Insurance Reimbursement Cuts

[drmorton2b]

With Medicaid and Medicare cuts on the horizon..Is it possible that there will ever be an increase in funding these programs that barely cover the cost of care? In MA we had a nursing home bed tax that allowed nursing homes to break even (due to low medicaid reimbursement rates). Our Bright Governor.. decided to raise the nursing home tax and put the money in the general fund.

My strong believe is that there will be another nursing shortage..(Insert the nurses who have seen it before again and again). However, due to decreased reimbursements from insurance companies both private and government.. This will not be a sign on bonus style shortage..

Its also my opinion that the home care nursing sector will continue to expand.

When will Hospitals and Providers band together and say enough is enough with all of these cuts to reimbursements?

Sadly most do not.. because they close floors and facilities.

I am optimistic enough to go back to school for my RN and then BSN since I do believe a shortage will happen. I work in psych and detox and the facilities I work at literally are the only game in town and actually do okay.

Comments?

[linearthinker, DNP, RN]

My guess is those facilities will try to make do with unlicensed personnel. If reimbursements are down, expenses will have to go down, period.

[netglow, ASN, RN]

This economic downturn is a bit different. We have the added problem of strong links made to import nurses (they call it a "diverse workforce") that were built in the late 90's. This was and still is heavily marketed as a way for hospitals - you must always remember that hospitals are in existence to make lots of money priority #1 - to get nurses working here for less in the long run. Remember hospitals do lobby their state/fed gov contacts to ease the way for profit. Once you get 80 to 90% nurses not educated in the states, you can begin to force global poor workplace practice on your entire nursing staff and face no pushback. I had found several seminars geared to make this easy for facilities to do... So, really it's big business that is going to decide where they want to find their nurses should the economy turn around... they already know where, and it's not from the United States where, thousands of nurses graduate every year and are not hired. These two links I found on a most basic search, they are old, but you get the idea.

http://content.healthaffairs.org/content/23/3/78.full

http://www.super-solutions.com/pdfs/diversenursefinal.pdf

[2011NursingStudent]

Some of these cuts are going to lead to people becoming ineligible and purchasing private insurance instead, which is a better option anyway. In Illinois for example, almost all parents qualify for "All Kids" and many of them, including myself, are perfectly capable of paying for private insurance for our kids. They have $100/mo copay for parents making over $40k, but if they were to cancel coverage to parents that make that much, we'd just go and buy Blue Cross/Blue Shield or something else.

[netglow, ASN, RN]

Have you ever bought individual/family comprehensive health insurance on the open market (not group/employer-based)? I think you might benefit from getting a quote off of BCBS website and see just how "inexpensive" it is. Have you/your child ever had a medical condition that needed tx other than something like a URI? They will take your "affidavit" on your application and then search the database which contains all claims from all your interactions with healthcare. If you have just about any "condition" that needs or might need further care, you will be denied. If you lie and then try to get tx for such a condition, you will be charged with fraud as well be stuck with paying cash for all your treatment.

[2011NursingStudent]

Have you ever bought individual/family comprehensive health insurance on the open market (not group/employer-based)? I think you might benefit from getting a quote off of BCBS website and see just how "inexpensive" it is. Have you/your child ever had a medical condition that needed tx other than something like a URI? They will take your "affidavit" on your application and then search the database which contains all claims from all your interactions with healthcare. If you have just about any "condition" that needs or might need further care, you will be denied. If you lie and then try to get tx for such a condition, you will be charged with fraud as well be stuck with paying cash for all your treatment.

Yes, my own policy is from Blue Cross/Blue Shield, and was purchased from their website, not my employer b/c I work p/t. Including maternity coverage, its $269/mo.

People that have pre-existing conditions still qualify for Medicaid, as far as I know, none of the cuts have anything to do with that. (The cuts I've read about include not covering certain transplants, dental, limiting the # of ot and pt visits per year, etc)

[damrcngrl95]

Have you ever bought individual/family comprehensive health insurance on the open market (not group/employer-based)? I think you might benefit from getting a quote off of BCBS website and see just how "inexpensive" it is. Have you/your child ever had a medical condition that needed tx other than something like a URI? They will take your "affidavit" on your application and then search the database which contains all claims from all your interactions with healthcare. If you have just about any "condition" that needs or might need further care, you will be denied. If you lie and then try to get tx for such a condition, you will be charged with fraud as well be stuck with paying cash for all your treatment.

That is so scary that insurance companies can do that. My husband is military and we have Tricare. I have not had nonmilitary insurance for so long that I have no concept of what civilian families do for insurance. All I know is that I believe everyone should have access to medical care and that the ER is not the answer for routine care. I'm not a nurse, but I am trying to keep up with the bills being put up for a vote as congress tries to balance the budget.