Re: Allan: I have the solution to fix Medicaid.Start by auditing the Insurance industry.They set the rates that the government pays.
I think you have this almost exactly backwards. Insurance reimbursesment levels are generally derived from the payment schedules set up by CMS (medicare). Insurance invariably pays more than government for one primary reason: CMS is supposed to get best pricing (although there are exceptions). The only groups authorized by law to contract at less than Medicare rates are Medicaid, which where I live (Tennessee) pays from 10-20% less than Medicare. Many insurance companies (such as Blue Cross/Blue Shield here in TN) are moving to a 100% Medicare reimbursement policy. Medicare has a highly convoluted, involved, bureaucratic, slow, inefficient method for determining reimbursement that is frequently divorced from reality, but it does not put in the prevailing insurance rates into its calculations. (An example I like of being divorced from reality is one of the things I do will get reimbursed from Medicare 4 times higher just 60 miles away over the Kentucky border, even though my costs are the same or higher to perform.)
And interesting enough (for my field), Medicare reimbursement for a lot of the tests I perform have not risen in 4 years. So even though you hear about these dramatic increases in costs, they are not trickling down to the labs.
