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MEDICAID: Patients receive different levels of care

Letter by Kelly K. Phillips, Graham on Feb. 28, 2012 at 1:06 pm with 4 Comments »
February 28, 2012 1:06 pm

It is apparent that patients on Medicaid receive a different level of care than those who can afford to purchase their medical insurance, which is unfortunate. The standard of care should be equal to all patients regardless of who the insurance provider is.

One of the main differences is the withholding of certain procedures (such as MRIs and CAT scans) and is due to the rigid process of pre-procedures – such as steroid injections, physical therapy, pharmacotherapy and X-rays which, collectively, add up to a considerable cost.

The conservative therapies must be exhausted prior to authorization for an MRI but they are not always necessary nor are they cost-effective. While I understand the need for some form of protocol prior to authorizing an expensive procedure such as an MRI, it is unfortunate that the patient’s individual needs and medical history are often overlooked in the process.

The medical directors within the Medicaid system need to work collaboratively with the physicians who are the “eyes and ears” of the government-subsidized program. The opinion of the medical professional who is caring for the patient should not be underestimated.

Perhaps the pre-procedure requirement for MRIs should be used as an outline with patient differences and prior health issues taken into consideration to provide the best patient-centered care while still minimizing cost.

(Phillips is a registered nurse.)

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Leave a comment Comments → 4
  1. alindasue says:

    I fully agree with Ms.(Mr.?) Phillips.

    Think of all the money that could be saved if all the other procedures and tests didn’t have to be tried and exhausted before the obviously needed one is allowed to be used.

  2. itwasntmethistime says:

    Yes, but think of all the money which would be wasted if health care providers were allowed to go right to the most expensive (and most profitable) test every time without due process.

    I see a huge amount of waste either way.

  3. alindasue says:

    itwasntmethistime,

    If there’s going to be “a huge amount of waste either way”, then doesn’t it make more sense to “waste” it on the procedures and tests that are more likely to be effective?

  4. itwasntmethistime says:

    alindasue,

    It would, if the most expensive, invasive tests were actually the best choice most often. It would also require somehow removing the motivation for profit, and if you and I could figure out how to get the corporate world to, oh, forget it.

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