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Thu Apr 20, 2017, 08:12 PM

UI Hospitals raise alarm over Medicaid denials

And now the chickens come home to roost. I suspect this will be a full blown crisis by mid-summer or early fall:

http://www.thegazette.com/subject/news/education/higher-education/university-of-iowa-hospitals-raise-alarm-over-medicaid-managed-care-denials-20170419

<snip>
Jean Robillard, vice president for medical affairs of the $1.9 billion University of Iowa Health Care enterprise and dean of the UI Carver College of Medicine, told the Board of Regents on Wednesday that his hospital recently has seen its collection percentage fall from 33.9 percent in January to 31.3 percent in March a spike largely tied to Medicaid managed care denials.

<snip>
The change has prompted the hospital system to adjust its operating income margin projections for the current budget year from 3.5 percent to 1.6 percent. When looking at actual numbers, UIHC has downgraded its 2017 operating income projections from $52.2 million to $23.9 million.

<snip>
Since the state last year handed over its Medicaid program and its nearly 600,000 low-income and disabled Iowans to three private insurance companies, an array of issues have emerged. And Robillard on Wednesday said the hospital still is seeking about $6.4 million in Medicaid reimbursements for old cases dating back 270 days or more contributing to concerns with the bottom line.

<comment> boy did Branstad ever fuck this up. But media is barely reporting it and certainly not giving it the urgency it deserves.

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Reply UI Hospitals raise alarm over Medicaid denials (Original post)
rurallib Apr 2017 OP
Lyricalinklines Apr 2017 #1
rurallib Apr 2017 #2
47of74 Apr 2017 #3

Response to rurallib (Original post)

Fri Apr 21, 2017, 02:43 AM

1. Is this related to ACA being underfunded or not rolled out as was intended?

GOP voted to change funding of it as it was rolled out. Unsure off the top of my head which parts....

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Response to Lyricalinklines (Reply #1)

Sun Apr 23, 2017, 07:47 PM

2. Sorry I was away for a bit - The answer is no

This is the direct result of Gov, Branstad unilaterally changing the administration of Medicaid in Iowa from a government run agency with very low overhead (<4%) to a "Managed Care Organization" (MCO). These are essentially arms of private insurance companies.

Iowa contracted with 3. Their overhead is at least 15% and they want more, claiming they are losing money.

That money comes from the Medicaid pot so at least an additional 10% of Iowa's Medicaid is not being used for client health.

The MCOs current practices are to deny payments to providers for services already rendered and approved. They are also cutting back on services for the extremely handicapped.

Hospitals and providers are really caught in the middle because many of these patients need the services, but not Medicaid is not paying due to the MCOs.

Democrats in the Iowa senate tried to block the privatization, but Republicans blocked their block and the system went in without oversight from the legislature. Some perfunctory oversight was added, but is not enforced.

Branstad claims the the system is working beautifully and the state is saving big bucks.
Those are what we call big fucking lies that are easily refutable.

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Response to rurallib (Reply #2)

Mon Apr 24, 2017, 09:39 PM

3. Brainfart and his groupies are ruining this state

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