Thursday, March 24, 2011

Western Highlands Network LME to keep Medicaid $$ management "local" : (this undoubtedly means reams of paperwork to be completed)

A local news article chirpily indicated that Western Highlands Network (WHN) LME which manages 8 counties for Medicaid mental health services in western NC, has scrambled to grab a contract from NC DHHS in order that local mental health Medicaid $$ be managed locally. (see: : Western Highlands Keeps Mental Health Dollars Local by Gary Glancy from a publication entitled, "Blue Ridge Now"

Arthur Carder, the CEO of WHN LME, is stated in the article to note that this will increase the Medicaid $$ that are managed by WHN LME from $27 million to $93 million. Asheville does need some jobs and so hopefully this will result in that.

However, my concern is this: my outpatient mental health services which I provide to NC Medicaid clients under Smoky Mountain Center LME (Haywood county is next to Buncombe and Medicaid is not managed by SMC LME, godforbid) are quite efficiently managed by NC DHHS. Why are we moving AWAY from a one-payer system or more of a one-payer system and towards increased administrative costs because each LME is managing a set of money?

This is what happens when I see clients for NC Medicaid outpatient therapy:

1. for adults, I see them up to 8 sessions and then must ask Value Options (NC DHHS farmed out the authorizations to them years ago) on a one page piece of paper to reauthorize. As long as I fill out the piece of paper correctly, I always get the sessions I want for the year. For adolescents/ children the number of visits before you must send VO a request is 26.

2. to bill for outpatient psychological assessment or therapy, I then go online to NC webclaims portal, and spend about 10 second submitting my billing which must be in every Thursday by 5 pm in order to be paid the following week.

And so tell me again how this is going to be made more efficient?-----it's not computing for me.

Other than creating jobs locally, this appears to be a waste of administrative tax-payer $$.

We need to move towards more ONE PAYER systems not towards more bits and pieces of the system fraught w/ administrative paperwork.

If what we're talking about is the administration of the case management services which Governor Perdue was so keen about----which is nothing more than moving papers around----a really silly expenditure of money that is very very minimally associated w/ patient contact----then sure, go manage that. Its already a bunch of paperwork and it gives the illusion of stuff being done.

This case management was put into place as Community Support Services (CSS) was being disbanded. CSS provided face-to-face contact w/ clients and while it may have cost money, in rurual western NC, in particular, it accessed Medicaid clients to services that are now----you guessed it----provided by this psychologist. I can do therapy driving someone to their medical appointment as well as I can sitting in an office or their home. Yes indeed, I take that mileage off my taxes at the end of the year.

Another case in point as re: the very real dollars and human costs of having lots of little insurance companies like Humana providing what I call 'pretend' Medicare services (they are called Medicare advantage companies and tax payers support private enterprise to the tune of 15-20% administrative costs versus -----federally!!-----administered Medicare which has administrative costs of less than 5%): this week I finally figured out why I am not getting paid to see my Humana clients in Haywood county (Humana ditched its PPO 12.31.2010 for no clear reason other than, to my mind, they weren't making enough money) and they outsourced their outpatient mental health services to a company in Texas (yeah, that's local) called LifeSync. This company sent me letters saying they couldn't 'find' so and so in their roster and so after calls and obtaining of social security numbers and they spending hours going thru a list of names sent to them---or not----by Humana's new program in Haywood county----they finally found the clients.

What a waste of time---for those administrators----and this psychologist.

The 'pretend' Medicare 'advantage' companies are temporary insurance companies. Doesn't anyone get this? Doesn't anyone understand the meaning of 'administrative monies going into private owners pockets'?----versus federally managed Medicare w/ its honed mechanisms? Or have all the tea baggers finally convinced everyone that yes indeed the feds are taking your money and you're not getting anything back for it? Shucks, let's give it to that rich guy who lives in that gated community you can't get to........

Any mechanism which is creating more paperwork is the wrong direction and I believe that as per my experience with WHN LME related to state funded clients (people who cannot get to Medicare/ Medicaid and need services and are thus defined as 'state funded'), there is nothing but an onslaught of useless, non-necessary paperwork heading any mental health practitioner's way who works w/ NC Medicaid clients.

Arthur Carder, CEO of WHN LME: refute what I surmise, if you would, please.


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