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| President's Perspective | |
By Dennis Cooley, MD, FAAP
MEDICAID REFORM
Most economist agree one of the biggest driving forces of the economic difficulties in this country is the amount of money we spend on health care. Health care costs are definitely a factor in the state budget. In FY 2011 the state spent $2.4 billion on the Medicaid program. It is no wonder then that the State is looking at ways to rein in these costs. Governor Sam Brownback has recently proposed changes in the program that his administration hopes can do just that.
First let's look at the current state of Medicaid in Kansas. According to data from the Kansas Health Institute in FY2011, 230,00 children and pregnant women were enrolled in Kansas Medicaid and CHIP. Medicaid is a cost share with the federal government which provides 60% of the program's money. (CHIP receives a 70/30 ratio from the feds). Collectively these programs for children are known as Healthwave. Individuals in Healthwave are all covered by Managed Care Organizations. Benefits for children in the Healthwave program follow the Bright Futures guidelines and periodicity schedule. Another 100,000 individuals, mostly made up of the disabled and the elderly, are on the Medicaid rolls but are not managed by MCOs. This latter group, while making up only 30% of the enrolled members, represents 70% of the costs for the entire program.
As mentioned above the State spent $2.4 billion dollars last year which makes up a large percentage of the state budget. In an attempt to rein in costs, the administration wants to place all enrollees under Managed Care Organizations. The new program will replace Healthwave and be called KanCare. It is scheduled to begin January of 2013. The administration is looking to cut costs in the program by 8-10% yearly or $853 million over the next 5 years. The Governor's office has stated that the cost savings would not be gained by cuts in physician payments or patient services but rather from care coordination, incentivized outcomes and cuts in administrative costs.
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| Issues & Commentary | |
Dennis Cooley MD, FAAP
Editor of Kansan Pediatrician
MORE CUTS TO FUNDING OF STATE'S CHILDREN'S PROGRAM
Child advocacy groups across the state are upset about the recent announcement from the Governor's office that his budget has cut funding of children's programs by another $16 million. The programs in question receive large amounts of their funding from the Children's Initiative Fund. This Fund was created in 1998 as part of the settlement from the tobacco industry. Kansas was one of 46 states that joined in the lawsuit against tobacco companies and have benefitted from the settlement. The Attorney General's Office oversees the money and annually makes an estimate of how much money the state will receive in the coming year. Kansas has elected to use most of this money to fund many children's programs through The Children's Initiative Fund. In 1999 the state established the Children's Cabinet whose nine members advise the Governor and the Legislature how to best spend the money in the CIF.
This year the AG's office estimated the amount the state will receive at $56 million and the Children's Cabinet made its recommendations based on this number.
In the last 2 years, however, the AG's office has over estimated the amount the state eventually received. In 2010 by $1.2 million and in 2011 by $6.7 million. Stating concerns the state will not receive the estimated $56 million The Governor wants to cut the amount budgeted by a whopping $16 million to a total of $40 million. How the number of $16 million was determined is not clear to me. Neither is it clear to child advocates in the state. Shannon Cotsoradis, Executive Director of the Kansas Action for Children, was recently quoted: "There has to be some justification for where they came up with the $40 million when the (Attorney General) said to anticipate $56 million but the Governor's Office has yet to give any indication of how it came with the $40 million dollar figure."
What happens if the state does receive more than $40 million from the tobacco industry this coming year? The Governor doesn't want to put the money back into the CIF for use on programs but rather wants to hold it and apply it to CIF for the following year.
It is understandable the administration wants to be on the safe side and set a conservative budget number that is less than the estimates. Cutting it by $16 million, however, seems much too excessive especially since the largest previous error in the estimate was $6 million. In addition not putting money received in excess of the $40 million back into the programs this year strikes me as wrong.
The legislature will have to agree with this budget and currently there is mixed feelings in the statehouse. As with so much going on now we have to take a wait and see on what is the final outcome is. In the meantime you can make a difference by expressing your views to your legislators. This is the time to contact them. |
| KAAP 2012 Spring CME Meeting | |
Join us at the Oread Hotel in Lawrence April 27 and 28 for the KAAP 2012 Spring CME Meeting. Workshops on Friday, April 27th, and plenary on Saturday April 28.
Online registration and a full brochure will be available soon at www.kansasaap.org.
Questions? Contact Chris Steege at chris.steege@kansasaap.org or (913) 780-5649. |
| TAP-TAM Update |
TAP-TAM Sites Celebrate Dr. Seuss!
Every day Turn a Page. Touch a Mind. (TAP-TAM) physicians and medical providers take the time to encourage families to share a book. For more than a decade, studies have indicated that parents who get books and literacy counseling from their doctors and nurses are more likely to read to their young children, read to them more often, and provide more books in the home. This important message never gets old, but every year on March 2nd we do like to have a little more fun promoting early literacy than usual.
This year will be our third annual Dr. Seuss literacy spotlight event. TAP-TAM sites are eagerly awaiting the arrival of their package that will include everything they need to celebrate with their patients. Inside the box will be Dr. Seuss stickers, coloring sheets, books, Cat in the Hat hats for kids as well as one lucky doctor or nurse, and a poster. Most sites will celebrate all week or even all month long with coloring contests, activities with local schools, decorations, and more.
For more information on how to get involved in Turn a Page. Touch a Mind., contact Mel Hudelson at (913) 940-8965 or mel.hudelson@kansasaap.org. |
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Social Media Series: Article Two - Policy & Procedures | |
By Kristen Stuppy, MD, FAAP
There are many benefits to having a social media presence, but many have resisted due to legal risks, time constraints, and uncertainties. While it is true that health care companies have run into problems with patients being identified-a clear HIPPA violation, these risks can be minimized to allow a medical office to have a strong and respected online presence. Before making your social sites public, be sure to draft a policy that is available for all users.
All businesses should have a Social Media Policy, regardless if your business has a social media presence or not. Your employees are likely on Facebook, Twitter, LinkedIn, or another site. A policy should address if they can access on-line sites during business hours from their phone if they have a down moment. It must address how office computers are used and if the office computers are monitored or if access to restricted sites is blocked. Discuss with employees the potential risks of becoming Facebook friends with co-workers and patients (note: this is VERY difficult to monitor). They need to be informed formally within the policy and reminded verbally at meetings to never associate any work related information on line, even if they don't mention patient names. This may seem obvious, but many people post about things that happen to them. The more people post, the more acceptable postings seem, when in reality posting about someone else is never acceptable. Working in any busy office is full of emotional events, and emotional events are often posted. Inform staff how office computers will be monitored and if any sites will be restricted.
Identify who in your office will be responsible for blogging or posting to Facebook or Twitter for your practice. They should be properly identified by name on the page, but the page name should be reflective of the office if you are using it for marketing purposes. This not only gives ownership to what they author, but it allows patients (and potential patients) to identify with the author. If you hire an outside blogger, be sure to identify who they are and their credentials. Those who have administrative responsibilities to your social media must understand the issues of patient confidentiality, the use of generalizations, and the need to include a broad range of patients and potential patients without alienating any particular group of people. They should be allowed to voice their opinions, but they should choose their subject matter carefully and be very cautious if the subject is debated. It the subject matter is questionable, they should make a clear disclaimer that they are reflecting personal thoughts, not necessarily the position of the practice. Identify who is responsible for reviewing responses from followers and how often should they look at your sites to be sure posts and comments are appropriate.
If you want to see examples of company Social Media Policies, a great resource is Social Media Governance.
Before making social media sites public, make a policy for users of your sites - the public. Address common issues in your policy, such as privacy/public view, solicitation, demeaning or foul language, inappropriate photographs, etc. Post the policy initially and re-post it from time to time. The frequency of re-posting your policy varies by how your site is used by your followers. If used properly, there is no need to keep preaching to the choir. If people use it inappropriately, remind all what is expected, such as no soliciting medical advice on the public forum. Give them alternate means to ask individual advice, such as an office visit, phone call, or encrypted (secure) email. As an example, we have our user's policy on our Info Facebook page, blog, and on our website.
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