Minnesota Physician cover stories

October 2017

Past cover stories

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Opioid Prescribing Improvement Project

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Quality reporting

The importance of accounting for social conditions

 

By Paul Kleeberg, MD, and Phil Deering, BA

 

Like many Minnesota physicians, Dr. Lynne Ogawa first saw her Minnesota Statewide Quality Reporting and Measurement System (SQRMS) outcomes toward the end of the last decade. At the time, the family practice doctor saw patients at the Fremont Clinic, located in the heart of North Minneapolis.

 

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice.

 

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives.

 

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

 

The CARES Model

A way to engage your patients

 

By Archelle Georgiou, MD

 

Sixty-two percent of Americans say they want to deliberate with their physician about their treatment options. And, to help make the right choices, consumers have been armed with an array of health information sites, symptom checkers, cost calculators, and provider quality scores and report cards.

 

Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP.

 

Regenerative Medicine:

Efficacy, Economics, and Evolution

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Recognizing Minnesota physician volunteers

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Or, imagine you are a stay-at-home parent for a medically complex child. Your spouse has two part-time jobs to help make ends meet, yet neither company provides health insurance. However, thanks to Medicaid, all of your child’s health care needs, treatments, and appointments are covered through the program. It is a lifeline for your family.

 

These are just a few of the faces of Medicaid today. They are the sons and daughters of working parents, children with special medical needs, kids whose families can’t afford adequate health care coverage, and infants who were born much too soon.

 

What started as a program to provide health insurance to low income individuals has now grown into the single largest insurer for kids. In 2016, Medicaid covered about 30 million children; over 600,000 of whom live in Minnesota. Almost half of all Medicaid enrollees are children, yet they fail to be included in Medicaid discussions at both federal and state levels time and time again. Debates around reforming the Medicaid system and potential cuts to its funding lack mention of the children most likely impacted and so largely covered. Through Medicaid, children have access to the health care they need when they need it the most. It is a critical program that has been essential in saving lives and will hopefully continue to do so in the years to come.

 

Painting the picture of Medicaid

Medicaid was signed into law in July 1965. Since its inception, the joint federal and state program remains a system established to provide health coverage for low-income people, including children. In 2014, the Affordable Care Act expanded eligibility in the Medicaid program to all individuals under the age of 65 in households with income up to 138 percent of the Federal Poverty Level. This increased access for millions of individuals in the country.

 

Today, children make up the single largest population covered by Medicaid. Unlike adults, they can be eligible for Medicaid based on disability or low birth weight status, in addition to the other qualifying factors. For many of our children with complex or special needs, Medicaid acts as a safety net, covering life-saving services, medications, and procedures that their private or commercial insurance does not. Without Medicaid coverage to rely on, many families would face financially devastating out-of-pocket costs or be forced to forgo necessary treatments.

 

Comprehensive benefit set for children

One of Medicaid’s largest advantages is the comprehensive benefit set that is included. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under 21. Congress passed the EPSDT benefit more than 40 years ago to ensure children and adolescents receive the appropriate preventive, dental, mental health, and developmental services they need. Recognizing that children are not little adults and that instead, they are growing and developing, the EPSDT aims to provide “The right care to the right child at the right time in the right setting.” Research also shows that children from low-income families often do not receive the preventive care or treatments they need to grow into healthy adults. They are disproportionately affected by health conditions such as poor vision and oral hygiene, asthma, obesity, trauma, and anxiety.

 

The EPSDT benefits recognize that a child’s access to quality health care shouldn’t be determined by their ZIP code or their income. They should have access to the health services they need within and across state lines. Providing developmentally-appropriate preventive and habilitative services decreases future spending on health care. Up-to-date vaccinations, screenings, and well-child check-ups help to avoid more serious illnesses, inpatient hospital stays, and emergency department visits down the road. As the old saying goes, “An ounce of prevention is worth a pound of cure.”

Providers need Medicaid, too

 

Without adequate Medicaid funding, access to hospitals, clinics, and necessary health care services would be scarce. Medicaid is a jointly funded state and federal program. The federal government pays states for a specified percentage of program expenditures called the Federal Medical Assistance Percentages (FMAP). Each state has a different FMAP that is based on set criteria such as per capita income. Nationally, the average FMAP is 57 percent, with some states receiving a match as high as 75 percent and others as low as 50 percent. That means that some states, such as Minnesota, are only receiving 50 cents for every dollar they spend on Medicaid, making the program virtually unsustainable without reliance on philanthropy, cost-shifting, or additional state and federal investments.

 

Last year, more than 43 percent of the patients we treated at Children’s Minnesota were on Medicaid and that number continues to grow. To put that in perspective, the average adult hospital sees less than 10 percent of their patients relying on the program. Medicaid makes up a disproportionate amount of our revenue, meaning the reimbursement we receive at Children’s from the state and federal government is critical to our ability to provide care to every patient that walks through our doors. Any cuts to the Medicaid program and financing could significantly impact our hospital, and in turn, the children and families we serve. Medicaid is not only vitally important to the people it aids but also to the providers who depend on its reimbursement to help cover the cost of care. If we want to maintain healthy, thriving communities, we must adequately reimburse and support the providers taking care of them.

 

Medicaid payment reform

Discussions around Medicaid reform through the implementation of block grants or per capita caps should be considered carefully. Even though children make up almost half of all Medicaid enrollees, they account for only about 20 percent of the costs. Our kids are not the cost drivers in the system, so we shouldn’t treat them as such. Unfortunately, unilateral cuts to Medicaid will inevitably disproportionately impact them.

 

If the federal government caps the amount of money each state can spend on their Medicaid program, states could be forced to cut eligibility, benefits, or enrollment. That would equate to losses in health care coverage or the comprehensive benefit sets for kids. Both are critical to ensuring our children grow up healthy and able to contribute to society.

The success of Medicaid today

 

The value of Medicaid is substantial and the program is as efficient as it is effective. Tremendous progress has been made in health care for children since the Medicaid program was introduced. Infant and child mortality rates have dropped significantly and children are able to seek preventive care, including well-child check-ups, immunizations, and developmental screenings, all leading to better long-term health. Research shows that children on Medicaid have higher educational attainment, better economic opportunity, and grow into healthier (and therefore less costly) adults than do children with no insurance at all. Clearly, investing in our kid’s health when they are young saves and improves lives and decreases spending in the future.

 

In 2016, the overall rate of uninsured Americans hit a record low at 8.8 percent; the uninsured rate for children was only 5 percent according to the National Health Interview Survey Early Release Program. While our goal should be to have every child insured, we have made remarkable progress through the Medicaid program and mandates requiring pediatric coverage and access to services. Completely removing or severely limiting Medicaid means critically impacting care for children across the country. There are real and tangible impacts on Americans and the health care they receive through Medicaid and these measurable effects should not be ignored.

 

Looking forward, discussions focused on Medicaid spending and health care reform will continue. Changes to benefits, cost-sharing requirements, and caps on funding could have devastating effects on pediatric health care and the kids we serve. If we are to continue to treat every kid who walks through our doors, and if our country’s children are to lead healthy, productive lives, we need a strong and robust Medicaid program.

 

At Children’s Minnesota, it’s all about the kids. Our mission is to be “every family’s essential partner in raising healthier children.” To do that, we must not only take care of the kids we see in our hospital, but also advocate for a system that protects and provides the access and coverage to the health care on which they rely. Our hope is that while on their mission to reform, policymakers keep sight of the best interests of our kids. Our children are counting on us.

 

Kelly Wolfe is public policy director at Children’s Minnesota and leads the government relations and policy advocacy work that advances the organization’s mission and vision. She oversees state and federal public policy issues ranging from Medicaid funding, hospital operations, and children’s health and development.

 

Minnesota Physician Publishing Inc. © 2017