Access to Care

Meeting Notes, May 28, 2014

Session #1
 

  • Specialty Care – Length of wait time and finding care after initial diagnosis
  • Location of specialty care- need easy access beside a directory of resources – process of care
  • Payment of indigent care for patient and doctors
  • Physicians don’t get paid but have 100% liability
  • How many come here for just medical care?
  • Primary Care – long waiting lists
  • Sarasota Co. provides primary care – Manatee does not
  • Dr. liability insurance – Drs. In short supply
  • Find providers for primary care
  • Develop a residency program – funding arm for this – reduce burden of liability – get doctors to say yes with incentives
  • Doctors choose to say no to Medicaid and only accept certain insurances
  • Biggest need is dental care – something as simple as pulling teeth
  • Part of the problem is liability for doctors and agencies – approach  legislators


Session #2
 

  • Free/reduced clinics for minor injuries/illnesses – reduce traffic at hospitals
  • Hours you can’t get care – do we know where to go without a wait
  • PS announcements about available resources according to needs
  • EMS costly – give them “authority” to determine level of care such as not needing to go to ER – problem with this is diagnosis
  • Over utilization of services – such as CT scans
  • Data base for patients and their health issues
  • Need some government assistance
  • Transportation to medical appointments
  • Home visits – bring back
  • Liability issues
  • Cost of care and who will pay?
  • Lead the way to socialized medicine – tort reform
  • Look at other states and counties with success for guidance
  • Behavioral health – process – who pays – available resources
  • Less money = Less doctors = long wait times
  • Find models in other areas to help us with health care issues
  • Sliding fee scales
  • Need a “road map” to resources
  • Liability issues for doctors
  • Shouldn’t allow EMT’s to diagnose
  • Time is running out for indigent care
  • How do we pay – Tax increase?
  • Approach hospitals to use reserves for indigent care
  • Hospital, community and local government work together as one to accomplish a good plan
  • To better serve community need more resources, equipment and services needed


Session #3
 

  • Cost of care?  - Comparison of providers cost
  • ER – most expensive – no one has said why – open 24/7 at same price – hospitals funneling all costs thru ER’s – no real perception of cost in ER to other clinics
  • ER’s need more access to supplies – might be an explanation to the above
  • Contracts with insurance companies drives cost of services according to facilities where care is given
  • Cost comparison is important to consumers
  • Cannot shop your healthcare
  • No job or insurance – how do you get insurance?
  • Where are the Medicaid funds going?
  • Working poor – who pays?
  • 60% of rural health is indigent and Medicaid – 10% of money from grants and donations – 30% commercial insurance
  • Limited resources at MCRHS – No referrals to specialty care
  • Communicable diseases – government forces inoculations
  • Government is the problem not the solution

Session #4
 

  • Overburdened services – no funding for indigent care = access decrease
  • After discharge too long wait list for follow-up care and specialty care – More clinics or more expansion of current?
  • Barriers – money and staffing of doctors and other medical staff
  • No access anywhere for anything for the working poor – can’t afford premiums
  • High numbers using outside county services and those coming here
  • Education and cultural barriers – perception of cultures about care in Manatee county
  • More focus on prevention and primary care
  • It’s who needs coverage from Medicaid or those that don’t qualify
  • How big is the issue – 23,000 MC residents do not qualify for healthcare plans – cannot afford “Affordable Care Act” based on income 
  • Difference in plans and levels – what about the gaps – how can they afford high deductibles?
  • We discussed access, but did not speak about how our citizens get the access.  Location?  Currently using 911.  Need other options, provide differently levels of service for community.   

Meeting Notes, June 3, 2014

Session #1
 

  • Medicaid  - no one in Manatee County for physical therapy
  • Rural Health - not working – no #$ need payment – bill’s not timely - how to pay? – diagnosis
  • Transportation*
  • Assign Medical HMO’s – specialty care local and  greater distances  - no access to care – increase cost but *not reimbursements  to Doctor
  • Rural Health is a medical practice that serves more than Manatee County
  • Outrageous co-pay
  • Establish a “Free” clinic
  • *Dental care – need a collaborative effort by Governments Federal, State, Local to give incentives
  • Residential treatment for substance abuse – no access – not affordable
  • Not enough facilities in Manatee County for residential treatment
  • Lobby for Medicaid to be equal to reimbursements* 
  • Doctors  need to provide service
  • *Lower costs  - need to have more access to care (specialty care)  at all levels*
  • Kaiser Study 2011 43% of medical costs was disallowed
    •     25% aged
    •     20% children
    •     12% adults
  • “Chronic care” population identify and keep healthy
  •  Care coordinated system
  • Enough Doctors to have better access in Manatee County  - Yes if all was equal
  • ? County stepped in lower liability insurance  what would happen

Session #2
 

  • Homeless discharge from Manatee Memorial Hospital and no *transportation – no way to get back to his camp
  • Cab is provided by Lakewood Ranch if  no transportation to get to bus to take back to camp
  • Specialty all care – lack of providers  in all areas  - low *reimbursement rates*
  • Identify all resources , hours of operation and make directory of such
  • Medical services going to state – how can people get access and information – mobile buses taking people to a staging area – Library? Would people go there?
  • “Navigation” on line to direct people to services to get managed  care  in Manatee County
  • Palm Shores helps with access to computers for  Dental, Eye, Mental Health access thru Navigation
  • Ability  to drive out-of-county for specialty care
  • Lack of “tip of spear” to break  thru and connect  all the dots of services available  - “Community Services  Board” (VA)
  • ?Resource Guide 2-1-1
  • No services for seniors with Dementia/ Alzheimer’s  to stay in home
  • Lack of “continuum of care”
  • * Discharge – support for home health care – more $ to stay in hospital
  • No services – affordable rehab
  • Educators for the “navigation” system – Community Care  coordinators
  • Language barriers in all age groups


Session #3
 

  • Transportation* to services  - time certain appointments
  • Providers who take your insurance?
  • Specialists who take Medicaid in Manatee County?
  • Would equal pay = number of Doctors for services
  • ? About Navigators – Rural Health at 1st.
  • Partner with School Board  and set up clinics at schools
  • Access to “preventative” care  - need more – promote a healthy life style
  • Cultural barriers  - comfortable  accessing care
  • Establishing a feeling  of  trust  concerning health care
  • Education in school about healthy life styles
  • Use schools more so people feel more confident on other community locations
  • Medical/specialist – diabetes education
  • Electronic access  - funds   to operate a “call-in” service “tele” medicine
  • Wait  time – does it  = more quality care  - no rushing and spend more time with you
  • Doctor reimbursement = less time with patient