Article 115. Focusing on Reduction of Medicaid Health Care Costs

Focusing on Reduction of Medicaid Health Care Costs

The reduction of State Medicaid health care costs is only a fraction of the total Medicaid costs. Total Medicaid costs for Missouri $9.9 billion of this the conversion of General Hospitals from low patient volume to high patient volume specialized clinics is expected to save only $1billion. 

The Medicaid savings is contingent on:
1. The state if not owning the new Clinics must at least manage the clinics. 
2.  All Medicaid Patients will be required to use the Clinics except in rural areas.
3.  Clinics must be located in populated areas to maintain sustained patient volume.
4.  Medicaid and Medicare Patients may use the Clinics to get the Patient Volume needed.

I have suggested that the State start with just one General Hospital in a metro area.  This is a good way to prove the process but I now want to introduce a second alternative which doubles up on the development of Daily Plans and the necessary facility reorganization. This is done to shorten the time for the State to start gathering savings.

When observing a metro area for implementation of this approach I would look at three or four General Hospitals all centrally located near where most Medicaid patients live.  The Idea is to have a plan for converting these hospitals into specialized Clinics.

The Plan:
1. Implement Continuous Improvement Teams in each General Hospital this will take a month before the teams understand the process.  The CI Teams are required to aid in designing the Daily Plans while working with the Consultant.  The State will provide nursing students to work with the consultant and be trained by him to continue the implementation in other metro areas. The students will act as Facilitators when installing the CI Teams and follow the development of the Daily Plans and the facility reorganization.

2. One year of data will be collected from each hospital showing all procedures done at the hospital.  The number of routine procedures done at each hospital will be used to determine where to best locate the routine Clinics. The assumption is that a combination of in-patient and out-patient procedures will be done in each of the selected hospitals.

3. The Consultant and the CI Team (along with trainees) will develop the Daily Plan for each of the routine areas.

4.  The Consultant will have the hospital facility plans for each hospital sent to his office.  By placing the Daily plans as they are completed over possible hospital locations the process will help to keep the cost of reorganization down with as few changes as possible.  At this point an Architect engaged by the state will complete the reorganization construction plan (adding rooms and extra surgery facilities).

5.  Three or four completely independent Clinics will be located in each of the original hospitals. Each Clinic will have its own waiting room and other facilities.  

6.  Procedures such as Cataract Surgery will need to be done in an Eye Clinic.   A birthing hospital is not included in the Clinic concept because the patients are not free to chose when the Procedure is to be done.  However there is much savings to gained by designing a separate Birthing hospital.

 7.  After the Daily Plans have been completed and trainees are available hospital facilities in other metro areas may be reviewed and reorganization plans made.

This approach will speedup the process for implementing the new Clinics in the entire State.  When the Federal Government recognizes the savings involved nearly all hospitals will be converted to the new Clinic plan.  The change will also be demanded by Health Insurance Companies.

Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com