Dave Ranney, KHI News Service, Author at �鶹Ů�� Health News

In Kansas, Small Medicaid Cuts Have Big Impact On Some Seniors

Dave Ranney, KHI News Service — Mon, 19 Apr 2010 11:07:10 +0000

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TOPEKA – State officials haven’t yet fully gauged the consequences of reducing in-home services for the elderly.

But Sharon Hansen’s perspective is up-close and personal. She says the budget cuts killed her 92-year-old mother.

“She’d fallen and hit her head,” Hansen said. “She’d been approved for what they call 24-hour care and she was doing all right in her little apartment.”

Then two or three days before Christmas, her mother’s case worker called to say that due to state spending cutbacks her mother would be getting only four hours of care a day.

“My sister and I pooled our savings and tried to keep the services going but there was no way we could afford it,” said Hansen, a long-time Mary Kay cosmetics sales representative who lives in Topeka. Her mother “ended up having to go to a nursing home. We didn’t have a choice. She hated it.”

After 12 days at the nursing home, Hansen took her mother, Helen Johnson, to the hospital where Johnson died 13 days later of heart failure.

“I know people can look at this and say ‘Well, that’s just one person,'” Hansen said. “But that’s not true, this affected my mother, it affected me, it affected my family. You do everything you can, and it’s not enough. This is going to be something that my family will be dealing with for the rest of our lives.”

Hansen said she’s angry at Gov. Mark Parkinson, who, last November, ordered a 10 percent cut in the state’s Medicaid rates, which led to the decision to reduce Hansen’s mother’s services.

“If he really cares about Kansans like he says he does then I’d say he needs to get his priorities straight,” she said.

Parkinson at the time said the decision was bad public policy but revenue shortfalls left no choice.

He’s proposed raising taxes to restore the Medicaid cuts and stave off more cuts to education and social service programs and has been waging a campaign to convince the public and legislators to go along.

Nursing home the only option

Carla Butler’s great aunt, Wilma Young, 76, moved to an Oskaloosa nursing home shortly after funding for her overnight services called sleep cycle support – was eliminated.

“She’d fallen a couple times and she’d been in the hospital,” Butler said. “She couldn’t be alone at night because she’d get up half-asleep to go to the bathroom and fall again so I got her approved for sleep support. But two days later, she got an infection and had to go back to the hospital.”

“In between that time and when she was ready to go back home is when they cut the funding,” said Butler, who helped care for Young. “After that, the nursing home was her only option.”

“She’s doing OK, I go see her twice a week,” she said. “She’s made some friends, but she doesn’t like it there. She’s sharing a room with another person now and she really doesn’t like that.”

The services that allowed Young to live in a one-bedroom apartment in McLouth cost Medicaid about $2,000 a month. Her stay in the nursing home is costing the program around $4,000 a month.

“Raw deal”

“There’s a lot of this that doesn’t make sense to me,” Butler said. “We were doing fine then they cut the funding and now she’s in a nursing home which she doesn’t like and that costs more. I think it’s a raw deal.”

Within Medicaid, in-home services are considered optional and may be cut; nursing home services are an entitlement and must be provided.

Young, who has diabetes, high blood pressure and a weak heart, while living at home had been taking part in a telehealth pilot project that used a computer program to monitor her vital signs.

“Along with her caregiver, we kept her out of the nursing home for two years. But when the sleep cycle support was taken away nobody felt comfortable leaving her alone at night,” said Monte Coffman, who runs Windsor Place, the Coffeyville-based company that oversees the telehealth project.

Good value

“It’s sad,” he said. “Sleep cycle support costs like $25 a night. It’s one of the best values the Department on Aging had to offer. And now it’s gone.”

The department also suspended Medicaid-funded dental services, non-medical companion-type care, and assisted technology support for the frail elderly.

Annette Graham runs the Central Plains Area Agency on Agency in Wichita. She said Young’s move to a nursing home and Johnson’s death were not unique.

“We’ve had many, many families tell us that losing sleep support was the straw that broke the camel’s back,” Graham said. “They held on as long as they could but without sleep support there wasn’t anything they could do. A nursing home became the only option.”

The loss of assisted technology support also has been troubling, she said.

“If you get to the point where you need a lift chair to get up or you can’t get on or off the toilet or take a shower without some bathroom modifications or you can’t get out of the house to go to the doctor’s office because you can’t up or down the steps and you need a ramp well, that assisted technology support isn’t available now,” Graham said.

“We’ve seen a lot of people have to go to a nursing home,” she said, “and we’ve had a lot of families say they’re holding on for as long as they can, but they’re also telling us they can’t hold on much longer if services don’t get restored in the next couple months.”

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Facing Shortage, Kansas Seeks To Increase Doctor Training

Dave Ranney, KHI News Service — Tue, 09 Feb 2010 00:00:08 +0000

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WICHITA – Kansas is going to need more doctors to meet the growing needs of an aging population, officials here say.

Meanwhile, the University of Kansas School of Medicine in Wichita has been successful training doctors who choose to remain in the state.

Almost half its graduates have stayed in Kansas; the national average for retaining medical school graduates is 29 percent.

With the aim of turning out more graduates, university officials here have long wanted to convert the Wichita campus to a four-year school. It’s a two-year program, now.

“I think we could produce more doctors in Kansas and the most likely place for that to happen is in Wichita,” said Dr. H. David Wilson, dean of the Wichita campus since July 1, 2009. “We could more than double the number of medical students we have now.”

Wilson has proposed taking on as many as 28 first-year students as early as next fall and 28 more in the fall of 2012.

By 2014, he’s hoping to have 50 first-year, 50 second-year, 75 third-year, and 75 fourth-year students.

Today, the school has 110 students — 55 in their third year, 55 in their fourth year.

In Kansas, first- and second-year medical students are trained at the KU School of Medicine in Kansas City.

Wilson, who came to Wichita from the University of North Dakota School of Medicine, said he’s in the “very initial stages” of meeting with private donors who could perhaps help cover the costs of the initial expansion. Tuition income, too, will help cover the costs.

“We recognize the state doesn’t have the money to support this activity at this time,” he said.

Wilson declined to say how much the expansion is expected to cost but noted it does not include a new building.

Wichita and the medical school, Wilson said, are well-suited for the expansion.

“We certainly have the medical facilities, the patient base and a large number of physicians who are willing to help educate medical students,” he said. “And I’m working closely with Wichita State University so that we won’t have to duplicate the science education and research components that are going on in Kansas City.”

The two largest hospitals in Kansas Via Christi Health System and Wesley Medical Center are in Wichita.

The city also has more than a thousand practicing physicians.

The plan includes the Wichita campus having ready access via video conferencing to classes taught on the Kansas City campus. Also, lectures are routinely podcast and available to students.

But at some point, the expansion’s success will depend on state funding.

“Absolutely,” Wilson said. “We can do this on tuition and good will private support – for a couple years, maybe three. But ultimately for us to produce more doctors for Kansas we’ll have to have the state’s help. It needs to be a partnership.”

In conjunction with the move to a four-year curriculum, Wilson wants to institute what is called patient-centered learning, a concept he helped pioneer in North Dakota.

“It’s a wonderful way to educate students,” he said. “They start out with real patient cases. They’re shown the way physicians use basic science to diagnose and treat and then on Fridays they actually meet and have a dialogue with the individual they’ve been studying.

“It’s not theoretical,” Wilson said. “It’s a real physician in front of the class talking about how the diagnosis was made and how treatment was instituted. And then the students have a chance to question the patient. What did they think? How did this affect you? How did it affect your family? How much did it cost? What do you think of the health care system?

“It’s a much more spirited, much more adult way to learn rather than the rote memorization we have now,” he said.

The Kansas Medical Society welcomes Wilson’s efforts.

“This discussion isn’t new there’s been talk about having a four-year medical school in Wichita for quite some time,” said Jerry Slaughter, executive director of the society. “What’s different now, I think, is people are starting to see that with health reform if there is health reform there’s going to be a significant reduction in the number of uninsured in this country, which is going to cause an increase in demand for services because these are people who for the most part aren’t accessing services now. And this is on top of the demographic thing with the population aging and physicians retiring.”

To some observers, Slaughter said, wanting to expand a medical school in the midst of a recession and state cutting appears futile.

“But the discussion needs to be going on now,” he said. “The vision needs to be there. People seem to forget that it takes seven to eight years minimum to produce a primary care specialist four years of school, three to four years of residency. You can’t just turn the tap and start producing them.”

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Kansas Medicaid Cuts Expected To Hinder Access To Care

Dave Ranney, KHI News Service — Tue, 08 Dec 2009 00:00:00 +0000

This story comes from our partner

TOPEKA – Consumer advocates and others say it will only become harder for low-income Kansans to get medical services now that the state is cutting Medicaid payments by 10 percent.

“Let’s be honest about this,” said Corrie Edwards, executive director of the Kansas Health Consumer Coalition. “Doctors are not taking any more Medicaid patients right now. They’re not.

“I was in Ashland (52 miles southeast of Dodge City) two weeks ago and there’s nobody there who’ll take Medicaid,” Edwards said. “The closest doc is two hours away – that’s two hours one way.

“It’s the same in Wichita or Topeka,” she said. “You can spend hours on the phone trying to find somebody who’ll take Medicaid.”

Physicians and hospital officials have long complained that Medicaid doesn’t cover their costs.

Cutting payments by 10 percent, Edwards said, will make a bad situation worse.

Gov. Mark Parkinson last month ordered the cuts in reimbursement rates to doctors, nursing homes and other providers as part of ongoing efforts to keep the state budget balanced.

The state faced about $258 million in red ink and the state constitution requires a balanced budget. The cuts ordered by the governor touched virtually every department and state office, not just the Medicaid program, with major cuts also ordered in education spending and highway maintenance.

In earlier rounds of cuts this year, state officials avoided reducing Medicaid reimbursements, but the governor said this time he was left with no good choices.

“There’s no way to sugar coat this,” Parkinson said. “This will have very negative effects across the state.”

Kansas Health Policy Authority officials that the reimbursement reductions will apply for all services provided after Jan. 1.

Harder On Some

The cuts are expected to fall especially hard on children and mothers.

Almost two-thirds of the state’s Medicaid population is comprised of children and pregnant women. The rest are either elderly or disabled. All are low-income.

In Kansas, childless, non-disabled adults are not eligible for Medicaid.

“The physicians who are going to be affected the most by this are those whose practices are in high Medicaid-volume areas, like in some of the urban areas,” said Kansas Medical Society Executive Director Jerry Slaughter. “.”

“People need to understand that before this cut, Medicaid paid about 65 to 75 percent of what a private insurer paid,” said Dennis Cooley, a Topeka pediatrician and president of the Kansas Chapter of the American Academy of Pediatrics. “At the same time, a typical primary care practice’s overhead costs come in at around 60 percent. So when Medicaid takes a 10 percent cut, that means you’re either seeing (patients) for free or you’re paying to see them.”

Cooley said he expects pediatricians now will accept fewer Medicaid patients. Some, he said, will decide to stop seeing them altogether.

“That’s my biggest fear in all this,” he said. “Because when that happens, more and more of these folks are going to turn to the local health department or the safety-net clinic, which, let’s not forget: Their funding is being cut, too.

“Pretty soon, they’ll be overrun and then there won’t be any place for these folks to go but the emergency room, which, as we all know, is the most inefficient, most costly place to receive care,” Cooley said.

Eventually, he said, the cut’s short-term savings will fall far short of the long-term costs.

“I understand the difficult situation the state is in,” Cooley said. “But a 10 percent cut is going to end up costing us a lot more than it’s going to save.”

Pain For Hospitals, Too

Hospitals also are worried.

“It’s still too early for (hospitals) to know how they’re going to respond to this,” said Tom Bell, executive director at the Kansas Hospital Association. “But a 10 percent cut is going to be very difficult to absorb. I suspect they’ll be taking a pretty close look at whatever services don’t provide the kind of margin they need.”

Bell and Slaughter said their members have been calling wanting to know if the cuts are likely to deepen in the months ahead.

“I don’t know that anybody knows the answer to that at his point,” Bell said.

“The thing I’m hearing about the most is that if this was a 5 percent cut and took effect in July 2010, (physicians) could plan for it or make adjustments,” Slaughter said. “But this is 10 percent, effective immediately. There’s no way to plan for it. So now they’re saying ‘Is this it? Or is it going to get deeper as we go along?’

“All we can say is we just don’t know,” he said. “It’s pretty frustrating.”

Dr. Vernon Millis, a Leavenworth pediatrician and a member of the Kansas Health Policy Authority board, said he had no plans to see fewer Medicaid patients.

“We’ll try to cut a few things here or there, but, frankly, we won’t change much,” Mills said. “All we can do, really, is just grin and bear it just like we have for the last 25 years.”

Now that it’s winter, he said, demand for back-to-school physicals and checkups has passed.

“Most of the kids who are coming in are coming in because they’re sick,” Mills said. “I have to see them. I don’t have an option.

“Let’s not forget who we’re talking about here,” he said. “These are children. They don’t have a say in these decisions, it’s the adults who are making the decisions and who keep saying how much they value children and then they turn around and cut education and Medicaid. I’ll have no part of that.”

specializes in coverage of health issues facing Kansans

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