Tuesday, January 05, 2010

NC Medicaid : ACCESS Care/ NC DHHS struggles to address tiers of barriers intrinsic to that system

I had a useful telephone call yesterday w/the ACCESS Care nurse, J. Frady (jfrady@ncaccesscare.org; overviewing Swain & Jackson county in western NC), which is devoted, via NC DHHS, to reigning in Medicaid costs. Two of my Medicaid clients, both heavy medical utilizers related to chronic illnesses requiring persistent medical care, received letters from ACCESS Care/ NC DHHS in an attempt to link these recipients to medical health care providers.

That's a great idea but both of them have PCP or Primary Care Providers. One has a life-time seizure disorder and requires monitoring of anti-seizure medication blood levels and the other has chronic pain and over the past couple of weeks -----when the doctor was not available from the large medical practice in Waynesville, NC----- has been refused treatment by the two local emergency rooms even after being transported there by ambulance.

Her problem? Oh, the non-narcotic/ neurogenic pain medication, Lyrica ($90 for 30 pills the pharmacy supervisor told me) which allows her to find sufficient relief from her fibromyalgia now requires a Medicaid pre-authorization even if there is a script in place at the pharmacy. Thus, she could not get her Lyrica over the long Christmas holiday and sat in her cold trailer suffering and going to the ER where they would not treat her as they believed her to be seeking narcotic pain medication. TWO ER's would not treat her.

As re: the other client, ACCESS Care via NC DHHS, had suggested that a Haywood county client find transportation to Jackson county, over a 50 mile round trip, in order to see a provider that has been linked to seeing Medicaid clients. I guess the client could line up the Medicaid van but the problem w/ this is that the Medicaid van picks people up very early and brings them home late for one physician appointment. Additionally, this is a significant charge for the state or NC Medicaid. The client needs a PCP in the same town and there are only two Medicaid PCP in Waynesville, NC.

The PROBLEM is that if they have to miss a visit due to: 1. no transportation 2. not having the $3 co-pay, for instance, the provider drops them. Oh yeah: remember NC DHHS Mental Health Community Support Services which are getting ready to die out for adults over 21? They were providing some of the transportation to these appointments.

If the client is dropped by the medical practice for not making their one appointment, then they have to find----or better said I have to help them find----a PCP whom takes Medicaid.

There are two primary care providers in Haywood county for Medicaid clients, w/ one being at Mountain Medical in Clyde, NC, and the other associated w/ Haywood Women's Center (sees males also; in temporary housing at this time). Thankfully, both providers have been able to provide ACUTE visits which allowed the clients to be seen within a week. Otherwise, the appointment would have been in MAY, 2010 and in fact the official intake is still in May, 2010.

They were pulled into the ACCESS Care / NC DHHS system as a result of frequent emergency room visits. I'm told that everytime an ambulance takes someone to the hospital, that's a $500 fee. That does not include the emergency room care/ medications/ other costs. So, you might figure 2 grand for a visit which should have been addressed by the PCP but then as a result of the pre-authorization of the Lyrica, the client would not have been able to get her medication ANYWAY.

You might speculate that a lot of money could be saved re: these people w/ some chronic health issues if there were more Medicaid providers instead of those 2 grand ambulance trips in order to simply get some anti-seizure medication or relief from chronic pain.

I see these clients in their homes and I like to think I provide a liason service between then and their physicians whom, as you might expect, get a little tired of hearing from this clinical/ health psychologist via letters & phone calls.

What compounds the entire issue is a simple matter which should have been addressed decades ago and that is the interfacing of medical information across providers which still protects HIPAA concerns.

Oh, and that doesn't include the third client who takes Opana ($1500/ month: a time release narcotic medication). She couldn't get access to that because Medicaid apparently runs out of money towards the end of the year whereupon the pharmacy attempts to bill Medicare, Part D, which simply boots the matter back to NC Medicaid which says that Medicare needs to pay for it. Their explanation? It takes a long time to cross-over the records from 2009 to 2010 so that next year we all start this process again.

NC Medicaid might save a whole lot of money by considering all the boondoggles like those described above that simply cause more----not less----money to be spent. Forget the fact that human suffering takes place. As Dylan said: money talks: bull---- walks.

1 Comments:

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