Category Archives: State government

Medicaid overhaul to move slower, be more targeted

The overhaul of the state’s Medicaid system will move a little more slowly than earlier anticipated, but it’s still moving.

That was one of the takeaways from a question and answer session in Little Rock attended by hundreds of medical providers and led by State DHS Director John Selig, Medicaid Director Dr. Joe Thompson, Medicaid Medical Director Dr. Bill Golden, and Steve Spaulding, vice president of enterprise networks for Blue Cross.

DHS and the Beebe administration have proposed replacing the state’s fee for service system, in which Medicaid keeps paying as long as doctors keep treating, with concepts such as “bundled payments” for “episodic care.” The state has gotten a waiver from the federal Department of Health and Human Services to try to implement the idea as a pilot project.

In other words, the state would pay a certain amount to all the providers (bundled payments) for an episode, such as an appendectomy, and no more. The idea is to give medical providers a financial incentive to provide only necessary care.

How that system will work is a topic of big concern and debate in the medical community. As originally planned, providers would decide how to divide the money for each patient. That’s still being talked about, though Selig did indicate to one questioner that Medicaid could be the decision maker. Still, it could be a mess. As David Wroten, director of the Arkansas Medical Society told me, a state is a pretty big pilot project.

The plan was to start going into effect in July 2012, and that’s still the timeline, but the presenters said the state may begin by trying to pick low-hanging fruit and roll out the changes over time. For example, an early focus area could be early delivery of babies, which data show is being done too often for convenience instead of medical necessity.

The idea is being considered because the state faces a $200 million shortfall in Medicaid in 2013, with future deficits looking even scarier. Thompson pointed out that a 5 percent savings in Medicaid’s $4 billion budget would equal $200 million.

Medicaid is the program that pays for care for the poor, the disabled, many nursing home residents and others, and you can’t reform health care without it. In Arkansas, 750,000 people are on it, and it pays for 60 percent of all childbirths.

Spaudling said Blue Cross wants to participate so it won’t be at cross purposes with the state. “The whole idea is to share information and find ways that we can both push on the same side of the rock,” he said.

I talked with Selig (above) after the meeting to get his thoughts. I have no idea why his head is so flat in the video. I promise he does not look like that in real life.

Column: An oath and a pledge

My column this week focuses on the Taxpayer Protection Pledge that 19 legislators signed before this year’s session. I don’t think they should have done so.

The pledge was pushed by Americans for Tax Reform, a Washington, D.C., outfit led by Grover Norquist that opposes all tax increases. It states that legislators will “oppose and vote against any and all efforts to increase taxes.”

My point in the column is that signing such a pledge makes legislators beholden to a special interest group like ATR and forces them into rigid ideological positions.

That dynamic was clearly at work in this session. When faced with the question of allowing Arkansans to vote on highway tax increases, at least two legislators have said that, rather than letting their consciences be their guides, they instead relied on Norquist. Moreover, the pledge forced legislators into performing all kinds of moral and mental gymnastics. Five didn’t vote for or against a $1 fee increase to fund the Arkansas State Police retirement fund. I’m pretty sure the pledge was the reason they took that somewhat wishy-washy route.

What about you? Should legislators sign such pledges before a session?

By the way, here is the list of signers.

Column: How to pay doctors?

My Arkansas News Bureau column this week discusses the Beebe administration’s Arkansas Health Transformation Initiative.

That’s a lofty-sounding title for a plan that is forming to remake Medicaid, the federal-state program that serves many lower-income Arkansans as well as Arkansans with disabilities and those in nursing homes. The initiative would “bundle” payments to groups of medical providers rather than paying each individual provider using the traditional fee-for-service method.

Why is that significant? Under fee-for-service, Medicaid keeps paying as long as doctors keep billing, so there is no incentive to cut costs. The goal is to provide that incentive before Medicaid starts running huge deficits soon.

Doctors would be paid a negotiated flat fee per episode as inducement to avoid duplicate and unnecessary care – much like you or I would pay for many other services we receive. Imagine telling a house painter that you’ll just pay him as long as he keeps painting. He might very well paint just enough to get the job done right. Or he might cover your house in layers of paint.

Lots of medical providers, of course, do not believe they should be paid like house painters, so it’s going to be a heckuva fight.

Here’s the column.

Column: Democrats try to give Arkansas the finger

That’s the headline I couldn’t use in my column today for the Arkansas News Bureau, for obvious reasons.

The “finger” in question is the “Fayetteville Finger,” the effort by Democrats to redraw congressional maps to their advantage by creating a peninsula stretching from the Fourth District up to Fayetteville.

Their motivation is simple: Put more likely Democratic voters in the First and Fourth districts and stuff Republican voters in the Third.

It comes at the end of the state’s first ever two-party session – one that went pretty well, frankly. Aside from this stunt – and a few others – if this is Arkansas partisanship, I can live with it. It certainly works better than the kind we have seen in Washington.

Here’s the column.

House panel says no to 350 school threshold

The House Education Committee just passed House Bill 2010, by Rep. Jon Hubbard, that would basically remove the 350 threshold that school districts are required to maintain in order to avoid consolidation. I only heard one no vote.

Hubbard pointed to the Weiner School District, which was required to consolidate with Harrisburg even though it was performing well academically.

It now goes to the House. We’ll see.

Now Hubbard is testifying in favor of House Bill 2011 that would pay private school families and home-school families. It would have an immediate impact of more than $80 million. The parents would be reimbursed for expenses. Under questioning, he says he doesn’t have the details worked out. It would take effect next year.

Unanimously failed.