Category: Medicaid

The Medicaid Dominoes are Falling.

Second lawsuit by Appalachian Regional Healthcare against Medicaid Managed Care:  This time we also hear from the other side!

The prolonged period of confusion following the state-wide implementation of Medicaid Managed care throughout Kentucky was bad enough, but not unexpected given its broad sweep and its short implementation period. (Some background is available by clicking on the Medicaid Tag at the bottom of this article.)  After an initial flurry of hearings in Frankfort, not much was appearing in the media, and those of us not in medical billing offices, seeing patients, or for that matter beneficiaries of Medicaid might have hoped that things were sorting themselves out. Alas, the worst seems yet to come. For me, the most recent and indeed frightening public notice that things were not self-correcting was the lawsuit filed by Appalachian Regional Healthcare (ARH) against one of the three new managed care organizations (MCOs) and Kentucky’s Medicaid Cabinet.

In that suit against Kentucky Spirit, we learned that not all the MCOs were able to pull together the necessary state-wide networks, that at least one large healthcare provider organization with a corner on a regional market was able to thumb its nose at an MCO, that payments to hospitals were painfully slow and lower than desired, and that Kentucky Hospitals have been engaged in disputes (legal and otherwise) with the Cabinet for quite some time over the adequacy of payments. It is always true that a lawsuit only represents one side’s positions, but these conclusions seem rather self-evident. You can read the lawsuit for yourself as well as my initial analysis elsewhere in these pages. It was clear to me that something bad was going to happen.

Now other shoes are falling. Insider Louisville extended its breaking reporting to a second and not unexpected lawsuit by ARH against Coventry Health Care and included a copy of a letter from the Executive Vice President of Coventry to the President of ARH. That suit itself is not yet available to me, but it sounds like it was very similar to the one against Kentucky Spirit. We are told that “Coventry will mount a fierce defense that will be an enormous drain for ARH.” I guess this is how the big boys play, but in fairness, Coventry tells a very different and equally believable story than that told by ARH in its suit against Kentucky Spirit, and seems earnestly to want to make things right for the citizens of Kentucky. Continue reading “The Medicaid Dominoes are Falling.”

Further musings on the lawsuit by ARH Hospitals against KY Medicaid

Appalachian Regional Healthcare, and ARH Mary Breckinridge Hospital are suing the Kentucky Medicaid managed care company, Kentucky Spirit, and the Kentucky Cabinet for Health and Family Services in hopes of getting paid better and quicker for their services to Medicaid beneficiaries. The lawsuit is outlined in greater detail in an earlier submission by KHPI, and by Insider Louisville which first reported the story. Hospital finance is at best always confusing so I did some exploratory research regarding Critical Access Hospitals such as Mary Breckinridge, and how they are paid. I also took a quick look at how much hospitals in Kentucky charge their patients for the same inpatient diagnoses. Very interesting! The smell of blood in the water is getting stronger. Continue reading “Further musings on the lawsuit by ARH Hospitals against KY Medicaid”

Medicaid Managed Care Update: Month 5.

From Bad to Really Bad.
Lawsuit reveals soft underbelly of low payments for Medicaid services.

Our friends at Insider Louisville brought to our attention a lawsuit just filed by Appalachian Regional Healthcare Inc. (ARH) against Kentucky Spirit Health Plan, one of the three new Medicaid managed care networks in the state. As they say, such a lawsuit presents only one side of the case, but in a system cloaked in secrecy and muddled by incomprehensible financing, the information revealed is of great interest. Included as a codefendant with Kentucky Spirit is the Kentucky Cabinet for Health and Family Services! If even half of what ARH claims is mostly correct, our state Medicaid structure sits on very shaky ground. It’s going to take more than the theoretical savings from managed care to fix things. For more background from these pages, see posts of Feb 2, 2012,  Feb 11, 2102,  Feb 24, 2012, and March 2, 2012 or click the “Medicaid” button in the Categories list.

Terry Boyd of Insider Louisville had done a nice job of outlining the nuts and bolts of the lawsuit and specific problems faced by Kentucky Spirit. Anecdotal information previously available to the public included complaints that the new managed care networks were paying low and slow. This lawsuit provides some real numbers that indicate, if true, that payments to providers are lower and slower. According to both federal and Kentucky Medicaid law, medical insurers are supposed to pay “clean claims” [bills that have been filled out completely and properly] within a specified period. Ninety percent of clean claims must be paid within 30 days, and 99% within 90 days. If the insurer believes the bill is faulty in some way, or plans to pay only a portion of the claim, it is required by statute to notify the provider within 30 days (two days if the claim was filed electronically). Continue reading “Medicaid Managed Care Update: Month 5.”

Third Meeting of UofL Hospital Operations Review Committee.

Finally some real data.

On April 5, the Ad Hoc Operations review committee of University Medical Center, Inc. (UMC) met for the third time. This was the first meeting in which substantive analysis was presented by the consultants of Dixon Hughes Goodman. Unfortunately, Committee attendance continues to dwindle. Only five of the 10 committee members attended, one of those by telephone. In the peanut public gallery were myself, reporter Patrick Howington, and someone from Brown-Forman. One additional meeting before a final meeting on May 9 is planned.

The entirety of the meeting was a PowerPoint presentation by the consultants with only a few questions and comments from committee members. No handouts were presented as the material was said to be a work in progress. I could not help but suspect there was also some desire that the information not be disseminated. Indeed, most of the data presented must have been disappointing to the University. In any event, I photographed the projected slides and they are available here.

Senior consultant Craig Anderson, Sr. gave an update on the status of the project and lead his team of two additional people through a brief review of the challenges facing all academic medical centers (AMCs), some themes and observations from initial interviews with Hospital and University personnel, and some initial data addressing four of the hypotheses to be tested: lack of physician alignment, quality of clinical care and operations, payer environment, and facility constraints. Continue reading “Third Meeting of UofL Hospital Operations Review Committee.”