Georgia Medicaid

CocheseUGA

CocheseUGA

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The state decided to turn over management of Medicaid to private business this year. This, in and of itself, isn't a bad idea to me. Private companies typically can cut more fat and run more efficiently than government can.

However, Atlanta, we have a problem.

The three HMOs running this operation now have severely low-balled hospitals on their offers. 70% of emergency visits would be ruled 'triage', and only be paid $50 to the hospital. Needless to say, that wouldn't even cover the supplies, much less personnel, expenses, paperwork, etc. Right now, hospitals lose a pretty good bit of money by taking Medicaid, but this offer is threatening to bankrupt our local hospital if they accept. And the media isn't making any friends with their coverage of the situation, basically blaming the hospital for not taking the contract, because they've had to cancel all elective surgeries under Medicaid (tonsillectomy, spinal fusion, other things fairly important to children).

If the hospital was forced to take the deal, they'd be out of business in two years. This includes the medical college attached to it.

Coverage: http://www.wjbf.com/midatlantic/jbf/news_index.apx.-content-articles-JBF-2006-08-30-0001.html
http://chronicle.augusta.com/stories/083106/met_94752.shtml

-Breaking- They appeared to sign a deal, but no details on how much money the hospitals are going to lose.

If you live in, or know someone who lives in GA, call a Congressperson and tell them to force the HMOs to offer a respectable deal, or to take back management of the program. And even if you don't, this is something to keep a lookout for in your area if your state has a similar program or is thinking about it.
 
[quote name='CocheseUGA']The state decided to turn over management of Medicaid to private business this year. This, in and of itself, isn't a bad idea to me. Private companies typically can cut more fat and run more efficiently than government can.[/QUOTE]


Not true. Medicare's administrative costs are somewhere in the 2-3% of it's total expenditures while private insurance companies administrative costs are about 20-25%.* Also Medicaid's goal isn't pushing to lower it's expenses to make a profit, their goal is trying to get people back to work so they can get back to paying taxes.

(Some say that doesn't include fraudulent payments that go uninvestigated thus raising the total waste. Which may or may not be true, Medicare tends to pay everything until they catch you cheating, private companies treat everyone like they are cheating and the burden is on you to prove you are not. Regardless, fraud loss isn't an administrative cost and even including fraudulent claims only increases their waste to something around 6% of their total operating costs.)
 
Thank you for the info. Unfortunately it looks like you are discovering the joys of privatization. I am sure the hospitals will be okay, they will just pass the cost on to you.
 
I work at Medical College of Georgia so I've been keeping a close eye on this as well. In essence, MCG is no longer accepting Medicaid patients until they get a better contract which as harsh as it sounds is the right thing to do.

BTW, that comment about Medicare paying everything is not true at all. They go by a DRG system in which they pay a set amount (which they determine of course) per diagnosis and that's it, regardless of how serious the case is which is pretty backward to me.
 
[quote name='dopa345']BTW, that comment about Medicare paying everything is not true at all. They go by a DRG system in which they pay a set amount (which they determine of course) per diagnosis and that's it, regardless of how serious the case is which is pretty backward to me.[/QUOTE]

Well, 'everything' might be a stretch, but the point stays the same: Medicare isn't in the business of actively avoiding payment.
 
[quote name='dopa345']I work at Medical College of Georgia so I've been keeping a close eye on this as well. In essence, MCG is no longer accepting Medicaid patients until they get a better contract which as harsh as it sounds is the right thing to do.

BTW, that comment about Medicare paying everything is not true at all. They go by a DRG system in which they pay a set amount (which they determine of course) per diagnosis and that's it, regardless of how serious the case is which is pretty backward to me.[/QUOTE]

They actually accepted the new contract with both companies, as did University. It's just taking time to reschedule the appointments.
 
Hey CocheseUGA, I just realized you live in Augusta, never thought I'd run into another CAG down here. I just moved to Augusta 2 months ago.
 
[quote name='dopa345']Hey CocheseUGA, I just realized you live in Augusta, never thought I'd run into another CAG down here. I just moved to Augusta 2 months ago.[/QUOTE]

It's not Boston (so I've heard), but it's ok.
 
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