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By Rose Hoban
More than a hundred physicians, many of them wearing their white coats, roamed the halls of the North Carolina General Assembly Wednesday, crowding into the doorways of lawmakers and holding closed-door meetings with members to ask legislators to back the Medicaid reform plan rolled out by the Department of Health and Human Services in late February.
In the Senate budget passed late last week, leaders of that chamber rejected the DHHS Medicaid reform plan and made explicit their wish to bring managed care companies to North Carolina to run the federal- and state-funded program that provides care for about 1.6 million low-income children, their parents, people with disabilities and the elderly.
The program costs about $13 billion per year, two-thirds of which is paid for by the federal government.
But doctors and other providers – and now Gov. Pat McCrory – are calling on members of the General Assembly to embrace the DHHS reform plan, which proposes the creation of accountable care organizations managed by physicians, in which providers share both savings and risk.
“This new [ACO] model would reward doctors for the quality of care, not the quantity,” said Dev Sangvai, president of the North Carolina Medical Society. The Medical Society and many provider organizations had offered input into the formation of the plan, to which they gave enthusiastic backing.
“We had reason to hope that the accountable care model would bring two lasting improvements to Medicaid. The Senate budget, however, discounts this collaborative effort.”
Support from McCrory
After spending the morning speaking to legislators, dozens of the doctors then walked two blocks to the governor’s mansion, where they met with McCrory and DHHS Sec. Aldona Wos, who told them they needed the providers’ help to change lawmakers’ minds.
“We need your help, but we can’t just tell them what we’re against,” McCrory told providers. “I’ve got everyone across the street telling me what they’re not for. We’re trying to present a plan in which we’re for something, and the beginning steps of implementation where we can work together as a team.”
McCrory and Wos both called the DHHS reform plan predictable and sustainable.
McCrory maintained it would avoid “surprises” such as last year’s $535 million overrun and this week’s news that federal regulators would not accept $60 million of assessments on mental health providers in the state.
“We continue to have Medicaid issues impact our costs up to the last several days and impact our budgets,” he said.
Originally, Wos had embraced the idea of managed care as the model for Medicaid reform. But over months of meetings with provider groups, her department eventually embraced accountable care.
“We have specific challenges here. We need to create a system that is North Carolina-specific, and that’s what we have created with your help and knowledge,” Wos told the doctors, appealing to them as a fellow health care provider.
“We know what we’re doing as physicians; we know how to care for our patients,” Wos said.
She instructed the doctors to tell lawmakers, “Offer us the flexibility so we can be creative and take care of patients in the most efficient and effective ways.”
Medicaid director Robin Cummings told the gathered crowd to talk to colleagues in their home communities.
“Tell your fellow doctors to get to Raleigh, talk to the folks, let them know what you know so they can make a better decision,” he said. “We have two physicians in charge of DHHS, at two levels, so we have an opportunity to do something really, really great.”
McCrory told reporters he’s “confident” he could bring legislators around to his way of thinking and called for open debate on the Medicaid ACO plan.
“We’re having very good discussions with both House and Senate leaders,” he said. “Some of those discussions with members of my administration are occurring as we talk, and we’re trying to find viable solutions for policy issues and operational issues.”
Docs push their plan
Chuck Rich, who manages Bladen Medical Associates in Bladenboro, said he had met with at least two senators and several House members.
“From both the House and the Senate, one of the things I heard repeatedly was the desire for greater budget predictability,” said Rich, who is also the head of Community Care of the Lower Cape Fear.
The Senate budget reduces eligibility for as many as 15,000 aged, blind and disabled beneficiaries. It also eliminates all funding and contracts for Community Care of North Carolina, the patient-centered medical home organization that helps local clinics and providers coordinate care to reduce overuse of health care resources.
Rich said he was convinced that if managed care companies were invited to run the state’s Medicaid program, it would result in reduced access to care, especially in rural areas such as his.
Providers fear that managed care companies would move to restrict care to patients in order to increase their profits.
“In a rural area, Medicaid is a big portion of our practice,” he said. “So if you’re talking about changes to a program that would impact 30 percent of our patient population, that may potentially have a devastating effect on practices.”
Sangvai noted that in North Carolina more than 80 percent of providers participate in Medicaid. In other states, that percentage can be as low as 35 percent or 40 percent of providers.
“We know there are states that are trying to provide Medicaid services with half the level of participation we have in North Carolina,” Sangvai said.
But he said that with managed care, “If the process gets really complicated, you wonder what’s the motivation to continue to do this.”