NCMS CEO Meets with Governor and Health Care Leaders

North Carolina Medical Society (NCMS) CEO Robert Seligson participated in a meeting yesterday with Governor Pat McCrory, Secretary of the Department of Health and Human Services Aldona Wos, MD, Medicaid providers, state policy officials and other health care organization representatives to discuss the state’s Medicaid program.

While the problem-plagued NCTracks Medicaid Claims system was not discussed at this meeting, some new insights were revealed about the administration’s developing plans to reform the Medicaid system. These ideas include:

  • Providers’ greater “assumption of risk” will be progressive over time.
  • There would be a move away from fee-for-service to pay-for-value.
  • The state would have five to seven regions in which provider groups, including accountable care organizations and managed care organizations would compete to enroll Medicaid patients.
  • There would be three categories of Medicaid patients: 1) general, including mothers and children, 2) the mentally ill and developmentally disabled, and 3) institutional patients and those who are qualified for institutional care, but are receiving home and community services. 

“The NCMS is strongly committed to working with the administration, department and legislature along with our health care partners to develop a viable and sustainable plan,” Seligson emphasized. “Our common goal is to improve access, efficiency and address the many challenges that must be overcome first in order to effectively reform the system.”

The administration hopes to present their plan to the General Assembly by March 17.

After the meeting, Seligson was able to speak one-on-one with Gov. McCrory and Sec. Wos as well as representatives from Duke University Health Systems, Carolina’s Medical Center, Vidant Health, and Novant Health systems. Also represented at the meeting were the North Carolina Academy of Family Physicians, the North Carolina Pediatric Society and Community Care of North Carolina.

The NCMS remains fully engaged in resolving the serious problems with NCTracks and ensuring that Medicaid reform improves medical care for our state’s most vulnerable citizens. What are your thoughts on the ideas presented above?

 
 

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15 Comments

  • Michael S. Bryant MD FACS

    Three points that are necessary to understand regarding “assumption of risk” and “pay for value”. Medicare beneficiaries are difficult patients to manage for a variety of reasons. To hold providers accountable for “risk” and “value” and not hold the beneficiary accountable in any mannor is a dead end proposition. As we hear all the time physicians must have ‘stake in the game’, but if the beneficiary has no accountability then value and cost effective care are a never achievable goal(never event).
    Please note that the NCMS may not be looking out for the best interest of the individual private practice physician since its current leadership is mostly employed physicians and the organization has recently taken a large donation from BCBSNC. It is imperative that private practice physicians have their voice heard indiviually and not leave this endeavor solely up to the NCMS.
    Finally, if the proposed program changes are not physician friendly, both financially and clinically, the ranks of us that will accept Medicaid beneficiaries will significantly contract, therby making ACCESS TO CARE more difficult.

  • James G. Zolzer, MD

    As an OB/GYN provider, I can only echo what has already been stated and add my voice and that of my practice and partners to this discussion. We remain a small 3 doc independent group and try to provide a high level of service to the MCD population. We already assume great risk in their care. The compliance issues, illicit drug use, drug seeking, and multiple medical problems resulting from their life style choices complicate care without fair reimbursement. Changes to health will inevitably come at ever faster rates. Hopefully we can survive, but the outlook is anything but clear. If we are to be paid for value, will we be penalized when patients make poor decisions adversely affecting their outcome? Will we need to turn away anything other than low risk? Where will the high risk complicated cases find care?

  • Rueben Rivers MD

    This appears on face to be a noble effort at engagement. How do small shops build a budget model on reduced fees and withholds for value and stay in business?I do not know of anyone giving less than 100 % of their best effort admitting a patient in congestive heart failure at 2 am. Will you pay me 80% for that effort? Staff will not work for 80 % salary and then hope for recouping 20 % if threshholds met in my 30 years of private practice experience. We need more thoughtful discussion of a viable model addressing value and analysis..Old North State where are you in this conversation?

  • Kate Menard

    The NC ObGyn Society is interested and willing to contribute to the dialogue. With 50% of the births in NC funded by Medicaid, Obstetrics provider engagement is critical to ensuring access and value.

  • Terressa McDougald

    Our problem with NCTracks was identified back months ago, and there has been not one person able to rectify the problem. My surgeon has not been paid since June and it really is a burdensome issue. He wants to provide a service for those who have Medicaid, however rendering a service “free of charge” as it is at this time does not pay salaries or overhead. What a disaster and I am convinced it was a willful and deliberate disaster to prevent having to pay out the monies owed to our physicians. We are in a very rural, depressed area and Medicaid is a larger payor for us. Hope our doors can remain open.

  • John Wagnitz

    How will the practicing psychiatric members of NCMS be involved in this process?

  • Monson Shuh, M.D.

    The recipients of Medicaid should also bear responsibility for their welfare and health. In my practice, we see patients abuse alcohol, tobacco, and illegal drugs, leading to health problems, such as renal failure, coronary artery disease, lung cancer, etc. Another example from personal experience is a patient who received an expensive left ventricular assist device for coronary heart disease, but has been a noncompliant patient for many years ignoring physician advice and regulating his own medications.

  • Jim Hill

    Any interest on the part of the NCMS about encouraging the Governor to expand the Medicaid program which would provide health care coverage for an additional 350,000 patients with mostly federal dollars?
    Jim Hill

  • I really appreicate Mr. Seligson meeting with the powers that be. Providers have always had the greater assumption of risk when it comes to Medicaid patients. When will those who set policy realize that the recipients of these services must be held accountable for behavior when it comes to their utilization of our services? That will make a difference in the reduction of cost! Most providers continue to do the right things and are “awarded” by decreasing reimbursement and increased “risk”. At some point, I think many will simply stop participating!

  • William D. Medina,MD

    I am glad that NCMS is participating in these discussions. Are there data available comparing the cost of Medicaid care in North Carolina to that of other states? Specifically, the per capita expenditures? Also what percent of the population is covered by Medicaid in North Carolina and how does that compare to other states? Also how much money has been spent by Medicaid in North Carolina over each of the last 5 years and what percent of the state budget has this represented each of those years?
    Thank you.

  • Our pediatric practice is now approaching 60% Medicaid and some of our individual providers who speak Spanish see 70% Medicaid, and even though they earn less than their privately paid peers, feel strongly comitted to serving these children. This population of indigent children come with a complex presentation of challenges, including parenting issues, family dynamics,cultural differences and non-compliance. Our Medicaid no show rate is around 20%, despite multiple reminders from us and Medicaid case management. ER utilization remains high among this population as well. Staffing in pediatrics is high due to the number and variety of services that must be provided, i.e. multiple developmental, behavioral, and psycho-social screenings, vision and hearing tests and immunizations.

    It would seem reasonable to many of us in pediatrics to build more accountability into the Medicaid program to appropriately utilize the services they receive and comply more carefully with appointment times and treatment plans.

    Our fear is that decreased reimbursement from managed care Medicaid coupled with the aforementioned items, will make it impossible to survive financially as we continue to care for our state’s children.

    I am happy to hear that the discussions will be categorized, as special attention should be paid to the comprehensive services we provide to children.

  • Anthony Dietrich, MD

    NC’s refusal to expand medicaid is costing us greatly in our ability to treat the most vulnerable of our citizens.

    See: http://www.modernhealthcare.com/article/20131016/BLOG/310169995

  • The Western Carolina Medical Society deeply appreciates this update. Medicaid reform and Medicaid expansion are high priorities for WCMS in 2014. It is challenging to stay on top of critical information given the distance between Raleigh and our neck of the woods. Please continue to keep us apprised of “new insights” as you learn them, and let us know how we can best support NCMS’ efforts.

  • Sandra Brown

    No apologies huh?

    So we are putting lipstick on the medicaid HMO pig again I see. Given the underwhelming private payer response to signing up on the exchanges, I wonder if Wos et al will be surprised when they get the same response from the HMOs and ACOs.

    Although I am not philosophically a fan of the mega-merger activity that is reducing the state to 3 or 4 large systems, it will certainly give those systems quite the bargaining power.

  • I am encouraged to know that the NCMS is continuing to work on our behalf to fix this “Broken System”. As a result of the many outstanding issues that still plague the NC Tracks system it is getting harder and harder to convince our providers that we should continue to see patients associated with this payer. As a private independent practice who is very active in our community – I don’t know how much longer we will be able to absorb the outstanding costs that do not seem to be getting any closer to getting resolved. Thank you for your “Voice”.