Somehow stroke survivors will need to be some of the voices in setting standards for stroke care. We can't let doctors do this because they will just propose guidelines, not RESULTS. That would be ensuring stroke rehab failures for decades.
http://www.medpagetoday.com/PublicHealthPolicy/Medicaid/57533?
WASHINGTON -- States will need to establish network adequacy standards for Medicaid managed care providers under a final rule issued Monday by the Centers for Medicare and Medicaid Services (CMS).
"Today's final rule has four goals: supporting states' efforts to
advance delivery system reform; strengthening the consumer experience of
care; strengthening program integrity; and aligning rules across health
insurance coverage programs to improve efficiency and help consumers,"
said Vikki Wachino, MPP,
director for the Center for Medicaid and CHIP Services at CMS, on a
conference call. As part of those goals, "Our final rule requires states
to establish network adequacy standards, and to establish time and
distance standards for primary care physicians, behavioral health
providers, pharmacy providers, and pediatric dentists."
The
rule also requires network adequacy standards for specialists, but
leaves it up to states to decide which specialists and what the
standards will be. "We agree with commenters that states should define
this category and set network adequacy standards that are appropriate at
the state level," the final rule stated.
"We believe that allowing states to define the 'specialist' category
better reflects the needs of their respective programs, and we believe
it would be inappropriate for CMS to define this standard at the federal
level. We also believe that states are in the best position to engage a
variety of stakeholders when defining the 'specialist' category and
setting appropriate network adequacy standards for such defined
'specialist' providers. We specifically encourage states to be
transparent in this process."
States must comply with the network adequacy requirements "no later
than the rating period for Medicaid managed care contracts starting on
or after July 1, 2018," according to the rule.
The 1,424-page rule also establishes the program's first-ever quality
rating system, and "requires additional transparency on how Medicaid
rates are set to help ensure fiscal integrity of the Medicaid managed
care program, including data on utilization and quality of services,"
Wachino said.
In addition, it "sets medical loss ratios for Medicaid managed care
plans and better aligns reporting of medical loss ratios with Medicare
Advantage and the marketplace. This will improve the experience for
people who transition between coverage programs, and eases the burden on
providers who participate in several programs."
Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts
Tuesday, April 26, 2016
Wednesday, September 16, 2015
Uninsured, Medicaid stroke victims experience worse medical outcomes than patients with private insurance
I think the key point here is that these people aren't able to properly access preventative care and are likely sicker to begin with.
http://www.news-medical.net/news/20150914/Uninsured-Medicaid-stroke-victims-experience-worse-medical-outcomes-than-patients-with-private-insurance.aspx
http://www.news-medical.net/news/20150914/Uninsured-Medicaid-stroke-victims-experience-worse-medical-outcomes-than-patients-with-private-insurance.aspx
Stroke victims who use Medicaid or are uninsured were more likely
to die, stay hospitalized longer and have worse medical outcomes than
patients with private insurance, a study by University of Florida Health
researchers has found.
The uninsured and Medicaid patients were also more likely to develop a new medical condition in the hospital, according to a study published recently in the Journal of Neurosurgery. The study was the largest and most comprehensive analysis of how insurance status relates to stroke outcomes in the United States. Researchers analyzed nationwide data from more than 1.5 million hospital admissions involving stroke patients between 2002 and 2011.
The most concerning part of the findings was the statistically higher rate of patient-safety issues for those without private insurance, as well as their higher death rate, longer stays and worse outcomes, researchers said. Among Medicaid and self-pay patients, 5.1 percent of stroke victims died in the hospital, compared with 4.4 percent of those with private insurance.
That doesn't mean hospitals treat people differently based on their insurance status, said Maryam Rahman, M.D., an assistant professor in the UF College of Medicine's department of neurosurgery and the study's principal investigator. Rather, the difference in mortality rates and medical outcomes between Medicaid patients and those with private insurance may be influenced by what happens before they arrive at a hospital.
"This is most likely related to the fact that Medicaid and uninsured patients don't have access to primary preventive care the way insured patients do," Rahman said. "In general, they're going to be a sicker population with higher obesity rates and a greater rate of uncontrolled diabetes. That's going to influence how they do with any diagnosis."
Patients with Medicaid or no insurance are often in worse shape due to many factors, Rahman said. Stroke outcomes in particular are dependent on how quickly a patient gets medical attention.
"They may not be recognizing the symptoms in a timely fashion or getting to the hospital soon enough," she said.
Once hospitalized, those with Medicaid or no insurance also fared differently, the study found. Medicaid and uninsured patients were more likely to suffer from pressure ulcers, respiratory failure and infections. Still, privately insured patients weren't immune from so-called patient-safety indicators: They were more likely to have postoperative bleeding, pulmonary embolism and accidental cuts and punctures than Medicaid patients, the study found. Overall, 22.8 percent of Medicaid and self-paying patients had some type of patient-safety indicator, compared with 13.6 percent of patients with private insurance.
Stroke patients with private insurance may also have other advantages that improve their outcomes, such as better access to inpatient rehabilitation services once they leave the hospital, said Kyle Fargen, M.D., the study's lead author, an assistant professor of neurosurgery at the Medical University of South Carolina. Fargen was a resident in the UF College of Medicine's department of neurosurgery when the journal article was written.
"This really does suggest that patients without private insurance are not getting the quality of care that privately insured patients are getting," Fargen said.
The findings can be put to use in several ways, including a better understanding of the factors that put some people at higher risk for poor outcomes after a stroke, the researchers said. Hospitals that treat higher-risk Medicaid patients with more complicated medical histories shouldn't necessarily be graded the same way as hospitals with more privately insured patients, Rahman said. The study's findings should also be useful to government officials who want to know that health care money is being spent effectively, she said. Fargen said it's likely that health care quality measures will someday be tied very closely to the reimbursements that hospitals get for treating Medicaid and other patients with government-funded health care.
The uninsured and Medicaid patients were also more likely to develop a new medical condition in the hospital, according to a study published recently in the Journal of Neurosurgery. The study was the largest and most comprehensive analysis of how insurance status relates to stroke outcomes in the United States. Researchers analyzed nationwide data from more than 1.5 million hospital admissions involving stroke patients between 2002 and 2011.
The most concerning part of the findings was the statistically higher rate of patient-safety issues for those without private insurance, as well as their higher death rate, longer stays and worse outcomes, researchers said. Among Medicaid and self-pay patients, 5.1 percent of stroke victims died in the hospital, compared with 4.4 percent of those with private insurance.
That doesn't mean hospitals treat people differently based on their insurance status, said Maryam Rahman, M.D., an assistant professor in the UF College of Medicine's department of neurosurgery and the study's principal investigator. Rather, the difference in mortality rates and medical outcomes between Medicaid patients and those with private insurance may be influenced by what happens before they arrive at a hospital.
"This is most likely related to the fact that Medicaid and uninsured patients don't have access to primary preventive care the way insured patients do," Rahman said. "In general, they're going to be a sicker population with higher obesity rates and a greater rate of uncontrolled diabetes. That's going to influence how they do with any diagnosis."
Patients with Medicaid or no insurance are often in worse shape due to many factors, Rahman said. Stroke outcomes in particular are dependent on how quickly a patient gets medical attention.
"They may not be recognizing the symptoms in a timely fashion or getting to the hospital soon enough," she said.
Once hospitalized, those with Medicaid or no insurance also fared differently, the study found. Medicaid and uninsured patients were more likely to suffer from pressure ulcers, respiratory failure and infections. Still, privately insured patients weren't immune from so-called patient-safety indicators: They were more likely to have postoperative bleeding, pulmonary embolism and accidental cuts and punctures than Medicaid patients, the study found. Overall, 22.8 percent of Medicaid and self-paying patients had some type of patient-safety indicator, compared with 13.6 percent of patients with private insurance.
Stroke patients with private insurance may also have other advantages that improve their outcomes, such as better access to inpatient rehabilitation services once they leave the hospital, said Kyle Fargen, M.D., the study's lead author, an assistant professor of neurosurgery at the Medical University of South Carolina. Fargen was a resident in the UF College of Medicine's department of neurosurgery when the journal article was written.
"This really does suggest that patients without private insurance are not getting the quality of care that privately insured patients are getting," Fargen said.
The findings can be put to use in several ways, including a better understanding of the factors that put some people at higher risk for poor outcomes after a stroke, the researchers said. Hospitals that treat higher-risk Medicaid patients with more complicated medical histories shouldn't necessarily be graded the same way as hospitals with more privately insured patients, Rahman said. The study's findings should also be useful to government officials who want to know that health care money is being spent effectively, she said. Fargen said it's likely that health care quality measures will someday be tied very closely to the reimbursements that hospitals get for treating Medicaid and other patients with government-funded health care.
Source:
University of Florida
Saturday, January 5, 2013
Sen. Kirk's stroke offers him new Medicaid perspective
If you are one of his constituents, you need to have him sponsor a national Stroke Plan, it can be copied directly from the National Alzheimers' Plan.
He also needs to be educated on the need for NINDS funding to find hyperacute therapies that prevent a lot of the disability. Tell him he can become the Tipping Point for Stroke. I never heard anything after Senator Tim Johnson from South Dakota had his stroke so he let his opportunity to be a stroke spokesperson slip thru his fingers.
http://www.news-medical.net/news/20130104/Sen-Kirks-stroke-offers-him-new-Medicaid-perspective.aspx
Sen. Mark Kirk's stroke has awakened him to what people on Medicaid experience in their rehabilitation efforts, he said.
The Hill: Sen. Kirk Says Stroke Changed Perspective On Medicaid
Sen. Mark Kirk (R-Ill.) said his debilitating stroke has sparked a new interest in the experience of people on Medicaid. In an interview published Wednesday, Kirk said that most Illinois residents insured through the low-income health program would be eligible for just 11 rehabilitation sessions following a stroke. "Had I been limited to that I would have had no chance to recover like I did. So unlike before suffering the stroke, I'm much more focused on Medicaid and what my fellow citizens face," Kirk told the Chicago Sun Times (Vibeck, 1/2).
He also needs to be educated on the need for NINDS funding to find hyperacute therapies that prevent a lot of the disability. Tell him he can become the Tipping Point for Stroke. I never heard anything after Senator Tim Johnson from South Dakota had his stroke so he let his opportunity to be a stroke spokesperson slip thru his fingers.
http://www.news-medical.net/news/20130104/Sen-Kirks-stroke-offers-him-new-Medicaid-perspective.aspx
Sen. Mark Kirk's stroke has awakened him to what people on Medicaid experience in their rehabilitation efforts, he said.
The Hill: Sen. Kirk Says Stroke Changed Perspective On Medicaid
Sen. Mark Kirk (R-Ill.) said his debilitating stroke has sparked a new interest in the experience of people on Medicaid. In an interview published Wednesday, Kirk said that most Illinois residents insured through the low-income health program would be eligible for just 11 rehabilitation sessions following a stroke. "Had I been limited to that I would have had no chance to recover like I did. So unlike before suffering the stroke, I'm much more focused on Medicaid and what my fellow citizens face," Kirk told the Chicago Sun Times (Vibeck, 1/2).
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