Study: Medical Care Lags for RI Women

In a study examining health disparities among women, researchers using Rhode Island data found that women with disabilities receive less medical care and are more likely to experience adverse birth outcomes than typical women.

The study published in the December issue of Medical Care found that over 10 percent of women with disabilities in Rhode Island had a low birthweight infant, compared with 7 percent among non-disabled women. Meanwhile, over 13 percent of disabled women delivered babies prematurely versus 9 percent of typical women.

4 Years of Managed Care in Kentucky

FRANKFORT, Ky. — Kentucky’s Medicaid Managed Care system has experienced profound growing pains since its implementation four years ago, but Cabinet for Health and Family Services officials assured a legislative panel Thursday that the state is taking steps to resolve disputes between medical providers and managed care organizations.Providers like Sen. Danny Carroll, chief executive officer of Easter Seals West Kentucky, which provides care for disabled adults and youths, have complained of delayed or denied Medicaid payments and a morass of bureaucratic hurdles to clear for each MCO.

Reports Cites Importance of Coordinated Care in Hospitalizations, ER Use

Interesting story from Crain's New York's Health Pulse look at New Yorker's with developmental disabilities use of the emergency room and hospitalizations. As we move toward Medicaid Managed Points out the importance of coordinating care, especially having a discharge plan, before a person returns to his/her home. Pasting below because it requires a subscription.

A new report examines data on hospital and emergency department use among the developmentally disabled in New York state—a group that is relatively small but costly to the health system. The report, prepared by Welsh Analytics using 2013 SPARCS data and edited by the ArthurWebbGroup, documents how such special populations compare with general patients in their inpatient and emergency department utilization.

About 1.6% of inpatient hospitalizations involved a person with developmental disabilities, excluding epilepsy. Conditions include intellectual disabilities, cerebral palsy and autism-spectrum disorders.

The developmentally disabled population will be one of the last in the state to be enrolled in managed care when individuals begin to voluntarily enroll in October 2015. Health consultant Arthur Webb said he believes the report, online here, offers guidance to hospitals and policymakers on how to reduce unnecessary inpatient and ED visits.

“Unlike behavioral health, this is a population small enough that you can get your hands around it,” he said. “It lends itself to some real improvements.”

The developmentally disabled are more than twice as likely to be admitted to the hospital from the ED. Medicare or Medicaid was the primary payer for 80% of hospital visits, while dual eligibles accounted for 27.4% of inpatient discharges in the state.

Coordinating care between hospitals and the community-based providers who care for the developmentally disabled is key; only in about one-fifth of cases do these patients have a formal plan for home care, the report found.

“That shouldn’t happen,” Mr. Webb said. “Making sure there is a plan for discharge is a major area with room for improvement.”

In New York City, 1.4% of inpatient stays involved a person with developmental disabilities. That translates into about 14,000 inpatient discharges and 13,000 outpatient ED visits for that population.

The report identified the Rockaways, the Bronx, eastern Brooklyn and northern Staten Island as neighborhoods that showed “somewhat higher” rates of inpatient admissions for developmentally disabled residents.

“We can reach into these communities and see if we can’t improve the plan of care and improve their access to primary care,” said Mr. Webb. “It really lends itself to some very proactive approaches to managing care.”

States Watch 2015 Health Care Issues

Much of the health-care conversations this year will concentrate on two issues with major budgetary and insurance coverage implications that Governing has previously covered. Those are the upcoming U.S. Supreme Court decision that could end federal subsidies in the 30-some states that don’t operate their own exchange, making insurance unaffordable for many, and whether Congress reauthorizes the Children’s Health Insurance Program, which covers 8 million kids from low-income families through state and federal funding.

Unfortunately for states, those are also both issues over which they have little control. There are, however, several other areas to watch over which states do have greater control and still others worth keeping an eye on where federal policymakers remain in the driver’s seat.

Higher Payments May Prompt More New Jersey Doctors to Accept Medicaid Patients

A two-year project is under way to encourage primary care doctors to accept Medicaid-eligible patients by paying for many services at the same level as Medicare.
Many poor or disabled patients have limited access to healthcare because so few doctors have been willing to accept the low Medicaid reimbursement rates.
The federal government will cover the difference between Medicare and Medicaid reimbursements for 146 primary-care services from Jan. 1 through the end of 2014. The increased payments will be made to family physicians, pediatricians and internal medicine doctors who specialize in primary care.

Autistic Aduts Report Worse Health Care

Adults with autism report significantly worse health care experiences than adults without autism, according to a study published in the November issue of the Journal of General Internal Medicine.
Christina Nicolaidis, MD, MPH, of the Oregon Health & Science University in Portland, and colleagues used a community-based participatory research (CBPR) approach to adapt a survey for adults with autism. The online cross-sectional survey was completed by 209 adults with autism whose health care experiences were compared with those of 228 adults without autism.

Autistic Kids 9 Times More Likely to Have ER Visit

BALTIMORE -- New research has found that children with autism spectrum disorders (ASD) are nine times more likely to be at a hospital emergency room for psychiatric reasons.
The study found that severe behaviors tied to aggression were the leading cause of emergency visits among autistic children.
The researchers also found that the likelihood of a psychiatric emergency room visit was higher if a child carried private health insurance rather than medical assistance.

This Election, a Stark Choice in Health Care

Joyce Beck, who runs a small hospital and network of medical clinics in rural Nebraska, is reluctant to plan for the future until voters decide between President Obama and Mitt Romney. The candidates’ sharply divergent proposals for Medicare, Medicaid and coverage of the uninsured have created too much uncertainty, she explained. 

“We are all on hold, waiting to see what the election brings,” said Ms. Beck, chief executive of Thayer County Health Services in Hebron, Neb. 

When Americans go to the polls next month, they will cast a vote not just for president but for one of two profoundly different visions for the future of the country’s health care system.

Romney Champions Medicaid in Ohio with No Mention of Proposal for Severe Cuts

Feeling a little political this morning, will try to provide a proper balance.

During a rally in Mt. Vernon, Ohio on Wednesday, Mitt Romney touted the benefits of Medicaid and claimed that all Americans will be able to obtain health care insurance without President Obama’s Affordable Care Act.
Responding to a question from a woman whose son suffers from Spina Bifida, Romney disparaged Obama’s health care measure — which would expand access to 30 million Americans — and claimed that the law is unnecessary for people suffering from chronic conditions:

ROMNEY: Actually, we had health care in America before Obamacare came along. And we still have health care in America…Each of us today in America has a choice of the type of health care plan we might choose. People who are poor are able to get Medicaid, which is a government support effort for those who can’t afford to have insurance. And these things aren’t going to disappear without Obamacare.

Penn Medicine Breaks Silence on Heart Transplant Denial for Autistic Patient

Penn Medicine is part of the Hospital
of the University of Pennsylvania.

Much of the coverage devoted to Paul Corby’s quest to get a heart transplant has focused on the cardiac and transplant side of things. But Paul, of Pottsville, PA hasn’t been denied placement on the heart transplant list for cardiac reasons.
Paul has been denied placement on the heart transplant list, at least in part, because he has autism.
Paul, who has a rare congenital heart disorder called Left Ventricular Noncompaction (LVN), has had three mini-strokes already. He’s 23 years old. His father died of a stroke, caused by the same disease, at age 27.  Penn Medicine at Radnor, part of the Hospital of the University of Pennsylvania, denied Paul placement on the heart transplant list in part because Paul is autistic.
A letter from a Penn Medicine transplant doctor to Paul’s mother, Karen Corby, reads, “I have recommended against a transplant given his psychiatric issues, autism, the complexity of the process, multiple procedures and the unknown and unpredictable effect of steroids on behavior."

In ER, Caregiver Key to Treating Autistic Patients

The bright lights and noise in an emergency department or examination room can disturb and upset a patient with an autism spectrum disorder; so can the exam itself if the doctor does not use the proper approach.
Unfortunately, caregivers of patients with autism frequently report that a trip to the hospital can turn into a distress-filled struggle, getting in the way of proper treatment, according to a recently published online article by five emergency physicians, including three from Allegheny General Hospital.