Thursday, August 31, 2006

The Night the Lights Went Out in Georgia

After a rocky three-month start-up, Georgia's Medicaid and PeachCare overhaul goes statewide Friday, with hundreds of thousands of patients joining HMOs.

Many physicians have cited payment and patient-care problems experienced when the managed care program started in metro Atlanta and central Georgia in June, and they fear they will surface as the program expands this week. Several doctors said many families still have not received their ID cards for the new program, confusing patients.

In an attempt to shore up a money losing operation, the state opted to allow tighter managed care for their Medicaid program. Based on what has occurred so far it does not appear to be working.

On Wednesday, the state said the total number of people joining HMOs statewide could be one-fourth fewer than expected, in part because the state began checking citizenship and income of beneficiaries on Jan. 1. The total number of people joining HMOs statewide will be 847,000, not 1.2 million as was originally projected, officials said

Note the operative phrase here . . .” began checking citizenship and income of beneficiaries”

Does this mean there were almost 400,000 people receiving free health care that were not eligible?

Kind of put’s a dent in the argument that the private health care system is wasteful. Having 400,000 more people than are truly QUALIFIED is almost a 50% overcharge.

Keep in mind this is TAXPAYER money, not the government.

The government doesn’t have any money.

MCG Health, an Augusta hospital system and leading Medicaid provider, told state officials Tuesday that it would not accept nonemergency Medicaid patients because it had not reached a contract with two HMOs serving that area. Staff members have started canceling patient appointments scheduled for Friday

Fewer Medicaid recipients AND fewer providers willing to see them.

I see a train wreck waiting to happen.

The HMO transition follows years of a traditional system of care in which Medicaid patients were allowed to go to whichever doctor would serve them. But after years of double-digit percentage increases in Medicaid costs, Perdue's administration opted to switch to HMOs, which have a reputation for tighter financial controls.

“Double-digit percentage increases”.

Even Medicaid, with it’s tight fisted tactics could not make a dent in controlling medical care inflation.

Since the start-up, though, physicians have complained that the state's three HMOs have delayed paying them millions of dollars for medical care. This month, a group of Georgia physicians filed suit against the private companies running the Medicaid HMOs, claiming these firms owe millions in outstanding claims to medical providers. The suit alleges the plaintiffs have had to lay off employees and cut back on providing services to low-income residents.

Some patients have also had trouble getting their regular medications and have experienced delays in receiving needed care, medical providers say.

When providers are scheduled to be reimbursed for care at a lower rate, and they are not paid at all, this is a disaster waiting to happen.

The state is counting on a projected $80 million in first-year savings from the initiative. In addition, experts say some doctors and other providers may end up dropping out of Medicaid because of problems, making access to care more difficult for poor patients, possibly pushing them into already overcrowded hospital emergency rooms for routine care.

Wonder how much of that $80M is due to kicking folks off the Medicaid role that never belonged there?

Dr. Adrienne Butler, a Waycross pediatrician, said she retired earlier this month. The upcoming Medicaid transition was "the last straw" for her.

Butler, 59, said she was already losing income, with Medicaid patients being about 80 percent of her practice. "There are families who don't know what [HMO] they're in," Butler said. "The frustration is really high."

This may not be another Tenncare but it could be a close second.
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