New Medicaid Changes in West Virginia and Kentucky May Affect Otolaryngology Practice

Kentucky has imposed limits on prescription drugs and on physical and speech therapy. Children are allowed 15 visits to the speech therapist each year. If more visits are necessary, then they can get authorization from the program, Dr. Badgett said. Adult patients are authorized for 10 visits to the speech therapist per year. Stroke victims and other elderly people are allowed 30 visits to the speech therapist each year. The prescription benefits entail modest co-pays, he continued, and most children and families will have no co-pays.

The redesign incorporates moderate restrictions. We tried not to make draconian changes. Before, there were no limits. Now we have 5-percent coinsurance on non-emergency ER use. We’ve had no outcry from physicians. They just want to know what the changes will be, Dr. Badgett said.

Criticism of Kentucky’s New Plan

Daniel Mongiardo, MD, who is an otolaryngologist and state senator in Kentucky, is not optimistic about the new plan. He said that neither the state nor the federal government can afford the huge health-care expenditures under the current system, so the state has resorted to a bag of tricks that shifts the costs onto patients who cannot afford it either.

Dr. Mongiardo predicted that patients will not get necessary services under the new plan, and he foresees serious problems. He said the new plan increases the co-pay for admission to the hospital to $50 and that many Medicaid beneficiaries cannot afford $50 and will not go to the hospital when necessary. We will see sicker and sicker patients and tragic outcomes, he said. When hospitals can no longer afford to take care of patients, quality of care suffers. We will also see more lawsuits.

Focusing on the limits for speech therapy, Dr. Mongiardo said that best practice is to have children see a speech therapist weekly until improvement is noted. In school, some children get speech therapy on a daily basis.

The bottom line is our system is broken. Health care is the only industry that has not undergone a major overhaul in recent years. There are multiple inefficiencies that need to be addressed. Information flow has to be computerized with a centralized access. To take money out of this broken system is only going to make things worse, he stated.

Dr. Mongiardo said that experience shows that managed care approaches do not fix the system. Things have only gotten worse under managed care. Politicians and bureaucrats think the same way, he commented. The approaches planned by West Virginia and Kentucky are tired approaches, he feels; he believes that a fresh perspective is necessary.