Ideas for Reforming NYS Medicaid

[Chant]

It is well known that generic drugs have little to no medical value, it more like taking a sugar pill. You want to deal with Medicaid in the right way, you will need to take away many of those liberal goodies the Medicaid people use like cab rides, Emergency rooms, dobubble dippers both the patient and doctors, and most importance is make Medicaid harder to get for new residence like making it a 5 year residency before you can receive Medicaid.

Quote:
Originally Posted by Linda_D
Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.


Both these statements aren't exactlly on. And this comes from my family doctor - generic drugs can be as good as the brand name, however the dosages in generic drugs are, or might not be, as uniformed as in the brand name version. As with the Thyroid medication I am on. My doctor wanted me on the brand name Synthroid at the beginning, until he found the proper doseage. Once that was done, I was switched to the generic and after my bloodwork was checked, I was able to stay on the generic because the slight difference from pill to pill didn't matter to me. My sister on the otherhand - with the same condition - has to stay on the brand name Synthroid because she cannot tolerate the slight differences in the generic pill to pill.
Depends on the patient and what the Dr. thinks is best for the patient. I don't think a patient should be held accountable for their dire needs.
If you want to cut the costs.... make it impossible for people to travel to NYS just for the free medical benefits. Have a residency requirement. Anyone who has worked in a hospital knows what I'm talking about with these 'vacationing patients".

[WNYresident]

Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.

NO, you make them pay the FULL cost difference. What makes that person any more entitled that they can get name brand for a couple of bucks while other people would have to pay the full difference.

[anyones neighbor]

I think you are mistaken, Riv.

It would NOT be legal if that was the case.

[WNYresident]

Linda provided a really good link to Medicaid info on eligibility. I would encourage everyone interested in ways to cut medicaid to read that document first before listing out what you think should be cut.

NYS is not allowed to cut whatever it wants. It's not allowed to create certain restrictions. But there are some areas that are 'optional' and that could be eliminated.

Thanks Linda for starting this thread!

Would there be a value to giving NYS medicaid/reform it's own forum and give a few people mod status to it?

http://www.speakupwny.com/forums/forumdisplay.php?f=70

[anyones neighbor]

OK here's MY story.
I always worked until I couldn't anymore. In 1994, I was paying my own Healthcare. When I quit working and went on Disability THEY paid my health insurance and in 1999 when I turned 62, I got Medicare. So I had Medicare, Health ins, and Medicaid. Now last April, SS decided to give me a widows pension, about $400 more than I was getting. Sounds great right? Last week I got a letter from Social Services that I had to pay back the Medicaid I used because I made too much. So NOW I have to do what the guy called BUY IN. I'll have to send $433 the first of every month to Medicaid. However, I will now also be COVERED for Medicaid as well. So I'm back at square one. What's left will NOT cover my monthly bills. Not sure what's next because I've cut everywhere I can.

[mikenold]

They must stop the abuses of the system.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.
For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too.

Read more: http://www.nypost.com/p/news/regiona...#ixzz14eJvT2xI

October 25, 2010
By Henry L. Davis, The Buffalo News, N.Y.
Oct. 24—One man last year called Rural/Metro Medical Services, the region’s busiest ambulance company, 313 times for a ride to a hospital.
Two other people used the company’s ambulances more than 180 times.
Still others received rides once or more a week.

A volunteer ambulance corps in DeWitt transported one man to Syracuse hospitals 140 times in 2009.

On more than one occasion, he called the ambulance three times in a single day. Nearly every time, he was checked out by doctors and told to go home because no treatment was needed.

Two other people used the company's ambulances more than 180 times.

Still others received rides once or more a week.

Rural/Metro -- a commercial ambulance service that contracts to cover the cities of Buffalo and Niagara Falls, as well as Cheektowaga, Hamburg, East Aurora, Springville and Evans -- responded to 96,930 calls for an ambulance in 2009. Of those, 71,633 came through 911.

The company doesn't distinguish inappropriate calls, but it gave The News a list of 10 unidentified patients who used ambulances the most, including some elderly residents transferred regularly from nursing homes to hospitals.

The cost of inappropriate ambulance use plays a part in the debate over what to do about it.

At Rural/Metro, an advanced life-support ambulance costs private insurers $800 to $1,000 per ride, and $500 to $600 for basic life-support services, according to Jay Smith, spokesman for the Buffalo office.

For patients on Medicare, the government health program for those 65 and older, the company receives about $395 for advanced life-support calls and $333 for basic life support.

This is completely outrageous and literally makes me sick. These sort of abuses should be stopped immediately for a savings in the millions and are only the first step.

[nogods]

They must stop the abuses of the system.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.
For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too.

Read more: http://www.nypost.com/p/news/regiona...#ixzz14eJvT2xI

October 25, 2010
By Henry L. Davis, The Buffalo News, N.Y.
Oct. 24—One man last year called Rural/Metro Medical Services, the region’s busiest ambulance company, 313 times for a ride to a hospital.
Two other people used the company’s ambulances more than 180 times.
Still others received rides once or more a week.

A volunteer ambulance corps in DeWitt transported one man to Syracuse hospitals 140 times in 2009.

On more than one occasion, he called the ambulance three times in a single day. Nearly every time, he was checked out by doctors and told to go home because no treatment was needed.

Two other people used the company's ambulances more than 180 times.

Still others received rides once or more a week.

Rural/Metro -- a commercial ambulance service that contracts to cover the cities of Buffalo and Niagara Falls, as well as Cheektowaga, Hamburg, East Aurora, Springville and Evans -- responded to 96,930 calls for an ambulance in 2009. Of those, 71,633 came through 911.

The company doesn't distinguish inappropriate calls, but it gave The News a list of 10 unidentified patients who used ambulances the most, including some elderly residents transferred regularly from nursing homes to hospitals.

The cost of inappropriate ambulance use plays a part in the debate over what to do about it.

At Rural/Metro, an advanced life-support ambulance costs private insurers $800 to $1,000 per ride, and $500 to $600 for basic life-support services, according to Jay Smith, spokesman for the Buffalo office.

For patients on Medicare, the government health program for those 65 and older, the company receives about $395 for advanced life-support calls and $333 for basic life support.

This is completely outrageous and literally makes me sick. These sort of abuses should be stopped immediately for a savings in the millions and are only the first step.

You are barking up the wrong "Ricky":

Richard Lynn "Rick" Scott (born December 2, 1952) is an American politician and businessman who is the current Governor-elect of Florida. Having defeated Bill McCollum in the Republican primary election, Scott defeated Democrat Alex Sink in a close race in the 2010 Florida gubernatorial election.

In 1988, Scott and Richard Rainwater, a multimillionaire financier from Fort Worth, each put up $125,000 in working capital in their new company, Columbia Hospital Corporation,and borrowed the remaining money needed to purchase two struggling hospitals in El Paso for $60 million.

By 1997, Columbia/HCA had become the world's largest health care provider with more than 340 hospitals, 130 surgery centers, and 550 home health locations in 38 states and two foreign countries. With annual revenues in excess of $23 billion, the company employed more than 285,000 people, making it the 7th largest U.S. employer and the 12th largest employer worldwide. Based on market capitalization, Columbia ranked in the top 50 companies in America and top 100 worldwide. That same year, the company was recognized by Business Week magazine as one of the 50 Best Performing Companies of the S&P 500.

In settlements reached in 2000 and 2002, Columbia/HCA rose to public attention when it pleaded guilty to 14 felonies and agreed to a $600+ million fine in what the Justice department then called the largest fraud case settled in the history of the Justice department.

A series of New York Times articles, beginning in 1996, began scrutinizing Columbia/HCA's business and Medicare billing practices. These culminated in the company being raided in July 1997 by Federal agents searching for documents. Among the crimes uncovered were doctors being offered financial incentives to bring in patients, falsifying diagnostic codes to increase reimbursements from Medicare and other government programs, and billing the government for unnecessary lab tests.

Following the raids, the Columbia/HCA board of directors forced Scott to resign as Chairman and CEO. He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million, mostly from his initial investment.In 1999, Columbia/HCA changed its name back to HCA, Inc.

[Dougles]

They don't do business in NYS... what's your point?

[300miles]

They must stop the abuses of the system.

This is completely outrageous and literally makes me sick. These sort of abuses should be stopped immediately for a savings in the millions and are only the first step.

The key question is How.

[Genoobie]

Someone brought up this point earlier, but healthcare is a big employer in our area, both union and non-union. If medicaid cuts go through, hospitals will be closed down. More than likely the local lobbies will not permit this (both union and non-union). Hence the lack of medicaid reform.

That being said, isn't there a significant amount of fraud and waste? Why not start there? Those are dollars that aren't doing *anything*. Then lets get into prescriptions / ER cab rides, etc.

[mikenold]

The key question is How.

The rules of engagement must be changed. If someone is caught cheating the system they should be charged for the services that they received for free. I understand that you cannot leave a freeloader on the sidewalk if something is truly wrong with them but it is a different thing if they are just gaming the system. There should be penalties which would include fines, and even jail time.

[wnyerlaughs]

Someone brought up this point earlier, but healthcare is a big employer in our area, both union and non-union. If medicaid cuts go through, hospitals will be closed down. More than likely the local lobbies will not permit this (both union and non-union). Hence the lack of medicaid reform.

That being said, isn't there a significant amount of fraud and waste? Why not start there? Those are dollars that aren't doing *anything*. Then lets get into prescriptions / ER cab rides, etc.

THAT is a good bingo! but there are also entrenched interests that benefit from the fraud and waste, and (in ther minds) THEIR interests are more important than taxpayer interests.

Cutting medicaid fraud and waste is like trying to take the food away from a rabid animal that's still feeding in the carcass. It all seems okay until until you try to disturb the instituinal interests that benefitting from the fraud/abuse.

Regarding generics versus branded drugs. The branded drug industry pays the state medicaid system significant cash rebates for the usage of brand drug X, Y or Z. IF they use generics, that incoming revenue gravy will dry up. Drug companies pay MILLIONS and MILLIONS of $$ in the form of rebates (based on how much of a drug was used) that medicaid receives as incoming revenue for its own "operations". If medicaid cut costs via generics, those branded drug rebates ($ revenue) to medicaid operations would dry up. No more gravy.

Follow the money trails. That always explains the motivations for things to either work well, or for things to be tied up in bureacratic special interests. Medicaid is one of the biggest black $$ holes in the state, with MANY feeding at the trough.

There was an example cited in Souther Tier if i recall. County Exec has program developed to cut waste, showed it to Paterson and Albany. They said "great idea", and buried it.

[wnyerlaughs]

The rules of engagement must be changed. If someone is caught cheating the system they should be charged for the services that they received for free. I understand that you cannot leave a freeloader on the sidewalk if something is truly wrong with them but it is a different thing if they are just gaming the system. There should be penalties which would include fines, and even jail time.

true, but gotta think bigger picture: the entrenched special interests that benefit from the system as is, including the fraud. If I'm in albany and getting drug company $ rebates because a dr in Rochester is prescribing ONLY drug x rather than the the less expensive "me-too" drug that does the same thing, I have very little incentive to stop or slow the dr down. In fact, i'd want him using more of the drug X, because it means more $ to us in albany and we can keep our budgets bloated based on the giant revenue we get from the drug companies.

[Dougles]

End all the extras!

And before people start crying about it...

Show me one city, that doesn't offer all the extras that has people "dying in the streets". Show me one state that has old people "dying in their homes by the 1000's".

These are the response most status quo lovers give.

[Bailey]

Someone brought up this point earlier, but healthcare is a big employer in our area, both union and non-union. If medicaid cuts go through, hospitals will be closed down. More than likely the local lobbies will not permit this (both union and non-union). Hence the lack of medicaid reform.

That being said, isn't there a significant amount of fraud and waste? Why not start there? Those are dollars that aren't doing *anything*. Then lets get into prescriptions / ER cab rides, etc.

Agreed, all waste needs to be eliminated. That being said, however, no one has suggested stopping providing needed services or even cutting the rates at which hospitals/doctors are paid. If needed services are being provided, I don't see why hospitals will be closing. If they are providing unneeded services, well then.....