Thursday, May 17, 2007

Bad appples argument resurfaces: NC state auditor reveals 25% fee reduction as 1 culprit; DHHS Service Definition see-saw also critical

The NC State Auditor has finished his report outlining the collapse of a '10,000 lives covered' Endorsed Provider company, specifically, New Vistas/ Mountain Laurel, overseen by Western Highlands LME in Buncombe County:

These issues are not unique to this Endorsed Provider agency. The problems are simply 'writ large' and every single Endorsed Provider agency struggles with moving forward as pertaining to the incompetent management of DHHS which mandates what Endorsed Provider companies can do---or not.

And related to the news coverage of that matter by the Asheville Citizen-Times, can someone tell me why the news-services can't be bothered to look at the details of official documents, like Service Definitions (created by DHHS in order to guide such things as Community Service) or 'small' details like '25% fee reduction' as associated with the NC Auditor's report which outlines matters associated with the collapse of the largest mental health provider in Western NC in October, 2006 (New Vistas/ Mountain Laurel). You would think that a journalist could at least think around the issue and posit it as something to ask questions about---to at least make an educated guess as to how this might impact a fledgling company??

In the 5.15.07 article by Nanci Bompey at 828-232-6003, via e-mail at , that reporter outlines the following matter (a continuation of the 'bad apples' gigging of the Endorsed Providers so mastered by Hooker-Odom, and then underlined by Easley):
".....They did not have the business experience to manage their private shop,” said Chris Mears, a spokesman for the state auditor’s office...."

Bad apples; bad apples; bad apples; bad apples; bad apples; bad apples. (See April archives of Madame Defarge: Sunday, April 29, 2007: Hooker-Odom sends destructive mixed signals to the public & gullible press : WHERE'S MY COPY OF HOOKER ODOM'S AUDIT?? )

Here is the link to the audit of the provider associated with '10,000 lives' pertaining to mental health coverage, which collapsed on the eve that Mike Moseley, Director of Mental Health, under DHHS, spoke to a shockingly respectful room of providers and consumers 50 plus miles away in a hard-to-find-auditorium at Western Carolina University: (you cannot cut and paste anything from this document and so you will have to look at it yourself)

My comment to the Asheville Citizen-Times writer was the following:
The Performance Audit, conducted by Mr.Merritt, The State of NC Auditor, noted, as re: New Vistas collapse, that the following occurred: "a 25% fee reduction." (page 1).
I would like to know what fledgling business would be able to handle that. I would like to know why DHHS, The Department of Health and Human Services, continues to mismanage funding----and moreover why the state legislature and the governor and the LME's continue to put up with it."

Here are my comments on the audit:

This was a quality audit. If only we could have been accorded the same respectful and thorough analysis by DHHS as associated with Community Support. They interviewed a range of impacted individuals in order to gather the data points (p. 9).

New Vistas (then combining with Mountain Laurel: NVML) proceeded as they had before, providing services to state funded clients as well as emergency psychiatric services (state funded clients receive a great deal less in services than Medicaid/ Medicare clients do) and Buncombe county has only adult psychiatric emergency services for Medicaid/ Medicare clients ONLY at Copestone/ St. Joe's. Buncombe is utilized as a reference point as this is the most populous county as associated with Western Highlands LME. (p. 12-13)

New Vistas was created as a 'safety net'; it was assumed that providers care for state-funded and non-Medicaid/ non-Medicare clients----or those w/o any mental health insurance or insurance period. (p. 13)---as they had in the past.

Major revenue stream loss was associated with no-shows by clients. (no information was given by the auditor as associated with matters impacting clients like: no transportation; no childcare, etc.; p. 13)

The new Service Definitions implemented in a haphazard manner by DHHS, March, 2006, was noted by the board of the company ot have been a key factor in the collapse of the company (p. 15). At the same time, DHHS---in its typical confusing fashion---put its Service Definitions OUT and then placed them ON HOLD, leaving al the Endorsed Providers, include NVML, in limbo. The LME's or boards governing the Endorsed Provider companies such as this one, have only been able to try and interpret these DHHS edicts as best they could----with the suggestion to the providers that they should call DHHS in order to obtain some clarity. This is really really not helpful.

The audit goes on to speak about 'insufficient operating capital.' So, tell me: how is it that the LME's will be sending back to the state millions of unused mental health dollars while the Endorsed Provider companies such as this one go wanting? Talk about famine during a time of plenty.....

Job stress associated with job instability began to take its toll on the company (p. 18); people quit as associated with the stressors of the job, causing even more people to quit. This was not unrelated to DHHS unfolding edicts, then putting them on hold, leaving everyone in a Catch22 non-man's land. Recently, Community Support providers have been gigged, as associated with a crappy audit (see previous Madame Defarge posts for specifics) , Hooker Odom cranks up her 'bad apples' machine; Easley, parrot-like echos this sentiment; news-services talk about the 'bad apples'----with no one taking the time to do the work as associated with looking at the details of the matter.

The audit made note (DUH) that state-funded clients require dual, time-consuming authorization. (p. 23)

(My comments as pertaining to desire on part of providers for standardization): There has been absolutely no progress made on the matter of standardization of methods associated with authorization as pertaining to providers indicating to DHHS that this was, in many cases, their number 1 priority. (p. 24).

The matter that there is a severe lack of emergency psychiatric services was expressed as a critically important matter many times by NVML personnel, to the auditor (p. 21)



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