Sunday, March 20, 2011

CEO's defend MississippiCAN at hearing

The House Committee on Medicaid held a hearing on the MississippiCan program last week on March 17. MississippiCan is an attempt by Medicaid to imitate Medicare Advantage. The program is administered by United Health Care and Magnolia Health Plan (Centene is the parent company.). Medicaid pays the two companies a capitated rate. Under a capitated rate plan, Medicaid pays the insurance companies a flat fee per patient. The insurance companies keep the difference between the health care costs for the patient and the capitated rate (See March 1, 2010 on MississippiCan below.) thus there is a financial incentive to contain health care costs.

Medicaid representatives at the hearing stated the program aimed to save the state five percent a year in Medicaid expenditures. Medicaid made several classes of enrollees eligible for MississippiCan: SSI, disabled child at home, working disabled, Department of Human Services Foster Care, and breast/cervical group patients. Medicaid claimed these groups had the highest costs.

The program has generated no small amount of controversy, as was evidenced at the hearing. Medicaid, UHC, and MHP representatives all predictably extolled the virtues of MississippiCan. It was going to lower costs. Personal stories of patients saved by MississippiCan were told. It broke new ground in actually being proactive in focusing on the patient's healthcare. Mom. America. Apple Pie. Who could be against MississippiCan?

Well, more than a few health care providers are. This correspondent has spoken to several who have experienced MississippiCan and the picture is not pretty. The testimony of several doctors at the hearing support what was privately reported to JJ. Medicaid states the program is voluntary. However, what Medicaid does is enroll the patient in MississippiCan and allows them to opt-out if a form is submitted. Many patients submitted such forms in December only to find out after January 1, 2011 the forms did not matter as Medicaid enrolled them in MississippiCan anyway. This is a big deal when the patients find out their doctors or therapy providers are not enrolled with either of the two plans.

In-network? What do you mean Kingfish. Frankly, MississippiCan is a cluster____ as it is creating many problems with healthcare providers. Medicaid actually had a very good system. If a provider submitted the proper paperwork before a deadline each week, Medicaid paid the claim a week later. Providers are now being told by UHC and MHP the payments can take over thirty days and up to ninety days to be made to the health care provider. Keep in mind these providers are not all hospitals enjoying millions of dollars in revenue streams. Many are special-needs therapists, pediatricians, solo practicioners, and others who aren't exactly able to enjoy a sudden cut-off in income for several weeks or months. In other words, small businesses we conservatives claim to love so much.

The insurance companies operate as do most in the industry: there are in-network and out-of-network health care providers. The in-network providers are paid a higher rate for services rendered to the patient than are those out-of-network. Unfortunately for the health-care providers, few were enrolled with either insurance company on January 1. Many of the providers lose money on the out-of-network rates and more than a few have quit accepting MississippiCan. Few, if any, will go on the record to complain about this because Medicaid has earned a reputation for auditing health care providers that make the wheel squeak too loudly. Then there is the paperwork. One doctor testified at the hearing it took her 45 minutes to an hour to complete the paperwork only she could complete for ONE MississippiCan patient.

Several providers reported to JJ the two insurance companies tell them it takes up to 90 days (or more in some cases) to process their application to become in-network providers. Not a big deal unless you are the mother of a special needs child forced to suddenly find a new pediatrician because the one who treated him his whole life is now suddenly out-of-network or is not enrolled with either company. Then she finds out there are only two or three such doctors in her area and oh, by the way, its going to take a while to get one to see a new patient. If the doctor will accept the patient.

The stories about the enrollment mess among healthcare providers sounds very similar to the one created when the government forced radical changes upon real estate appraisers two years ago. No one is prepared, there is a huge bottleneck of providers trying to get enrolled, and many face a sudden termination of revenue. Several have been forced to lay off employees as they were not able to afford such a drastic change in circumstances. These companies are small businesses. They don't get rich off of Medicaid patients but can't afford to see MississippiCan patients if they can't get paid. That is one tenant of capitalism you know: have to avoid losing money in order to stay in business.

The Mississippi Chapter of the American Academy of Pediatrics issued a statement (posted below) that argued "MississippiCan is not resulting in improved quality of care, improved efficiency, less paperwork,and more preventative care as Medicaid promised." Dr. Weissenberger gave her own stories that were in sharp contrast to the rosy picture portrayed by the suits (Her letter is posted below.). The CEO and CFO of Grenada Lake Medical Center damned the program as well. He made it quite clear no patient is turned away that needs help but the program is a huge mess they can no longer handle (My apologies. The camera only had two hours of memory and his testimony was not recorded.). Meanwhile, Mary Troupe of the Citizens with Disabilities downplayed the concerns of the doctors and those with complaints about the program as she shilled for MississippiCan. She testified it is a much-needed program, worked well in other states, and while the complaints didn't need to be ignored, not too much weight should be given to them as all of these companies were good folk that are going to work things out and have already made a positive difference for Medicaid patients.




Medicaid & United Health Care testimony


Magnolia Health Plan (Centenne) testimony


Dr. Weissenberg of American Academy of Pediatrics


Dr. Weissenberg (continued) and Dr. Chance (11:30)



Documents presented to Committee:
United Health Care Highlights
Mississippi Medicaid facts on MississippiCan
Magnolia Health Plan
Dr. Weissenberg's letter, Agenda, Letter from Academy of Pediatric Physicians



Agenda:
Opening remarks: Chairman Dirk Dedeaux
Medicaid: Phyllis Williams
United Healthcare: Jeff Drozda
Centene/Magnolia Health Plan: Pam Shipley
MHA: Mike Bailey
Grenada Lake Medical Center: Keith Hartsill, CEO
Citizens for Disabilities: Mary Troupe
American Academy of Pediatric Physicians: Dr. Weissenberg
Physician: Dr. Gerrihill Chance

6 comments:

Anonymous said...

"Meanwhile, Mary Troupe of the Citizens with Disabilities downplayed the concerns of the doctors " - Sorry - my BS detector just burst into flames :-(

Who is/are she or they? I treat LOTS of disabled patients, and never heard of her. This program has been a total disaster for patients.

Kingfish said...

An "advocate" for the disabled. Means well but frankly at the hearing, she sounded like a dupe. She made a better case for the program than the CEO's did. I've read enough of her letters to the editor and listened to her in interviews and testimony enough times to know better.

Anonymous said...

Kingfish,
As a provider who attended the "Provider Orientation" meeting (a month AFTER the program had been implemented), the Division of Medicaid, United Health Care and Magnolia Health Plan urged all providers to coninue providing current services to MSCan patients, instructed us on the necessary paperwork, and assured us that services would be covered until March 31st regardless of in- or out- of network status. (After March 31 services will only be provided by In-Network providers).

Well, well, well --- what a fool I was to believe them! The claims are coming in (very slowly) and to date LESS THAN 5% OF THE CLAIMS FROM JAN. 2011 HAVE BEEN PAID!!! Both companies have found a multitude of denial codes for this/that reason. Luckily, I had the forsight to know these theives were stealing from providers and cut off providing any more service for people in MSCan.

Bottom line, you have patients going without medications/services, providers going broke because they can't get reimbursed for provided services (that they were urged to provide) and BIG FAT INSURANCE companies getting RICHER!

Kaptain Kangaroo said...

Actually, don't you mean, "Denial Servicer" is going to get RICHER?

And, HB has done a good job reducing the abuse inherent in the system.

If you think differently, you have to love it when you hear (personal experience):

"My daughter is sick (no fever, sniffling and it's not like it is going to cost me anything); I'm not coming to work; I mean, like, the doctor is free."

I take issue with free. Free implies no value. Free implies the services you provide have no value. Free is not of any value. Free does not encourage participation in the social contract that we all signed up for when we decided to pay taxes.

It is an issue.

Kingfish said...

I don't care what business you are in, when you suddenly suffer a 50-75% drop in revenue or cash flow, you're going to suffer.

This program is a joke.

Anonymous said...

I am a beneficiary of Magnolia Health, unfortunately. I must say that Magnolia Health completely misrepresented themselves during the trial period, January 01 to March 31, 2011. After the deadline for changing back to Medicaid, they suddenly implemented new "policies" drastically limiting prescription coverage, enforcing age limits, and many more. I have started a petition requarding the intentional deception by Magnolia Health, and would like you all, members and providers, to take a look and sign it. The web address is http://www.PetitionOnline.com/MS411/petition.html. Please help support this cause. Thank you

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