tag:blogger.com,1999:blog-32053362.post4605217870976125343..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Immigrants left in the lurch againPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-32053362.post-28858696812183439292009-10-02T14:00:55.428-04:002009-10-02T14:00:55.428-04:00Sad but true. State government is strapped for fu...Sad but true. State government is strapped for funds and $41 mill is all they have. Also, the actual contracts for services are not specified, so we don't know what is "covered" and what is "not covered". We also do not know the copayment structure. So, let's say that CelticCare takes 10% for overhead, then the remainder is split 50-50 between hospital services and outpatient primary and specialty care, there is simply not enough $$ to run the plan. So, first, change all the primary care providers...this will delay access by several months for most. Delay reimbursement to the contracted providers....will buy another couple of months. Delay payment for emergency services to noncontracted providers...but the noncontracted still have to be paid by CelticCare for the emergency services. Better to be noncontracted in this situation as I see it.76 Degrees in San Diegohttps://www.blogger.com/profile/14358630186174729315noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-2670885009516446992009-10-02T07:21:10.371-04:002009-10-02T07:21:10.371-04:00This is truly awful treatment of these individuals...This is truly awful treatment of these individuals. They are tax-paying, legal residents, but because they do not have the ability to vote, it is easy to ignore them. I am glad to see that some form of coverage is back, but to limit it in this way - without regard to where these patients live and already get care - is ridiculous and just plain mean.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-37366310588376062222009-10-01T14:20:59.421-04:002009-10-01T14:20:59.421-04:00Being nonlocal, I have not been following this clo...Being nonlocal, I have not been following this closely, but I assume "Commonweath Care" means a subsidy fto meet the state's requirement of health insurance? If so, I wonder at the audacity of the legislature to single out legal (read, tax-paying) immigrants to exclude. It would be analogous to singling out only men (albeit citizens) of the same demographic status, and saying they won't be covered. In other words, these immigrants are contributing all the same things to our society as citizens of the same income level - so is it not a cynical move to exclude them just because they cannot vote you out for doing so? Or what am I missing?<br />Interesting; just - interesting.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39494236462319222812009-09-30T21:09:12.377-04:002009-09-30T21:09:12.377-04:00Press release from Massachusetts Immigrant & R...Press release from Massachusetts Immigrant & Refugee Advocacy Coalition:<br /><br />On Eve of New Immigrant Healthcare Coverage,<br />"CommCare Bridge" Remains Shaky<br /><br />BOSTON-- The new plan to provide health coverage for 31,000 immigrants rolls out in the Greater Boston area tomorrow. After cutting recent green-card recipients and other legal immigrants from Commonwealth Care coverage in the FY2010 budget, the state legislature compromised with the Patrick Administration and allocated $40 million -- less than one-third the cost of full CommCare coverage -- for a new managed-care plan, run by CeltiCare. On the eve of the roll out of the new plan, dubbed "CommCare Bridge," numerous questions and concerns remain about the bridge's security.<br /><br />"We appreciate the efforts and commitment of the administration and CeltiCare to make the best of a bad situation," said Eva A. Millona, Executive Director of the Massachusetts Immigrant & Refugee Advocacy Coalition (MIRA). "But it remains a bad situation.We are concerned about access to affordable and comprehensive health care for these hard-working, tax-paying Massachusetts residents who were singled out for the cuts. In particular, we worry about the adequacy of CommCare Bridge's network of providers, as well as the plan's increased out-of-pocket expenses and its cap on future enrollment."<br /><br />Currently, all but a small percentage of Boston's 11,500 CommCare Bridge members will need to find new health care providers, since the program's network does not currently include many institutions that have historically served this population, such as Boston Medical Center and Cambridge Health Alliance. Furthermore, with premium costs equal to those in full Commonwealth Care and some higher co-pays, the CommCare Bridge recipients will pay more for less.<br /><br />"Until we see full restoration of Commonwealth Care coverage for these Massachusetts taxpayers," Millona continued, "we cannot expect them to receive adequate health care. We look forward to working with the Governor and the legislature to restore these important funds."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-34440635097436678482009-09-30T21:06:19.671-04:002009-09-30T21:06:19.671-04:00Richard, the issue is not BIDMC. It is continuity...Richard, the issue is not BIDMC. It is continuity of care for these patients, who would otherwise go to BMC, Cambridge, Lawrence General, and BIDMC, as well as others.<br /><br />Yes, it would be nice to get a real explanation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47520989551589757882009-09-30T17:54:33.192-04:002009-09-30T17:54:33.192-04:00There are two sides to everything. What would be ...There are two sides to everything. What would be CeltiCare's explanation for what it did? It seems doubtful that the CeltiCare people came to work one morning and said "let's stick it to BIDMC." There must have been a better reason than that.Richard Wittruphttps://www.blogger.com/profile/10989851443772182737noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-13655124356752838152009-09-30T09:23:33.032-04:002009-09-30T09:23:33.032-04:00At $40 million annually to cover 31,000 persons th...At $40 million annually to cover 31,000 persons that is about $1300 per person as a "capitation" fee related to a specific population. It looks like a losing proposition unless they can seriously restrict care by making it difficult to use or by putting severe restrictions on the providers. If it is convenient for people to use, as with BIDMC community health centers, it will get used more. If it is inconvenient to use then it will be used less and will cost less.<br /><br />How does one operate a capitation system if the patients are permitted to roam from provider to provider where it is hard for the payer to control the access? How would the payments be allocated if a patient went use Caritas for some services and BIDMC for other services?<br /><br />This element of the process is probably an example of how things will work when the government gets involved with the programs now being considered. People are very uncomfortable with how their health care will change, and how it will be restricted. <br /><br />Do you believe that the comprensive prostate team services described in the immediately previous blog entry, and a corresponding program for breast and colon cancer, complete with screenings, colonoscopies and Pap smears, will be available? I suspect that there will be few PCPs that will prescribe that kind of comprehensive care at $1300 per head per year.Engineer on Medicarenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80366626930016564192009-09-30T06:23:28.330-04:002009-09-30T06:23:28.330-04:00The cost argument, as you suggest, is a canard. A...The cost argument, as you suggest, is a canard. All of us would agree to the same rates being charged by those hospitals in this restricted network.<br /><br />BTW, we anticipate that those charges would be in the same category as Medicaid payments, which are not profitable. This is not about making money for us, BMC, and CHA.<br /><br />The insurer, though, was not even willing to get that far into the negotiations, though, just saying that they already had enough tertiary capacity -- whatever that means.<br /><br />And, if they had to limit tertiary providers, why not do it thorugh an open selection/bidding process, perhaps using cost, existing practice relationships, and cultural competence as selection criteria?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-77897808535372997342009-09-30T06:12:32.846-04:002009-09-30T06:12:32.846-04:00Looking at this from the outside, I can see on the...Looking at this from the outside, I can see on the surface that restricting choice may reduce costs. We've all talked about that, about how you can't have all three, right? And of course the hospitals left out have a self-interest motive to be included.<br />However, I would certainly like more information about how Partners and Caritas (?) have "creatively" come up with ways to cover these patients and how costs would be increased by expanding the network. If there are reasonable answers to these questions, then so be it. If there are not reasonable answers, then it is just another example of predatory competition in health care, with the patient as loser.<br />I have to say I was a bit cynical about Celticare when you first published this story some weeks ago, but let's see their data - not be content with their unsupported assertions.<br /><br />nonlocalAnonymousnoreply@blogger.com