Florida’s HMO medicaid system is in full cardiac arrest!

share thoughts as the no pay raise is in order for pediatricians in 2015. so sad for the children who need our services!

Jeffrey A. Hirschfield, MD, CPI, ABLM

I was naive and truly believed that the transition from the traditional medicaid to HMO privatization would help pediatricians. In fact, to the contrary, pediatricians are more worried then ever that they will be overrun as this HMO train wreck marches forward enrolling kids and without a captain at the helm. As a Florida medicaid provider for over 11+ years ,I reliquished my participation in the traditional medicaid program in 2008 and characterized the environment as mismanaged. A system that was regressive and unruly and even used strong arm tactics at times with audits to scare their providers. Notices for refunds from providers for services rendered in the trailing 24 months would appear by certified mail and through unjustified claim demands and then one-sided arbitration meetings would result in even more penalties and fines.  What could we do?  Why would a pediatrician with a true love of medicine and helping children need…

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Florida’s HMO medicaid system is in full cardiac arrest!

I was naive and truly believed that the transition from the traditional medicaid to HMO privatization would help pediatricians. In fact, to the contrary, pediatricians are more worried then ever that they will be overrun as this HMO train wreck marches forward enrolling kids and without a captain at the helm. As a Florida medicaid provider for over 11+ years ,I reliquished my participation in the traditional medicaid program in 2008 and characterized the environment as mismanaged. A system that was regressive and unruly and even used strong arm tactics at times with audits to scare their providers. Notices for refunds from providers for services rendered in the trailing 24 months would appear by certified mail and through unjustified claim demands and then one-sided arbitration meetings would result in even more penalties and fines.  What could we do?  Why would a pediatrician with a true love of medicine and helping children need to work within such a broken system. It was heartbreaking to disconnect after many years of providing quality pediatric healthcare and the data to prove it, but that was not enough.  When you give everything professionally and personally to improve patient outcomes and then get nothing but aggravation for your diligent work, it gives you a very bitter taste in your mouth. At the same time, I have seen many of my dear colleagues anguish and languish within the current HMO Medicaid plans as their offices got financially strapped and burdened.  Office medicaid panels burgeoning and accounting for more than 50% of their patients in some circumstances. If the HMO’s truly value pediatric access and improved patient healthcare then the administrators of these plans need to get out of their offices and start negotiating face to face with any pediatricians willing to talk to them and truly “partner” in this important cause.  We as pediatricians should not and will not sit back any longer with ongoing payment hassles, delayed payments be content receiving a $35/ patient at 1/2 the reimbursement of traditional payers.  After all, for many of us, we are true gatekeepers for our little patients.  Should we provide our professional services at this 50% discount alongside our medicare (adult) colleagues? I think not!!  HMO’s, you are on notice that if you want pediatric recipients to get the well deserved medical attention and access they need, then treat us as human beings and true partners and give us that well deserved raise, one that allow us to keep our lights on in the office and give you the results of improved medical care and access for your patients.  If not, you can keep fooling yourselves into thinking that your strategy of little access or poor medical care provided in ER’s works.

http://kaiserhealthnews.org/news/miami-herald-florida-pediatricians-medicaid-pay-raise/


Healthcare access is in a state of chaos!

should state “biased”

Jeffrey A. Hirschfield, MD, CPI, ABLM

Of course information is usually biased to meet an agenda.  To get a more reasoned analysis, just go out and ask friends, neighbors, colleagues if they feel that healthcare has deteriorated in some way for their families over the past 5 years.  For some people, there may be an ideological slant of course, but in reality we all seek, as consumers of healthcare, an improvement in clinical outcomes and not some concocted blathering of how this system is operating more efficiently.  If you or a loved one needs healthcare, you will find that many individual or families are facing higher and higher hurdles to get their needed care. Those are the hard true facts and we as individuals need to be prepared to eliminate “broker” so called “healthcare companies” coupled with nonpolitical solutions, leaving more than pocket change for the care of all Americans.  We can do it.  Don’t be fooled by this current mess.

More Proof Obamacare Is Increasing Coverage, but Not Access to Health Care

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Healthcare access is in a state of chaos!

Of course information is usually biased to meet an agenda.  To get a more reasoned analysis, just go out and ask friends, neighbors, colleagues if they feel that healthcare has deteriorated in some way for their families over the past 5 years.  For some people, there may be an ideological slant of course, but in reality we all seek, as consumers of healthcare, an improvement in clinical outcomes and not some concocted blathering of how this system is operating more efficiently.  If you or a loved one needs healthcare, you will find that many individual or families are facing higher and higher hurdles to get their needed care. Those are the hard true facts and we as individuals need to be prepared to eliminate “broker” so called “healthcare companies” coupled with nonpolitical solutions, leaving more than pocket change for the care of all Americans.  We can do it.  Don’t be fooled by this current mess.

More Proof Obamacare Is Increasing Coverage, but Not Access to Health Care


Ebola virus, is it contagious through cough and sneeze?

Scientists are not 100% certain and cannot rule out that ebola mutation events would not lead to increased spread throughout the world. The real concern for epidemic levels of disease could be from transmission of airborne droplet particles. Theoretically, coughing or sneezing particles could stay airborne for hours exposing more potential individuals by even inhalation routes.  A common example of this occurs with influenza virus.  A vaccine approach for the masses would be ideal for this virus.  Look for research data in early 2015 from patients currently in research trials to determine the vaccine candidates safety and effectiveness.  For now, the implementation of FDA approved screening tests and isolation policies for high-risk individuals traveling from these Ebola disease- burdened areas of Africa are prudent and warranted to protect us from becoming infected.

“Dr. C.J. Peters, who battled a 1989 outbreak of the virus among research monkeys housed in Virginia and who later led the CDC’s most far-reaching study of Ebola’s transmissibility in humans, said he would not rule out the possibility that it spreads through the air in tight quarters.”

http://www.latimes.com/nation/la-na-ebola-questions-20141007-story.html#page=1


ADHD- but what really is the diagnosis?

“The main question at this point is whether phenotypic characteristics such as inattention, anxiety, depression, and overall executive dysfunction represent epiphenomena arising from common disrupted brain regions or pathways, or whether each DSM diagnostic entity should be understood individually as possessing discrete biological signatures. Current knowledge points to the former.”

Analysis:  This was a very nice article showing how the manifestation of various symptoms of mental health disorders may have common cause(s) or etiologies.

Caution:  Although there are strict criteria for psychiatric disorder diagnosis, physicians must consider a wholistic and personalized method to the successful management and treatment of an affected individual rather than using a “one-size-fits-all” approach to treatment.

http://www.medscape.com/viewarticle/836219_3


Caution: Death by added sugar

It should come as no surprise that “added sugar” may contribute to early death from complications of cardiovascular disease, obesity, Type 2 diabetes, increased cholesterol, or high blood pressure.  Sugar increases insulin hormone and increased heart rate and blood pressure.  Sugar also promotes blood vessel constriction that elevates blood pressure. To make this situation even worse, man-made fructose corn syrup found in beverages and foods cause insulin resistance and increases hunger levels. Foods such as sweetened granola, yogurts, milk, and tomato sauce are loaded with added sugars.  Look carefully at your food labels.

“extrinsic or added sugar refers to sucrose or other refined sugars in soft drinks and incorporated into food, fruit drinks, and other beverages.”

http://www.circ.ahajournals.org/content/106/4/523.full

A prudent upper limit of intake is half of the discretionary calorie allowance, which for most American women is no more than 100
calories per day and for most American men is no more than 150 calories per day from added sugars

Click to access 1011.full.pdf


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