Providers air Medicaid doubts

Arkansas Democrat Gazette

8/14/12

JONESBORO — Public and private industry officials touting an overhaul of the state Medicaid program met a tough reception Monday as doctors and other providers peppered them with concerns that the state values cutting costs more than quality, accessible medical care.

“You can replace that word [quality] and put in ‘cheaper,’” said Roosevelt Gilliam, a Jonesboro electrophysiologist, a type of cardiologist.

Gilliam and other doctors said they thought the state Medicaid’s move away from the fee for service model, where providers are paid for each test and procedure, toward a system that seeks cost savings through greater efficiency and coordination of care could punish providers who cared for poorer, less healthy patients.

State Medicaid Director Andy Allison told the crowd of about 125 at St. Bernards Medical Center that Arkansas has no other choice but to fix the way providers are paid in order to curb escalating costs.

“Medicaid spending is no longer sustainable,” Allison said. “We know what we’re asking for is really difficult.”

The state is facing a deficit of up to $400 million next year in the $7.8 billion program, which serves about 780,000 people.

Gov. Mike Beebe has said that higher taxes or cuts to services might be necessary if costs can’t be brought under control.

On Monday, state Surgeon General Joe Thompson said that Medicaid couldn’t ask for hundreds of millions in state aid to plug the fiscal hole without demonstrating it is taking steps to save money.

That didn’t mollify many in the audience. Several doctors complained that patients wouldn’t accept efforts to save money by refusing unnecessary antibiotics for common colds, for example.

“The patient is the one variable they can’t control,” said one physician who asked not to be identified.

Jason Brandt, a Jonesboro orthopedic surgeon, said that forcing doctors to split cost overruns with Medicaid might force high-risk patients to be turned way by leery doctors afraid of taking a financial hit for spending too many healthcare dollars.

“They don’t want to ration care. They want us to ration care,” he said.

Brandt said he felt better about the payment fix after talking with Allision and other officials and learning that certain high-cost patients and procedures would be exempt from the averages that will determine if providers make money from providing cost efficient care, owe money for charging more than other doctors or break even.

But he still has concerns.

“It’s all happened so fast. All of a sudden, it’s ‘here it is,’” Brandt said.

Other providers said Medicaid performance reports recently sent to providers were inaccurate. Those reports show providers where they rank in costs among their peers and will determine their payments when the new system, which began in July, becomes fully operational over the next few years.

“We need to hear back about what is not working,” Thompson said. Medicaid wants to fix any glitches before the overhaul is implemented, he added.

Steve Spaulding, vice president of Blue Cross, Blue Shield of Arkansas, said the state’s partnership with Arkansas’ two largest private insurers (QualChoice of Arkansas is also on board), isn’t a “consolidation” of public and private payers.

Instead, private insurers will follow the same payment structure as Medicaid but negotiate their own rates with providers.

Spaulding has said previously that there are no plans to cut reimbursement rates from private insurers.

Having private insurers on board is the only way the fix will work, Allison said.

“If it was just Medicaid, I guarantee I could not fill this room,” Allison said. “There would be no incentive to change your business.”