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Medicaid programs now have a new option to offer "health homes" to enrollees with chronic conditions, included in the Affordable Care Act (ACA). "The main reason we will see strong interest is that this is a population that is very high-cost, and often goes without needed care," says Jocelyn Guyer, co-executive director of Georgetown University's Center for Children and Families in Washington, DC.
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When a program funded through state-only dollars is targeted for reduction or elimination, there is a possibility that it can be funded through Medicaid instead, notes Patricia MacTaggart, a lead research scientist and lecturer in the Health Policy Department at George Washington University in Washington, DC.
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For decades, a California long-term care program provided case management for about 12,000 elderly Medicaid clients who qualify for placement in a nursing facility but want to remain in the community, but it is now faced with total elimination.
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After the Multipurpose Senior Service Program (MSSP) was targeted for elimination in January 2011, the program's staff put together their own analysis to prove the cost savings achieved by the program, reports Eileen M. Koons, MSW, ACSW, director of Huntington Senior Care Network.
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Medicaid programs underfunded nursing facility care by $5.6 billion in 2010, paying $7.17 per hour per patient, less than the nation's current minimum wage of $7.25 an hour, according to an analysis from the American Health Care Association in Washington, DC.
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Case: A 40-year-old man with a history of hepatitis C and alcoholism presents to the ED with dental caries. A brief history and unremarkable physical examination is documented. The patient is discharged and fills his prescription for hydrocodone 5 mg/acetaminophen 500 mg (1-2 tablets every 4-6 hours as needed, #25).
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Given the fact that almost every patient, family member, and ED staff member is carrying a cell phone, it's not surprising that inappropriate photos or videos have been posted online which means increased legal risks for EDs.
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Corey M. Slovis, MD, professor and chairman of the Department of Emergency Medicine at Vanderbilt University Medical Center in Nashville, says to remember that requirements of the Health Insurance Portability and Accountability Act (HIPAA) apply not only to words, but also to images.
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Did an ear, nose and throat consultant refuse to come in for a critical-airway patient, a neurosurgeon for an intracranial bleed, or a hand surgeon for a patient with a tendon rupture? "Any of these instances could lead to poor or unsafe patient care and strained future relationships," says Chad Kessler, MD, FACEP, FAAEM, section chief of emergency medicine at Jesse Brown VA Hospital in Chicago.
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Michael Blaivas, MD, RDMS, professor of emergency medicine in the Department of Emergency Medicine at Northside Hospital Forsyth in Cumming, GA, says he has reviewed multiple cases involving consultants refusing to come to the ED, with a bad outcome resulting. "Mostly, this means an unhappy patient, but in critically ill ones can mean a lawsuit," he says.
