Imposing Caps on Federal Spending for Medicaid
One reason many patients are able to receive health care treatments is because of the assistance they receive by participation in Medicaid. “Medicaid is a joint federal-and-state program that covers acute and long-term health care for groups of low-income people” (Congressional Budget Office, n.d., p. 221). While the federal government is largely in control, states are required to share in the financial debt created by enrollments through covered groups. Over the last two decades Medicaid spending has risen around 7% annually, and as such a budget plan of proposed changes was introduced with several options for reducing mandatory Medicaid spending from 2017 to 2026 (Congressional Budget Office, n.d). We will be discussing health option 2 under mandatory spending, which is to impose federal Medicaid caps aimed at lowering the overall deficit. A personal goal of mine is to work for a dedicated diagnostic imaging facility, so I think it will be necessary to look and see how those changes might affect potential services and clientele. Following option 2 will be a brief look at some of the demographics covered under Medicaid, and what a facility might be able to do in order to mitigate negative fallout from the new proposition should any exist.
Caps on Spending per Enrollee
Perhaps one of the largest issues affecting the steady ascent of Medicaid spending lies in the state’s ability to drive federal funding. This variation is difficult to effectively manage which leads to more federal oversight. The proposed cap on spending per enrollee (growth of caps based on consumer price index for all urban consumers) is projected to result in a $7 billion dollar deficit reduction from 2020 to 2026 (Congressional Budget Office, n.d). Part of the way to the federal government wants to offset spending is by expanding the eligibility categories. The per-enrollee caps could then, “establish one average per-person cost limit for all enrollees” (Congressional Budget Office, n.d., p. 224). This price can be further influenced by creating individual brackets based on factors such as age or disability. In this way it would still be a set cap, but still allow for some demographic manipulation. My initial conclusion is that depending on where the individual cap is set, it could result in currently eligible members falling out of coverage which would impact my facility in patients unable to receive treatment.
Radiology & Medicaid
However, one of the reasons I believe the inevitable Medicaid spending reduction can be overcome by a dedicated imaging center is since, “many health care facilities rely on medical imaging services to subsidize other functions that generate little or no revenue” (Watson, 2014, p. 271). By virtue of being a stand-alone facility the obligation to distribute revenue resides solely within the organization, so long as the clinic complies with federal regulations to remain eligible to continue receiving reimbursement. The traditional fee for service model allows for a more simplistic one-to-one exchange between services rendered and fees recaptured, a trait that benefits an independent diagnostic imaging center and can be passed on as savings to patients.The biggest problem I can see is that “Medicaid enrollees were significantly more likely than those who were uninsured during the year to say they had been seen by a doctor or nurse the same or the next day, and nearly as likely as privately insured adults” (Blumenthal et al., 2015, p. 2). Ultimately, this has the capacity to lower the overall population health which is intrinsically linked to increased prices and spending. The goal though here is not to debate the morality of the proposal, but rather how to successfully navigate it, which an imaging center seems well suited to do.
References
Congressional Budget Office. (n.d.). Options for reducing the deficit: 2017 to 2026. https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142-budgetoptions2.pdf
Blumenthal, D., Rasmussen, P. W., Collins, S. R., & Doty, M. M. (2015). Does Medicaid Make a Difference? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014. Issue Brief (Commonwealth Fund), 19, 1–9.
Watson, L. (2014). Medicare reimbursement: What R.T.s should know. Radiologic Technology, 85(3), 271-286.