Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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Wisconsin elderly and disabled say they don’t want social and medical services merged in LTC plan
MADISON, WI—Loud protests from the elderly and disabled have led Wisconsin’s governor to retreat from his highly publicized efforts to overhaul the state’s long-term care plan. Two sometimes boisterous public hearings convinced the Department of Health and Family Services (DHFS) to rethink the plan.
Lynn Breedlove, executive director of the Wisconsin Coalition for Advocacy, said the plan drew fire because the merging of health care with social services and long-term care services seemed too risky to some people. The disabled and frail elderly like county governments to operate the social service network, he said. "We like local control," he told The Capital Times, explaining that residents can call members of the county board if they have problems. Worried that long-term managed care would end up being dominated by medical providers and HMOs, the elderly and disabled were saying, "I don’t want health care to be taking over my life," Mr. Breedlove said. DHFS Secretary Joe Leean said the public hearings convinced him it was "prudent to step back and reassess" elements of the plan.
The Capital Times, June 16, 1997.
Tennessee targets state hospital costs as officials scramble to fix TennCare Partners program
NASHVILLE, TN—Tennessee’s state psychiatric hospitals have been put on notice by the behavioral health organizations managing TennCare Partners program that some of their patients may be diverted to private facilities in an attempt to better manage costs. TennCare Partners is Tennessee’s embattled $326 million behavioral health carve-out program, Other changes in the offing include reducing the risk for mental health centers and revising the funding formula.
Besides these changes, the state also must grapple with the pull-out of one of two behavioral health organizations managing the statewide program. When contract negotiations faltered, Premier Behavioral Systems of Nashville notified the state it will continue to participate in the program only until Tennessee can make other arrangements. Among the unresolved issues cited by Premier were the census levels at the mental hospitals and drug costs.
Currently, Tennessee Behavioral Health and Premier are paid $23 a month for each of the 1.2 million enrollees in the program. Beginning July 1, the state—at the request of HCFA—expects to pay two capitation rates: $319.41 a month for the estimated 50,000 priority clients who are most severely mentally ill and about $10 per month for other enrollees. HCFA officials are planning a July 20-23 visit to the state.
Community mental health centers have cut services by 12-15% in the first six months of the program, according to a state survey Further studies to determine if services have been added or lost should be completed shortly. Other fact-finding surveys will provide details about access and quality of care as well as the productivity of the two behavioral health organizations managing the program.
State hospital superintendents say if TennCare patients are moved from their hospitals, the hospitals will be left with the most troubled patients, such as criminals referred to state hospitals by the courts because no one else will treat them. Many of these highly troubled patients don’t have insurance. Some superintendents charged that the policy of diverting patients from state hospitals will violate laws against patient choice. The state’s five psychiatric hospitals have 900 patients.
The Commercial Appeal, June 13, June 15, June 21, July 8, 1997.
Thousands of PA Medicaid beneficiaries get wrong primary care physician assignments
PHILADELPHIA—The state Welfare Department, health plans in the HealthChoices Medicaid managed care program, and Benova, Inc., the enrollment broker, are scrambling to correct an error which resulted in tens of thousands of poor people being incorrectly assigned to primary care physicians.
"Computer glitch’ would be too light a word," said Mary Ellen Fritz, spokeswoman for the Welfare Department, who explained that the major mix-up was due to deadline pressures, computer foul-ups and human error.
State officials conceded that, in one HMO alone, about 50,000 patients requested changes in their primary care physicians within the first three months of the program. The majority wanted to switch because they had been assigned to a physician they had not requested.
Patti Deitch, who oversees two federally funded health clinics in Philadelphia, said that 652 of 1,065 HealthChoices members who chose clinic doctors as their primary-care physicians were incorrectly assigned to other doctors. The city Health Department believes it has lost 1,500 to 2,000 patients at its nine health centers as a result of the problem.
A contributing factor to the problems was that when HealthChoices began in February, the lists of doctors provided to Benova by HMOs were not up do date. In addition, the computers used by Benova, the four HMOs and the Welfare Department could not easily talk to one another.
Philadelphia Inquirer, July 2, 1997.
California pediatrician charges managed care group fired her because she complained about conditions
LOS ANGELES—A California pediatrician has filed suit against a managed health care group that will test a 1993 statute prohibiting retaliation against doctors who advocate for better patient care.
The pediatrician said she was fired by the Greater Valley Medical Group shortly after complaining about working a 72-hour shift during which she fielded 158 phone calls, treated 20 children and shuttled between two hospitals. Dr. Claudia Jensen alleges that she was fired for being a whistleblower.
The Greater Valley Medical Group responds that the two other doctors were terminated at about the same time as Dr. Jensen and that the terminations were strictly due to financial reasons.
Los Angeles Times, June 17, 1997
Former Ohio Dept. of Insurance official says conflict of interest probe will show he did nothing wrong
COLUMBUS, OH—The former deputy director of the Ohio Department of Insurance is being investigated for a possible conflict of interest in his dealings with an insurance industry lobbyist.
Inspector General Richard Ward confirmed that he was investigating allegations that David Randall may have improperly accepted travel, lodging or other gifts from lobbyist Thomas Strussion.
State Rep. Michael Fox was censured in late June by the General Assembly and stripped of his chairmanship of the Education Committee for violating ethics laws in accepting a plane ticket and lodging from Mr. Strussion. Rep. Fox said he forgot to reimburse Mr. Strussion until May 15. The Columbus lobbyist denied wrongdoing.
Mr. Randall, who resigned his position in March to become senior vice president of Cleveland-based Emerald Health Network Inc., a preferred health care provider network, said he was confident the investigation would show he did nothing wrong.
Mr. Randall played a leading role in developing standards for provider-sponsored networks in Ohio.
Cincinnati Post, June 28, 1997.
Minnesota’s largest HMO says inflation is back; warns doctors to rein in costs or face cut in income
ST. PAUL, MN —Medica, Minnesota’s largest HMO, has sent letters to 6,300 doctors, warning that up to 10% of the income they receive from the managed care organization could be cut unless they rein in costs.
Medica officials have singled out sharp increases in the numbers of routine X-rays, CAT scans and prescriptions, particularly for antidepressants, as major contributors to rising costs.
"The news here is that medical inflation is back, and with more ferocity than ever before," said David Strand, Medica president.
Two weeks earlier, Blue Cross and Blue Shield of Minnesota, which covers 1.7 million state residents, cut fees to some specialist physicians by 10% to save about $3 million of the $525 million it spends on health services each year.
According to Mr. Strand, during the first four months of this year, Medica’s health-care costs under physician control surpassed budget targets by $4.5 million.
St. Paul Pioneer Press, July 3, 1997.
PA health plans join to track Medicaid prenatal care
PHILADELPHIA—Four private managed care plans participating in the Philadelphia-area Medicaid managed care program will soon begin using a common system to track the prenatal care provided to all poor women in five counties.
Calling it a model for private/public partnerships, City Health Commissioner Estelle Richman said Healthier Babies is aimed at identifying effective prenatal-care programs and funneling limited Medicaid funds to programs of demonstrated effectiveness.
The new tracking system for prenatal care, which is scheduled to start operating by 1999, is being funded with $165,000 from the Robert Wood Johnson Foundation, with the amount scheduled to increase to $500,000 over three years. The managed care plans will contribute another $500,000 in cash or in-kind services.
Richard Baron, medical director at Health Partners, one of the four managed care firms, called the project "a breakthrough in regional collaboration" involving four highly competitive private companies as well as state and local health officials and advocacy groups.
Although each managed care plan offers outreach programs for pregnant women, nobody knows which programs work because data has not been collected in a scientific way, he said. The new system may be able to show if smoking cessation programs for pregnant women result in better outcomes for babies, for example. It may also indicate if outcomes are better for women and children at hospitals with more experience in maternity care.
Philadelphia Inquirer, June 19. 1997
NY judge rules state must release doctor-specific data about hospital admissions to newspapers
ALBANY, NY—A New York state judge has ordered the State Department of Health to release raw information about doctors’ treatment of hospital patients to two newspapers, Newsday and the New York Times.The judge ruled that physicians have no privacy right when it comes to the work they do.
A massive computer database called the Statewide Planning and Research Cooperative System, or SPARCS, contains the names of doctors involved in any hospital admission. Data could be used to develop detailed assessments of physicians’ hospital practices, such as how often a doctor uses one treatment over another, or how many of the doctor’s patients have complications.
"Clearly, the release of data on physicians will have a chilling effect on the state’s ability to get voluntary compliance on collecting the data," says Medical Society of New York spokesman Thomas Donoghue, who notes that the information is "basically accumulated for epidemiological studies."
While the state Department of Health routinely releases certain information from the database, including details of diagnosis, treatment, cost and outcome for every hospital admission in the state, it has not released identifying information about patients or physicians. The newspapers agreed that such protections were proper for patients, but not for doctors.
New York Newsday, June 17, 1997.
Illinois drive-thru mastectomy law requires coverage of annual mammograms for women 40 and up
SPRINGFIELD, IL— Illinois Gov. Jim Edgar signed into law in June a bill that ends "drive-through" mastectomies and that also requires insurance companies to provide coverage for annual mammograms for women from the age of 40.
At the signing, the governor’s wife Brenda Edgar announced the creation of the Office of Women’s Health, which will be part of the Illinois Department of Public Health. The office will oversee the Illinois Women’s Health Campaign, a public awareness program targeting health needs for women 40 and older. The campaign will include a toll-free health help line and focus on menopause, osteoporosis, mental health, domestic violence, breast cancer and heart disease.
Chicago Tribune, June 11, 1997.
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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