Are Medicaid patients overusing the ER?

by | August 21st, 2014 | Posted in Blog, Healthcare | Comments (0)

ERIn the debate over Medicaid, a frequently heard claim is that Medicaid recipients overuse emergency rooms for non-emergency care, and that we need to address this problem if we are to contain Medicaid spending.

This past session, the Legislature approved HB 2906, which directs the Oklahoma Health Care Authority, the state’s Medicaid agency, to conduct a study of current and potential ways to reduce trips to the emergency department. Earlier in session, legislation passed the House that would have limited Medicaid coverage to six emergency room visits per year.

However, Health Care Authority data seems to dispel the idea that ER overuse by Medicaid members is as pervasive or as serious a problem as many assume. In State Fiscal Year 2013, there were just over 1 million Oklahomans enrolled in SoonerCare. Of this population, nearly three in four (73.8 percent) made no emergency room visits in a 12-month period. Another 21 percent visited the ER once or twice. Only 11,763 individuals, or 1.1 percent of the Medicaid population, had six or more ER visits. This small population accounted for some 107,000 ER visits, or about one in five of all visits.

ERusageFY2013Since 2004, the Health Care Authority has operated the High ER utilization project, which identifies and contacts members who have been to the ER more than once in a quarter and provides information about appropriate usage and referrals to care management. The program has a provider education component as well. Since 2007, emergency room usage has declined from an annual average of 0.58 annual visit per member to 0.53 annual visits per member. Although we should be careful about making direct comparisons because of differences in demographic make-up and data sources, ER utilization for Medicaid recipients appears comparable to the overall population. According to the Kaiser Family Foundation, Oklahomans had 488 ER visits per 1,000 people in 2011; OHCA data suggests that Medicaid recipients made 550 visits per 1,000 people in fiscal year 2011.

It’s also not apparent that ER visits are a major expense in the Medicaid program. In fiscal year 2013, total emergency department costs, including facility and professional claims, were $141.0 million, which represents less than 3 percent of total SoonerCare expenditures of $4.97 billion (with ancillary services, the total cost was $178.3 million, or 3.6 percent of total expenditures). The average cost per emergency room visit was $257.31.

The Health Care Authority’s efforts to monitor and prevent inappropriate emergency room usage should certainly be continued. However, the idea that many Medicaid members make unnecessary trips to the ER seems to reflect myths and anecdotes more than reality.

Tobacco tax revenue declined last year. Here’s why that’s mostly good news.

by | August 13th, 2014 | Posted in Blog, Healthcare, Taxes | Comments (0)

In 2004, Oklahoma voters approved SQ 713, which increased the excise tax on cigarettes and other tobacco products while eliminating the state and local sales tax on these products. The new revenues from the increased taxes were dedicated to a variety of health-related purposes, including the Insure Oklahoma premium assistance program, a comprehensive cancer center, trauma care, tobacco cessation, and others.

Tobacco tax revenues allocated for health care under SQ 713 rose from $107.1 million in FY 2006, when the new taxes took full effect, to $145.6 million in FY 2012. However, these revenues fell slightly in FY 2013 and then dropped dramatically by $18.3 million (13 percent) in the fiscal year that just ended. The two largest recipients of tobacco tax funds – Oklahoma Health Care Authority general operations and the Insure Oklahoma fund – saw their funding decrease by $7.3 million and $6.0 million respectively in FY 2014. The shortfall contributed to the Health Care Authority having to enact larger cuts to provider payments and services.

TobaccoTaxRev06-14What accounts for the drop in tobacco tax collections? The answer is complicated.

continue reading Tobacco tax revenue declined last year. Here’s why that’s mostly good news.

Results on the first year of Obamacare are in. What’s it look like for Oklahoma?

by | August 4th, 2014 | Posted in Blog, Healthcare | Comments (0)
obamacare awesome

Image by Will O’Neill used under a Creative Commons license

The Affordable Care Act’s first open enrollment period, when eligible Americans could compare and purchase health insurance on the online marketplaces, was a bit of a roller coaster. But despite considerable hiccups with the launch of in October, eight million people had signed up nationwide when enrollment closed on March 31st, a number that exceeded earlier estimates. The nationwide uninsured rate has dropped precipitously thanks to the marketplaces and to expansions of Medicaid coverage in states that accepted federal funds. And those with new health insurance coverage report being pleased with it.

However, much of the ACA’s positive benefits in Oklahoma have been muted by the state government’s obstruction of the law, especially by its refusal to accept federal funds and expand coverage. Here’s what’s happening.

continue reading Results on the first year of Obamacare are in. What’s it look like for Oklahoma?

Gov. Fallin blames Obama for Oklahoma’s Medicaid cuts. The real reason is closer to home.

by | July 14th, 2014 | Posted in Blog, Healthcare | Comments (16)
President Barack Obama greets Governor Mary Fallin at Tinker Air Force Base.

President Barack Obama greets Governor Mary Fallin at Tinker Air Force Base.

Earlier this year, we warned that Oklahoma risked deep cuts to our state’s health care safety net if we didn’t increase state funding for Medicaid and mental health services. The Oklahoma Health Care Authority, which administers Medicaid, needed $90 million and the Department of the Mental Health and Substance Abuse Services needed $20.9 million in new funding just to maintain existing services.

Instead, lawmakers budgeted flat funding for the Health Care Authority and just $2.2 million in new funding for mental health. As a result, Oklahoma has slashed Medicaid doctor reimbursements, hiked copayments for Medicaid patients, and reduced eligibility for services. Families who stand to lose behavioral health rehabilitation services have spoken out about the cuts. In response, Governor Fallin responded with a statement blaming President Obama. Governor Fallin’s spokesman Alex Weintz said:

continue reading Gov. Fallin blames Obama for Oklahoma’s Medicaid cuts. The real reason is closer to home.

Insure Oklahoma extended – but we could do so much more

by | July 9th, 2014 | Posted in Blog, Healthcare | Comments (0)

InsureOklahoma_logoA rare bright spot in health care-related news came early last week with the announcement that Insure Oklahoma, a public-private partnership providing health insurance for some 18,500 low-income Oklahomans and their families, has been given permission by the federal government to continue operating for another year. 

The program had been expected to be discontinued at the end of 2013, with the understanding that the state would accept federal funds to extend health insurance coverage to all eligible low-income Oklahomans, thus negating the need for Insure Oklahoma.  But Oklahoma refused to accept the funds, and for the past two years, the state has negotiated extensions with the federal government. While heartening for those who would lose their insurance were Insure Oklahoma to expire, the current system of negotiated extensions isn’t sustainable. Here’s what’s going on:

continue reading Insure Oklahoma extended – but we could do so much more

Opportunity Missed: the Prescription Monitoring Program in Oklahoma

by | July 3rd, 2014 | Posted in Blog, Healthcare | Comments (1)

Photo by Hiii Fiii used under a Creative Commons license

Prescription drug abuse is an epidemic in Oklahoma. In 2012, Oklahoma ranked first nationwide for painkiller addiction, fifth for deaths due to drug overdoses, and fifth for number of painkiller prescriptions written. Preliminary data from the Bureau of Narcotics and Dangerous Drugs indicates that 2013 saw 788 overdose deaths, 593 of which were from prescription drugs. These numbers are expected to rise as medical examiners review more data.

This session, lawmakers had the opportunity to enact effective legislation to combat prescription drug addiction in the state – and they fumbled it. Here’s the background:

continue reading Opportunity Missed: the Prescription Monitoring Program in Oklahoma

More proof that hiking Medicaid copays doesn’t add up

by | June 24th, 2014 | Posted in Blog, Healthcare | Comments (1)
Photo by Robert Neff used under a Creative Commons license.

Photo by Robert Neff used under a Creative Commons license.

As we’ve discussed before in this blog post and fact sheet, the Oklahoma Health Care Authority is considering hiking copayments for Medicaid patients to get a prescription or doctor’s visit, as a way to partially cover Oklahoma’s Medicaid funding shortfall. However, the best evidence shows that the promised savings won’t be realized. Research shows that even modest copay increases contribute to worse health outcomes for patients and don’t generate significant savings in the long run.

Unfortunately, the Health Care Authority (OHCA) does not seem to have taken this research into account when developing their plan.  OHCA documents estimate the plan will save $3.1 million for the state ($8.3 million including federal funds). However, that estimate assumes that utilization of services would remain constant, despite the fact that they would now cost significantly more.

continue reading More proof that hiking Medicaid copays doesn’t add up

Act quickly to stop harmful Medicaid changes

by | June 16th, 2014 | Posted in Blog, Healthcare | Comments (8)
empty wallet

Photo by NoHoDamon used under a Creative Commons license.

A few weeks ago, we reported on the Oklahoma Health Care Authority’s plan to increase copayments for Medicaid recipients in an effort to cut costs in the face of a $90 million budget shortfall.

These copay increases could be devastating to Oklahoma’s poorest and sickest citizens, and they won’t even save money in the long run. Oklahomans need to act quickly to stop the fee hikes from taking effect. The Health Care Authority Board will meet on Thursday, June 26th to consider adopting an Emergency Rule to increase the copayments.

In our new fact sheet, we explain why Oklahoma should not hike Medicaid copays. Some highlights:

continue reading Act quickly to stop harmful Medicaid changes

Oklahoma needs more primary care physicians, but we’re still putting up barriers (Guest post: JeVonna Caine)

by | June 4th, 2014 | Posted in Blog, Healthcare | Comments (1)

JeVonna_CaineJeVonna Caine, one of OK Policy’s 2013-14 Research Fellows, is pursuing a Masters of Public Health in Health Administration and Policy from the OU Health Sciences Center, while also working at the State Department of Health in the Health Planning & Grants department. She has an extensive background in community health education and research with previous positions at Georgetown University and Youth Services of Tulsa.

With the influx of insurance enrollment through the Patient Protection and Affordable Care Act (aka ACA, aka Obamacare), nationwide uninsured rates are at their lowest since 2008. This signals an impending increase in the demand for primary care services. However, Oklahoma is currently ranked 48th in the nation for access to primary care physicians (PCPs). Oklahoma needs to do better to grow the supply of primary care physicians, but we still put up significant barriers. Work-related stress, declining reimbursements and increasing administrative requirements all discourage medical students from training to be PCPs, particularly in rural communities.

continue reading Oklahoma needs more primary care physicians, but we’re still putting up barriers (Guest post: JeVonna Caine)

More than 50 Oklahoma musicians release song to raise awareness of Affordable Care Act

by | May 30th, 2014 | Posted in Blog, Healthcare, Upcoming Events | Comments (0)

take a stand

On June 4 in Tulsa and June 5 in Oklahoma City, the Red Dirt Rangers are hosting a release party for a single and music video produced by more than fifty Oklahoma musicians. The new song, “Stand (Let Your Voices Be Heard)”, aims to raise awareness of Oklahoma’s dire health statistics, opportunities to gain health coverage under the Affordable Care Act, and the need for Oklahoma to accept federal funds to extend coverage further. The event will also raise money for the Red Dirt Relief Fund, which provides assistance for Oklahoma musicians facing a medical emergency without health insurance.

Because of Oklahoma’s decision not to extend health coverage to low-income Oklahomans, some 140,000 adults have been denied access to affordable health care. The few options available to the uninsured are vulnerable to state funding cuts, and the safety net designed to help them is shrinking.

The Tulsa event will be at 7pm, Wednesday, June 4 at the Woody Guthrie Center. The Oklahoma City events will be at 5:30pm, Thursday, June 5 at the Hart Building. The events are free and open to the public. Donations and all proceeds from sales of the song will go to the Red Dirt Relief Fund.

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