Tuesday, May 22, 2007

Can the LME's be trusted?:the tale of Jay Laurens and specially sanctioned Piedmont Behavioral Health LME

This is the tale of Jay Laurens, the Executive Director of Rowan Homes, who apparently decided to speak up re: the way was being spent by Piedmont Behavioral Health, and therefore incurred the disfavor of this LME----who punished him by removing him as an appropriate provider. This should make everyone sit up and wonder: can it happen with the LME with which I am involved? This is a recipe for currying favor, licking boot, and obsequious/fake/ fawning behavior by such inclined Endorsed Provider companies when presented with the opportunity by so-inclined LME's. And it certainly is not out of the realm of possibility. This is yet another argument for the creation of a ONE PAYER SYSTEM wherein everyone would be created as equals----or unequals. Such behaviors could more easily take place with an isolated LME than at the state level. REMEMBER: the profit margin of Medicare/ Medicaid is 5%: this is a very efficient system. What do you think the profit margins of companies such as NC BC/BS are?

associated article: http://www.salisburypost.com/area/309271306692634.php
".....In spite of all that, a judge ruled the Concord agency had theauthority to contract with whomever it wanted — and didn't have tokeep doing business with Rowan Homes.That authority puts Piedmont Behavioral in a unique position.Around the state, organizations like Piedmont Behavioral — called"local management entities" under the state's mental health andsubstance abuse treatment structure — are required to contract withany Medicaid-eligible agency that shows itself "willing and qualified"to provide services, such as Rowan Homes.Since 2005, however, Piedmont Behavioral has been exempt from thatrule as the site of a pilot program state officials hoped would provea more efficient, cost-effective way to deliver mental health care....

Critics, including Rowan Homes Executive Director Jay Laurens, say the state has concentrated too much power at Piedmont Behavioral, which oversees mental health and substance abuse services in five counties, including Rowan and Cabarrus, and required too little accountability in return.

Advocates, including state legislators and executives at the state Department of Health and Human Services, say the pilot program is working and may be expanded later this year. ..."


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