Defining LUXURY Medical Products/Services for Medicaid Population

[drusso]

In the era of state rationing, how/who should control this issue?

A good starting list:
Spinal injections
RF procedures
cosmetic surgery
Any thing Regen Med-related
Joint arthroplasty
Fertility treatment
Botulinum toxin for migraine prophylaxis
Biological infusions for RA, AI diseases
Biological/immunotherapy for cancer
Neuromodulation
Pain pumps
Chronic opioid therapy
Psychotherapy (most commercial insurance doesn't pay for psychotherapy)

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[nvrsumr]

I have alot of medicaid patients who work. Usually this is not cerebral work but labor intensive. I do not believe that they should be denied interventional pain services

 

[DrCommonSense]

In the era of state rationing, how/who should control this issue?

A good starting list:
Spinal injections
RF procedures
cosmetic surgery
Any thing Regen Med-related
Joint arthroplasty
Fertility treatment
Botulinum toxin for migraine prophylaxis
Biological infusions for RA, AI diseases
Biological/immunotherapy for cancer
Neuromodulation
Pain pumps
Chronic opioid therapy
Psychotherapy (most commercial insurance doesn't pay for psychotherapy)

so basically pay for nothing but some PCP visits, ER visits, emergencies that impact life and some BP meds?

 

[SSdoc33]

I have alot of medicaid patients who work. Usually this is not cerebral work but labor intensive. I do not believe that they should be denied interventional pain services

so you actually see the medicaid patients? i thought you were in PP. does medicaid in your area reimburse somewhere around medicare rates?

 

[nvrsumr]

20% of our state population is on Medicaid. My referring docs like that I see them. Since I have had a zero narcotic practice for many years I probably see the best of the caid bunch.

 

[drusso]

20% of our state population is on Medicaid. My referring docs like that I see them. Since I have had a zero narcotic practice for many years I probably see the best of the caid bunch.

Why should the government pay for treatment of their "altered comfort" and "back-ache?" After all, no one would suggest that cosmetic surgery be paid by Medicaid for "altered appearance" aka "ugly" which is a subjective condition.

Similarly, it's not wise to pay for fertility treatment for Medicaid people.

http://nypost.com/2017/04/16/new-st...er-fertility-services-for-lower-income-women/

Why should the government pay for "altered comfort" aka back-ache, neck-ache. shoulder-ache, hip-ache, etc which is also a subjective condition?

In other words, can anyone persuasively argue why the government should ration fertility treatment & cosmetic surgery, but pay for pain management instead?

 

[bedrock]

20% of our state population is on Medicaid. My referring docs like that I see them. Since I have had a zero narcotic practice for many years I probably see the best of the caid bunch.

that is definitely the best situation to be seeing medicaid, where narcotics are completely off the table and so you are mainly see those that actually want to get better.

 

[DrCommonSense]

Why should the government pay for treatment of their "altered comfort" and "back-ache?" After all, no one would suggest that cosmetic surgery be paid by Medicaid for "altered appearance" aka "ugly" which is a subjective condition.

Similarly, it's not wise to pay for fertility treatment for Medicaid people.

http://nypost.com/2017/04/16/new-st...er-fertility-services-for-lower-income-women/

Why should the government pay for "altered comfort" aka back-ache, neck-ache. shoulder-ache, hip-ache, etc which is also a subjective condition?

In other words, can anyone persuasively argue why the government should ration fertility treatment & cosmetic surgery, but pay for pain management instead?

Why should Medicaid pay for back surgery that isn't due to cauda equina/severe weakness or non trauma ortho surgery?

Why should Medicaid pay for epidurals in labor?

Why should Medicaid pay for hysterectomies for pain control?

Why should Medicaid pay for Lyrica at 700/month for pain conditions?

Why should Medicaid pay for Celebrex at 250/month for just pain control?

Why should Medicaid pay for any name brand pharma product that doesn't extend life and cure a disease fully to make a patient functional?

 

[SSdoc33]

20% of our state population is on Medicaid. My referring docs like that I see them. Since I have had a zero narcotic practice for many years I probably see the best of the caid bunch.

do you break even on them? or is it mainly to satisfy the referring docs?

 

[Ducttape]

why should private insurance pay for any of those treatments either, given your negative opinion of their lack of efficacy?


I would argue against not paying for labor epidurals, however.

 

[nvrsumr]

do you break even on them? or is it mainly to satisfy the referring docs?

community service

 

[SSdoc33]

community service

"pro-bono"

 

[olafa]

and medicaid should NOT pay for gender reassignment either, but they do. I dont make the rules...

 

[DrCommonSense]

why should private insurance pay for any of those treatments either, given your negative opinion of their lack of efficacy?


I would argue against not paying for labor epidurals, however.

Why should they? Pain in labor isn't life threatening.

 

[Ducttape]

Multiple reasons - the quality and experience of delivery, particularly difficult ones, can be night and day with epidurals.

Second, limiting labor epidurals also mean you limit one of the safer ways to provide anesthesia for a c-section, especially emergent.

They can be bolused prior to removal for longer duration pain and minimize post delivery opioids.


And it's a slippery slope. Once you eliminate labor epidurals, what is the logic with allowing any anesthetic block prior to surgery? After all, you can just go back to the 1980s and just give more inhaled agents and 10x more opioids during and postoperatively...



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[DrCommonSense]

Multiple reasons - the quality and experience of delivery, particularly difficult ones, can be night and day with epidurals.

Second, limiting labor epidurals also mean you limit one of the safer ways to provide anesthesia for a c-section, especially emergent.

They can be bolused prior to removal for longer duration pain and minimize post delivery opioids.


And it's a slippery slope. Once you eliminate labor epidurals, what is the logic with allowing any anesthetic block prior to surgery? After all, you can just go back to the 1980s and just give more inhaled agents and 10x more opioids during and postoperatively...



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Most hospitals in India don't offer Epidurals. There is no evidence that placing an epidural improves labor outcomes.

C sections can be done using a spinal anesthetic.

Yes it is "slippery" but technically ANYTHING that isn't really life or death or preventive medicine is "luxury" in medicine.

 

[Ducttape]

Most hospitals in India don't offer Epidurals. There is no evidence that placing an epidural improves labor outcomes.

C sections can be done using a spinal anesthetic.

Yes it is "slippery" but technically ANYTHING that isn't really life or death or preventive medicine is "luxury" in medicine.

By that ridiculous definition, only CPR qualifies for treatment.

Oh not sure if I would compare US healthcare to India's.

the maternal mortality rate in India is 174 per 100,000.

It's 14 in the US.


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[DrCommonSense]

By that ridiculous definition, only CPR qualifies for treatment.

Oh not sure if I would compare US healthcare to India's.

the maternal mortality rate in India is 174 per 100,000.

It's 14 in the US.


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Maternal Death rate depends on epidurals? Got a study to back that up?

Also, I said LIFE sustaining/threatening stuff is the only truly "essential" healthcare services needed.

Should Medicaid be paying for the obese disabled guy's TKR? THR?