations given many new O-care rules and likely state medicaid cuts. (Yes, the contraception mandate will be an issue for the many Catholic hospitals in IL. Not the topic here, however.)
- Responsa - Friday, Feb 24, 12 @ 12:50 pm:
Aristotle– the necessary ongoing schooling, the malpractice insurance costs, the equipment outlay, the support employees, and the physical office requirements of doctors in a clinic being forced to provide medical services below cost is not comparable to your cab driver analogy.
- Gregor - Friday, Feb 24, 12 @ 12:58 pm:
The medicaid math is like triage.
And nobody likes that math, or the mathematician.
Between a choice of cutting the elderly and cutting children, you spare children, of course, because they have their entire lives ahead of them, and any adult who’s had children would tell you that they’d rather see the next generation get a better chance, than hang on themselves. That said, there is no need to put more kids on the program when their parents can pay for some or all their care.
And it is stupid to kick elderly and Developmentally challenged, out of facilities, only to also lose the home care funding that would have replaced institutionalization and incidentally helped create jobs for health care workers.
Obesity is generally self-inflicted, so those treatments, I feel, should be funded as electives, and state aid limited to expert phone and internet counseling services.
As far as dental, at first glance that seems uncontroversial as something to cut, but recent studies have proven links between dental/gum health and diabetes and heart problems, both of which lead to higher care expenses for everyone than just to keep treating the dental cases with a minimum level of care. I think you keep dental visits but you don’t pay for cosmetic stuff, only cleanings, plain cavity fillings, extractions, flouride, and simple dentures or what-have-you.
At the provider side, we should be demanding providers take more extensive use of “informatics”, that is, computerization of records, which boosts efficiency as well as giving a better way to track treatments and costs, and rapidly communicate between all the stakeholders.
- titan - Friday, Feb 24, 12 @ 1:03 pm:
Aristotle - It isn’t possible to successfully mandate service providers to provide services at a loss on a long term basis.
The cab analogy doesn’t work, because the fares are set up to provide - overall - a profit (even though some individual rides are not profitable). We’re already at the point where the gov can’t require more services at a loss in medicine.
- Wensicia - Friday, Feb 24, 12 @ 1:07 pm:
Restrict eligibility and cut back on what’s covered is the best way to start.
- Kerfuffle - Friday, Feb 24, 12 @ 1:14 pm:
Aristotle: “I believe my analogy remains sound.”
It is only sound until health care providers decide rather than go broke they will move to another state where reimbursement rates provide for a margin of profits or hosptals and nursing homes close their doors. So, under your analogy, cab drivers will be taking patients across state borders and maybe we can get other states to pick up the cost of health care for our citizens as well as the cost of the cab fare to get there.
- Skeeter - Friday, Feb 24, 12 @ 1:23 pm:
Aristotle has a point. As a member of the Trial Bar of the United States District Court, I’m required to handle cases assigned to me by that court, often without fee.
If lawyers have to do it, it seems docs should have a similar requirement.
- Aristotle - Friday, Feb 24, 12 @ 1:23 pm:
Titan - “overall profit” Under that logic, medical providers should be required to disclose profit and loss statements before they can turn down a medicaid patient. And just to make it fair, let’s cap the doctor’s pay so as not to skew the loss side of the ledger. Under those conditions, i.e., a provider is operating overall at a loss; I would agree that a provider can reject a patient; but any provider who is making an overall “profit” would still be required to accept the medicaid patient. That would seem to open up the pool of providers to a great extent, thus reducing the artificial shortage of “willing” providers.
- reformer - Friday, Feb 24, 12 @ 1:25 pm:
Sixty percent of Medicaid goes to nursing homes.
IL already ranks last in reimbursement rates to nursing homes.
Our choices are these:
1) Kick people in need off Medicaid.
2) Lower rates to providers.
3) Delay payments, or
4) Admit we don’t have sufficient revenue to provide the basic services we think are necessary.
- steve schnorf - Friday, Feb 24, 12 @ 1:29 pm:
I pick #4. Now what?
- Kerfuffle - Friday, Feb 24, 12 @ 1:29 pm:
Skeeter - “If lawyers have to do it, it seems docs should have a similar requirement.”
How many cases do you get in a year that are assigned to you vs. the number of cases you handle where you charge a fee? I’ll bet the percentages aren’t even close. Would you remain in business in this state if the courts mandated so many cases that you could not make a profit?
- Aristotle - Friday, Feb 24, 12 @ 1:33 pm:
I pick #2, but add the requirement that providers cannot reject medicaid patients.
- Skeeter - Friday, Feb 24, 12 @ 1:38 pm:
Ker,
My understanding is that for a significant number of MDs, the number of patients that see for free comes close to zero.
If you spread out that burden some, it might help.
- Peggy R/Southern - Friday, Feb 24, 12 @ 1:39 pm:
Aristotle: Do you realize the extensive regulation your suggesting? Of individual doctors’ profits? That’s insane. You will have tons of good doctors going Galt. Profit regulation is what states do regarding monopolies. We want competitive, lower-cost markets for insurance and medical care.
Reformer: I understood that Medicare is for retirees, while Medicaid is for non-retirement age poor (ie, single moms and their minor children). That is the federal distinction I am sure.
- Kerfuffle - Friday, Feb 24, 12 @ 1:42 pm:
Reformer - “Sixty percent of Medicaid goes to nursing homes.”
#5 Mandate that anyone over the age of 70 be required to move out of Illinois.
- Rich Miller - Friday, Feb 24, 12 @ 1:45 pm:
===I pick #2===
You’re just $1.9 billion short. Try again.
- Cindy Lou - Friday, Feb 24, 12 @ 1:49 pm:
Wondering if they will actually look at the average cost of something as simple as a walker and/or wheelchair vs average cost of fall/fix and rehab BEFORE they decide what gets the cut mark checked next to it.
- Irish - Friday, Feb 24, 12 @ 1:52 pm:
Reformer
Although it was not offered I pick #5. #5 is a thorough audit of Medicaid procedures. ie: ER docs prescribing expensive non symptom related drugs to satisfy medicaid patients, namely giving scripts for viciden to patient presenting with a cold. This goes on more than you would think. The patient is either addicted or sells the pills on the street. In areas where there are many hospitals this patient can go to several ER’s and get pills from each. Another example are the Medicaid people who are on disability due to addiction. There is little monitoring of this program and little push to get these folks back into society and off of the Medicaid program that basically changes their supplier from a street corner to the corner pharmacy. If we want to be serious about Medicaid reform we should take the time to examine the programs thoroughly and get it right.
- Aristotle - Friday, Feb 24, 12 @ 2:01 pm:
Peggy R - Extensive regulation and monitoring doctors profits is not my forst choice or goal. I am simply saying that mandating providers to accept medicaid patients will spread the burden over more providers. I am sure the Michigan Ave. boutique offices can absorb some. What’s killing providers is the disprportionate share they are taking on.
Rich - “$1.9billion to go”. Cut the rates even more, but spread the burden.
- dupage dan - Friday, Feb 24, 12 @ 2:04 pm:
Skeeter,
What’s your overhead? How much legal diagnostic equipment do you maintain in your office? Do you have to maintain a sterile environment in your office? Do you have a full time staff person whose only job it is to scrutinize all patients insurance cards & seek referral approvals from the central billing agencies as mandated by the insurance carriers? As well as a receptionist and a medical tech to assist w/routine testing (BPs, temps, etc)?
How about your malpractice insurance? How many tens of thousands of dollars do you have to pay for that each year? If you are a specialist, especially in the more risky practices (you’re an attorney - maybe you can tell us what they are) your insurance can run well over 50K a year. That’s right, Skeeter, you’re correct - neuro-surgery and obstetrics are the big winners in the high malpractice insurance costs. Bet you can tell us why, too.
Really, now, can you compare the overhead costs of your office to that of a medical practice?
Frankly, the medical industry suffers from a lack of market forces. As long as there are 3rd party payers there is likely to be a problem. Many support medical savings accts that encourage people to self-limit their use of the system by rewarding those who use the system less. Medical malpractice lawsuits which cause Drs to be overcautious and order multiple tests to protect against lawsuits increase medical costs. I broke a rib once and ended up getting a 2D echocardiagram, bone scan, referral to an oncologist all because I complained of the pain. If medical costs in general can be lowered then the costs of medicaid can be reduced as well.
But, comparing your law practice to that of a medical practice is…..well……overacting a bit.
- Anonymous - Friday, Feb 24, 12 @ 2:09 pm:
Responsa’s seems to believe that PR talking points trump business logic and models when it comes to the medical profession.
Once went to a dermatologist on the North Shore. One doctor had–no lie–nine women behind the counter to support him, who did nothing but gossip and argue during all of my visits to the office. ALL were related to the M.D., of course–and one of them verified that they all worked full-time for the M.D., were on his payroll, and there were no other doctors practicing in that office.
Tell me, Responsa, why does a single dermatologist need nine relatives, which I’m sure are making a pretty penny, to contribute to his overhead and to expose his patients to additional stress by having to listen to their banter?
Great business model.
- Anonymous - Friday, Feb 24, 12 @ 2:10 pm:
Sorry…that should have been “Responsa seems to believe….
- Skeeter - Friday, Feb 24, 12 @ 2:13 pm:
Du Page Dan,
What? Doctors have overhead? I never knew that! Those poor doctors! How do they survive? We should hold a fundraiser!
Few things are a pathetic as hearing people whining when their average salary is higher than just about any occupation.
Doctors want the privilege of practicing but no obligations. The average salary for a doc in Family Practice (probably the lowest paid) is around $200,000. Average salaries in other fields are of course significantly higher.
They can afford to see a few patients for free.
It is one thing to say that doctors don’t want to see patients for free. I get it. I don’t want to take clients for free. But can’t? Except for very few, that is ridiculous and frankly sort of insulting.
- Demoralized - Friday, Feb 24, 12 @ 2:19 pm:
Peggy R:
The elderly receive BOTH Medicare and Medicaid. Medicaid pays their Medicare premiums. Medicaid picks up what Medicare doesn’t cover. Now, Medicare only covers limited long term care - i.e. medically necessary skilled care. Medicare doesn’t cover long term care if the person needs cared for generally because they cannot care for themselves (i.e. get dressed, get around to feed themself, etc.). There are a great many people that do not meet the definition under Medicare to get long term care.
- wordslinger - Friday, Feb 24, 12 @ 2:28 pm:
–Between a choice of cutting the elderly and cutting children, you spare children, of course,–
Not so you’d notice, because seniors, God bless them, live better and longer today than ever. I don’t begrudge that, but certainly seniors in need have a leg up on children in need in our society.
But we’re talking about Medicaid, anyway.
I think Aristotle and Skeeter are on to something (as were Hippocrates and Dr. Mudd). How do doctors refuse anyone?
They’re licensed. They’ve been educated in schools that take tons of taxpayer money. The taxpayers — through employee benefits, VA benefits, Medicaid, Medicare– are by far single biggest payer.
I think, as a society, we have to start shaving zeroes off the right-hand side of the cost of medical care. Maybe we forgive all student loans for medical students and require free care. Maybe we insist that “non-profit” hospitals actually be non-profit. I don’t know. But we can’t sustain the arc of health costs. This issue ain’t going away anytime soon.
- Anonymous - Friday, Feb 24, 12 @ 2:33 pm:
Oh, and I should add that during each of those visits–and when trying to make my own appointments, the calendar used to make patients’ appointments kept being moved by the nine women, as a form of sabotage it seemed, to make the others *look* incompetent–which was usually the crux of their arguments when they weren’t gossiping about their patients and each other.
It also took them quite some time to find patients’ files because they kept “moving around” as well. And, the waiting room was always filled with patients who had to wait an hour to get in to see the M.D. because of the front office’s incompetence.
Needless to say, the M.D. looked EXTREMELY stressed and unhappy when you finally got in to see him.
- Plutocrat03 - Friday, Feb 24, 12 @ 2:41 pm:
Seems like the solution is free services for all.
And here I thought slavery had been outlawed
- Judgment Day - Friday, Feb 24, 12 @ 2:45 pm:
“#5 is a thorough audit of Medicaid procedures”
Irish, that’s a nice try, but in IL, it’s going to pretty much be a total failure. I have recently (over the last 6 months or so) started to get a little bit more of a ‘ground floor’ education (self investigative) into the back office computer systems used by HFS and the various assorted limitations and weaknesses.
Let’s just say that you’re not going to get to where you want to go from where you are currently. Not happening, and certainly not anytime soon. The back office operations at the state level (particularly digital) are woefully inadequate for what you would want to do.
- Kerfuffle - Friday, Feb 24, 12 @ 2:47 pm:
Aristotle: “Cut the rates even more, but spread the burden.”
Okay then, if a 9% rate reduction equates to $825 million and we need to get to 2.7 billion then we would need to cut rates by only 31%. I’m sure it won’t affect the quality of care at all. I’m also sure that no hospitals will close, no doctors will close their practices, and that Al Gore did in fact invent the internet.
- Kerfuffle - Friday, Feb 24, 12 @ 2:53 pm:
Skeeter - You wouldn’t by chance be a medical malpractice attorney would you?
- Aristotle - Friday, Feb 24, 12 @ 3:01 pm:
Kerfuffle - “cut rates by only 31%”
Thus,retaining 69% of revenues, assuming you are a 100% medicaid provider. A lot of businesses in Illinois would kill to have retained that much revenue over the past several years. Time to get real.
- Rich Miller - Friday, Feb 24, 12 @ 3:04 pm:
Aristotle, it cannot be done. You’d crash every Medicaid provider in Illinois.
- Kerfuffle - Friday, Feb 24, 12 @ 3:05 pm:
Aristotle: “Thus,retaining 69% of revenues…”
You mistake revenue for profits. If you get a dollar for a unit of service and it cost $1.25 to provide that unit you have a loss.
You also don’t seem to recognize the consequence of the action you are suggesting.
- Skeeter - Friday, Feb 24, 12 @ 3:05 pm:
Ker,
Great paranoia. That sort of comment is why I avoid the comment sections on other blogs/news sites. “Hmmm, what is the hidden meaning? What is the masked agenda?” I can’t stand wading through that sort of stuff on other sites. The lack of such comments is what makes the comment section on this site worthwhile.
You don’t have substance, so you attack who you think I might be. If you have a substantive response, I’m happy to respond. But don’t give me that sort of nonsense.
In answer to your mindless question though, no, I don’t do med mal or any personal injury work at all. In fact, I have many friends who are M.D.s. Unlike some, I’m capable of posting without any financial incentive at all (except to the extent that good government is a financial incentive).
- Aristotle - Friday, Feb 24, 12 @ 3:16 pm:
If you cut rates across the board including supply chain, you have also reduced unit of service costs. Let’s not get carried away with simplistic accounting arguments. You’re position is predicated on the assumption that providers are losing money. That point can’t be demonstrated until the cost side is vetted.
- Kerfuffle - Friday, Feb 24, 12 @ 3:19 pm:
Skeeter - Your skin is too thin! I, as you seem to suggest, have no financial “skin” in this game as you seem to suggest and don’t disagree with your suggestion that doctors who don’t provide Medicare services ought to but I just fail to see where this solves the problem in any way, shape, or form - it just spreads the pain.
- Kerfuffle - Friday, Feb 24, 12 @ 3:26 pm:
Aristotle - My accounting may be simplistic but would you work for 31% less than what you are making now when you could go elsewhere are work for more than what you are making (based upon IL already having the lowest reimbursement rates in the nation). Your simplistic solution to just keep cutting rates will impair the availability of critical services throughout the state.
- mark walker - Friday, Feb 24, 12 @ 3:29 pm:
It’s a start. One proposed set of choices, of many to come, I hope, in many spending and revenue areas.
- ZC - Friday, Feb 24, 12 @ 3:36 pm:
I’ve gotten a little more insight into this issue since I started dating a pediatrician, who sees a lot of Medicaid money supporting her hospital. A couple of passing thoughts:
1) Medicaid reimbursement rates for some of the most important forms of pediatric care are quite low; cutting them further would probably put a great deal of financial strain on hospitals and providers;
2) However, there are some hospitals in Chicago (I won’t name names) where it would probably be a good thing and a health service to all, if they went out of business, or at least if their pediatric departments did. Other hospitals could readily absorb their case loads, some doctors would lose their jobs and parents might have to drive a mile further, but overall health outcomes in the city wouldn’t be affected (or might actually improve). A lot of wasted taxpayer dollars out there - a kid gets admitted to a second-rate hospital, for something perfectly treatable in a low-cost manner, and they don’t know what to do, or they misdiagnose and they have the kid immediately sent to another hospital’s ER - thousands wind up being billed to Medicaid for something that probably cost like $500 or less to fix.
I am NOT saying you could fix all of Medicaid’s woes with anonymous “waste and graft” fixes to the system - or I don’t have the training to estimate how much cost savings there are. But it definitely adds up. As national health care experts keep saying about Medicare, we could probably somewhat boost payments for the most serious stuff, and reduce a significant part of the growth curve (while not eliminating it altogether), if we could just figure out how much of our health care dollar we’re wasting right now. The political challenges to that, of course, are vast. And as some commenters have pointed out, I’m not even talking about where the majority of Medicaid dollars in Illinois go these days.
- Aristotle - Friday, Feb 24, 12 @ 3:41 pm:
Rich - you titled this section “The Difficult Medicaid Choices Ahead”. I assumed “difficult” was the operative word. I am proposing an increase in the number of providers. Until all providers must provide the service, we will never fully understand what “the system” can sustain.
- Irish - Friday, Feb 24, 12 @ 3:46 pm:
Judgement Day - Might be, I am not arguing with you. But if we can’t track Medicaid expenditures how do we know which programs are working and which are not? How do we reform something that we can’t track expenditures, use, participation, etc. If the systems aren’t adequate then let’s get some that are. How can we possibly even know that taking away home based services from a person that can’t cook their own meals is truly needed unless we eliminate all the unecessary expenditures and the fraud from the program before hand? That’s why I stated at the beginning that true reform and streamlining has to be the goal and not just lip service and continue as we are. It’s like hiring a plumber and telling him to fix your plumbing issues but he can’t look at the whole plumbing system.
So the question becomes, does the Governor really want Medicaid reform, or does he want to frighten everyone into being happy when cuts are less? I am going to cut off your head….maybe I’ll just take a finger.
I am still wondering why PQ is stating we have to have $2.7 billion in Medicaid cuts, yet talking about adding 100,000 people to Medicaid roles.
I totally agree with Rich that we need to get behind a positive push to solve the state’s problems and get rid of the negativity. I thought his column was very on point. But sometimes the tail has a hard time pushing the dog when we have questions like the my previous paragraph.
The Governor called for budgeting for results or whatever that plan is. How do you know your results if you have no way of tracking them? (Ironically he has praised IDNR for being one of the leaders in this and said it is a model for all other agencies and then cut it 13.5% compared to 9% or less in most other agencies. )
- Senior Advocate - Friday, Feb 24, 12 @ 3:49 pm:
Pat Comstock states “It is impossible for us to think of doing what we are required to do with anything less.”
What is amazing is that the nursing homes state they have so little coming in but when you see the cost reports of the for-profit nursing homes (http://www.hfs.illinois.gov/costreports/) you see some of these owners taking home upwards of $1 million a year. They aren’t shorting themselves - they are shorting the residents and the front line workers. We shouldn’t fall for the “us poor providers” routine!
- Peggy R/Southern - Friday, Feb 24, 12 @ 3:50 pm:
Aristotle, re: regulating dr’s income and pro-bono obligations. Consumers are the eligible recipients of Medicaid/Care. We have a right to choose our own doctors. Consumer choice and availability of choices determine case loads of individual practices. The new fed rules on medicaid/care may affect doctors’ willingness to see some patients as well…or leave the business they are obligated to take patients that leave them operating at a loss. We’re not talking GED types here, but extensively trained and educated men and women, who spent loads of $ for that training. I want my drs quite skilled.
Demoralized: OK. Thanks re: Medicare/Caid distinctions.
- cassandra - Friday, Feb 24, 12 @ 3:53 pm:
The NYT has an article about expanded use of home care for the elderly in lieu of nursing home placement up on its website now. I’m wondering where Illinois is on the continuum of home to nursing home for those needing long-term care.
- sal-says - Friday, Feb 24, 12 @ 4:16 pm:
Every ‘cut’ is going to be painful. Do the cuts so that there’s the least pain possible for everybody.
‘Everybody’ needs to take …and expect… a —’little’— less. State workers, unions, politicians, entitlement recipients, providers, EVERYBODY.
The pie is smaller; everybody gets a smaller piece. Or we all end up with nothing.
Get this fixed.
- reformer - Friday, Feb 24, 12 @ 4:20 pm:
Irish
I don’t like waste, fraud and abuse any more than you do. It’s a pipe dream, however, to think our Medicaid problem will be resolved when we just crack down on WF&A. Instead it will require difficult decisions as Rich says.
- soccermom - Friday, Feb 24, 12 @ 4:43 pm:
If I were looking for a place to investigate WFA and cost overruns, I’d start with the for-profit nursing homes.
- soccermom - Friday, Feb 24, 12 @ 4:47 pm:
How much money have the taxpayers of Illinois paid to this place? http://www.oakpark.com/News/Articles/02-21-2012/Family_plans_lawsuit_in_murder_at_Oak_Park_nursing_home
- wordslinger - Friday, Feb 24, 12 @ 5:06 pm:
Don’t know, Soccermom. Maybe Rep. Rose can get on it when he’s done finding out what happened with his Charleston big-foot contributor’s place down the street from the EIU football stadium.
They got millions for years from the state, despite their obvious criminal neglect. Did I miss that Rep. Rose press conference on this murderous scandal in his district?
Maybe when he’s done chasing down folks living the high life on food stamps.
http://chicago.cbslocal.com/2011/03/21/state-ignored-evidence-vs-group-home-before-residents-death/
- Judgment Day - Saturday, Feb 25, 12 @ 1:36 pm:
Re:
“But if we can’t track Medicaid expenditures how do we know which programs are working and which are not? How do we reform something that we can’t track expenditures, use, participation, etc. If the systems aren’t adequate then let’s get some that are.”
The problem isn’t that ‘The System’ doesn’t work - it works - sorta, kinda, well maybe, on occasion, etc. But efficiency is not part of the equation.
What you have way, way too much of is a back office system (actually, a number of different back office systems) where the workers get work done in spite of the systems, not because of the systems.
The State of IL has spent giant amounts of money over the years trying to make things work better, but it’s all been “top down” driven.
I don’t remember who made the observation, but an observation was made that there are two types of systems/Software design strategies: “Top Down” or “Bottom Up”.
Now both strategies have strengths and weaknesses:
1) “Top Down” - Organized, but Stupid.
2) “Bottom Up” - Chaotic, but Smart.
Now IMO, you can bring some degree of order to Chaos, but how do you go about making ‘Stupid’ smarter?
Particularly in digital systems….
And realize, IL is not alone in this. Other states (CA comes to mind) have spent outrageous sums of $$$$ on systems which have been complete failures. But the common ‘feature’ has always been a “Top Down” system design.
Bottom line is that these Systems need to be designed, built, and structured in a “Bottom Up” environment, and the entire governing structure is constructed so taking that approach is completely impossible - from the inside.
Honestly, between CMS and the State Auditor’s Office, it seems their unofficial shared motto is “No innovative thinking wanted here”.
If there’s going to be a systems solution that will allow us to make reasonable results assessments, it’s going to have to come from outside the process, because otherwise, IMO, it’s doomed.