Miami public hospitals end payments for dialysis treatment of the indigent

Miami public hospitals end payments for dialysis treatment of the indigent

By James Brewer
9 January 2010
The Jackson Health System in Miami’s Dade County has stopped paying for kidney dialysis for indigent patients. The move affects 175 kidney patients who have depended on the county hospitals to provide their life-saving treatments.

With this measure, the public hospital system, tasked with providing health care for the uninsured and the poor, is expecting to save $4.2 million of a projected $168 million budget shortfall this fiscal year.

Hospital spokespersons claim that most patients will be able to obtain treatment by going to emergency rooms. This will effectively shift the cost of dialysis from the county to the federal government, which provides emergency Medicaid payments for dialysis treatments performed in emergency rooms.

Under federal law, emergency rooms must provide treatment for patients in serious medical need. In order to get emergency room treatment however, patients must be in severe medical distress.

The St. Petersburg Times quotes Emelina Cordovi, 67, whose treatments at a South Miami Dade center were cut off December 31. “It is no game,” she told the newspaper. “We are talking of the lives of persons who depend exclusively on their dialysis.”

http://www.wsws.org/articles/2010/jan2010/miam-j09.shtml

Expansion of Public Programs--Medicare and Medicaid: Again, this doesn't include the Medicare buy-in proposal currently being scored by CBO. The Medicaid expansion is very significant, and in terms of really expanding coverage and getting people access might be the most critical part of the effort. The program would be expended to cover all poor Americans whose household income is below 133% of the federal poverty level (FPL) as of 2014. Any state that wanted to expand coverage sooner could do so as early as January 1, 2011. The states could limit coverage under this expansion to "benchmark" coverage, a basic package of the essential benefits available through the exchange. However, eligibility would be determined based on modified gross income without expenses factored in, so the eligibility ceiling isn't as high as it would be if the eligibility were determined as it is now for Medicaid--more income will be counted.

To assist the state, the federal government will cover 100% of the costs of expanding it from 2014-2016. For the next two years federal aid would depend on the state's coverage of non-elderly, non-pregnant individuals, and then after 2019, would receive increases based on expansion, up to 95% assistance. The bill maintains CHIP (which has been phased out in the House bill). The bill doesn't increase reimbursement rates for doctors providing care through Medicaid, a problem if that population is increased, since many providers refuse to take Medicaid. The House bill is also more generous, using 150% of poverty level as the cut-off.

The Medicare provisions are fairly significant tweaks intended to improve the quality and effectiveness--as well as contain costs--in the program. It does entail some cuts, the cuts you've been hearing Republicans yammer on endlessly about on the Senate floor in the past two weeks. Those includes most significantly reductions in Medicare Advantage plans, private plans that supplement Medicare that would now have to transition to a payment system based on competitive bid. A lot of the system changes in provider payment, quality and performance based reimbursement and penalties. It contains a number of proposals that would change the way that Medicare pays doctors, moving away from a system that rewards unnecessary tests and towards a system that rewards quality care. It starts to close the Part D "donut hole" in 2010, to be eliminated by 2019. It also created a new 15-member independent Medicare Advisory Board, appointed by the president and responsible for providing recommendations to Congress on reducing excess Medicare cost growth.

http://wwww.dailykos.com/storyonly/2009/12/13/813660/-Key-Elements-of-Senate-HCR-Bill

Yeah, I've heard this talking point before. A lot of it from folks that don't shit about disease processes and why certain tests are done.

I read something a few months ago by some hack complaining about Chest Xrays for folks with pneumonia and WBC on cancer patients. That language is vague and EXTREMELY disengenous. One minute these hacks are complaining Americans don't get enough access and another that they get too much. It's typical of the reactionary politic that is not grounded in issues and rolls on whatever crisis the financial elite complain should be the crisis of the moment.

Unecassary, when applied to Government spending, is more applicable to the millitary budget and the mass jailings in this country of the working classes.

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A bill is needed just not the one proposed that forces people to give money to these sponges.

has nothing to do with your hated insurance companies.

A former boss's wife was getting treatment, and he said something to that effect. :shrug:

The federal government should step in immediately with Medicaid for these poor people. You don't go to ERs for ongoing treatments. This country disgusts me some times.

thread--

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x4216290#4217200

Apparently there is now a 30 day reprieve on ending the dialysis. Apparently these folks were on Medicaid, some are apparently from outside the US, perhaps some may not have papers.

One of the problems with the bills in Congress is to shunt (ha!) funding to the states via Medicaid, rather than provide a nation-wide funded program. Problem is most states are having severe economic difficulties in the reession and are dramatically reducing Medicaid services. My state, for instance, has begun to drastically reduce caregiver funding for the developmentally disabled, and is cutting back on reimbursements to practitioners, like myself.

We can talk all we want about how wonderful the Congressional bills are, but in essence the transfer of funding to the states exacerbates an already horribly fragmented way of delivering and financing care.

end up being bounced back and forth going months on end without treatments.

me. Not a good way to provide care overall, very impermanent. Financing one day, and not the next, services cut off depending on a state's budget contribution. It's a travesty, and I'm glad some folks can benefit from it.

at community clinics for care. Yes, the labeling is a blow to many,---now this.