Saturday, August 18, 2012

you can't come here...not

In my state there is a program within medical assistance restricts those "who have used services at a frequency or amount that is not medically necessary and/or who have used health services that resulted in unnecessary costs to MA. Once identified, such recipients are placed under the care of a primary care physician/other designated providers who coordinate their care for a 24-month period."

This includes these people being required to go to only ONE assigned hospital for their care. Do they follow this program. OF COURSE NOT. They regularly come into our ER even though they are assigned to another hospital.

Here's the thing: If they go to a non-assigned hospital, unless it is a life threatening emergency, the bill will not be paid. Of course they have to have a medical clearance per our wonderful EMTALA regulations. After that they can be sent out the door to their assigned hospital. Does this happen? OF COURSE NOT. Docs still see them, order tests, etc. Why? WHO KNOWS.

Here's the thing, the person has no incentive to go to their assigned hospital. They don't care if it won't be paid. Even if they are billed, they won't pay it anyway. So in other words, this program is a joke. It no doubt spends thousands if not millions of dollars to run with no success.
Wonder why the health care system is going down the toilet? Here is one more reason...


jimbo26 said...

The rule-maker never thinks it/them through .

Mama D said...

No. Their incentive to go to the correct hospital should be that they won't be seen at any other hospital for a non-emergent issue! The fact that they do receive treatment at the other hospitals is the problem. If they know the hospitals don't bother to screen for who should be there, why should the pts take the trouble to go to only the one designated hospital? Totally pro-doc and -hospital, by the way, but this one sounds like largely their own fault for not enforcing the rules.

Mark p.s.2 said...

How do you know if something is life threatening or not in the patient? The doctor has to see the patient.

The new rules are fundamentally flawed.

I say give them what they want, legal drugs up to wazzoo. So much it scares them that they might die from overdose. If they have any brain cells they will figure out they have a drug problem. If they can't figure it out that using drugs is no kind of life, well at least they are not performing criminal activity to acquire their drugs.

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Anonymous said...

Mark: there are a lot of things wrong with your idea, chiefly the notion that opiate addicts will be scared straight by getting as many drugs as they want with no financial or legal consequences. Run that one over in your head again and see if it still sounds good.

As a plan to kill off addicts, though, it's brilliant -- if the city doesn't mind dealing with all those corpses and the attendant paperwork on top of the line of folks (all patient and well-behaved, of course) snaking out of the ER and around the block 24/7.