Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
Clip File
June 30, 1997
Mass. teaching hospitals turn down offer of federal dollars for promise to train fewer physicians
BOSTON—Boston’s prestigious teaching hospitals say they won’t accept federal money to stop training new doctors. Officials from five of Boston’s leading academic health centers had a change of heart about participating in the program after Sen. Edward M. Kennedy succeeded in getting Massachusetts in on the deal.
Officials from the academic centers say a national program, not a local program, is needed. Some hospitals, which have already made cuts in their teaching slots, also are reluctant to have the federal government tell them how and where to make deeper cuts.
Under a pilot plan in New York, 41 hospitals have agreed to cut the number of doctors they train by 20-25% over five years, producing 2,000 fewer residents. The administration’s proposal to Massachusetts called for a similar reduction. However, several hospitals in Boston say they have already cut their teaching slots by 20%, cuts that have caused them to lose money.
A report by the Commonwealth Fund Task Force on Academic Health Centers released last month proposes a national $18 billion trust fund to pay for the special mission of teaching hospitals—medical education, biomedical research and highly specialized patient care.
Boston Globe, May 16, 1997
Medical groups taking the heat in California
SACRAMENTO, CA—In July, the Pacific Business Group on Health, a consortium that buys health insurance for some of California’s largest companies, is expected to release its first-ever consumer satisfaction survey of large California medical groups. So far consumer satisfaction surveys have focused largely on health plans. Critics say that since many health plans share provider groups in common, measuring satisfaction at the provider group level is more meaningful.
Medical groups have also become the focus of concerns about how thinning profit margins under managed care in California may be affecting patient care. HMO executives say it is difficult for them to decipher what is going on, financially and clinically, in medical groups.
California HMOs worked behind the scenes for a year to develop a proposal with regulators for policing medical groups. Mark Hyde, chief executive of the Lifeguard HMO and former president of the California Association of Health Plans, told the Sacramento Bee he and other executives had helped develop a proposal that would require medical groups to provide periodic, audited financial statements.
Most HMOs require access to medical group audits, but HMO executives say the doctor groups don’t trust HMO management and try to shield financial information from them, for good reason. If they show a profit, the HMO may try to reduce their pay.
The proposal fizzled out when the state Corporations Commissioner left his job for a position with the Los Angeles Mayor.
Sacramento Bee, May 19-20, 1997
Florida ends contract with Unisys to process claims for state employees, retirees and their families
TALLAHASSEE, FL—The state of Florida will terminate its contract with Unisys to process health insurance claims for nearly 215,000 state workers, retirees and their families. Unisys, which processes Florida’s Medicaid claims, had a four year contract which was worth $11 million. The contract began in January 1996.
Employees have been concerned about slow payments and problems arising from complex claims, according to the governor’s deputy budget director. Legislators recently voted in favor of giving the contract to a company whose primary business is health insurance. Although Unisys has experience in Medicaid claims, the contract was its first expansion into health insurance. Unisys will continue to handle claims until a new company is selected or until the end of the year.
Miami Herald (Associated Press), May 31, 1997
Private firm to manage Philadelphia’s program
for mentally ill and substance abusers
PHILADELPHIA—City officials are moving ahead with plans to contract with a private managed care firm to run the non-profit Community Behavioral Health, a city-run organization that oversees services for the mentally ill and substance abusers.
CBH is enrolling Medicaid recipients under the state’s Health Choices program. In a progress report on CBH to the City Council recently, Philadelphia Health Commissioner Estelle Richman, city Health Commissioner says the group has signed up nearly 350,000 during its first three months of operation and run up a surplus of $7.25 million. The Consumer Satisfaction Team, a non-profit group under contract with the city to monitor consumer satisfaction with CBH, gave it good marks so far.
The progress report led some city officials to question why the council was releasing a request-for-proposal for a management contract. But supporters of privatization on the city council said draft specifications would place limits on profits by managed care firms. They also said all the treatment protocols developed by CHB, such as the number of counseling sessions, will be adhered to by any private contractor.
Critics accused Council President John Street of supporting the move because of campaign contributions from Value Behavioral Health, a Falls Church, Va. firm that is expected to bid. Mr Street said that he doesn’t want to create a new city bureaucracy of several hundred employees and that private companies have more experience managing mental health services than the city. While the city may not be managing it, Philadelphia will retain ultimate control over the program.
Inquirer, Philadelphia, Pa., June 5, 1997
Class-action suits charge PA’s Medicaid programs
is not ready for special needs populations
PHILADELPHIA—Beginning July 1, more than 100,000 disabled people in the Philadelphia area will be required to get their medical care from one of four Medicaid managed care plans under the new HealthChoices program. But two class action suits now contend that the state is ill-prepared to handle this medically needy population.
One suit contends that the state has failed to ensure access to care by the disabled in violation of the Americans with Disabilities Act. The plaintiffs are a teen with cerebral palsy sent to a dentist’s office that had no access for wheelchairs and a blind man who was unable to get information in Braille from his managed care plan, Health Partners. (A Health Partners spokeswoman said that the company provides a member handbook in Braille on request.)
"It’s one thing for a little store or restaurant not to have wheelchair access, but it’s another thing for the state to sanction medical care that is not wheelchair accessible," said Stephen F. Gold, a lawyer with the Public Interest Law Center.
In another suit, the state is charged with failing to ensure medically necessary care for some estimated 15,000 disabled children in the Philadelphia area. The suit alleges that two children with severe hearing loss were illegally denied special hearing aids by Keystone Mercy. A third plaintiff, an 11-year-old boy with a seizure disorder and attention deficit disorder, was refused speech therapy by Oaktree, another HMO, the suit alleges.
According to the children’s suit, in all three cases, the managed-care plans maintained that such services should be provided by school-based programs for the handicapped, not health-care providers. The complaint was filed by the Disabilities Law Project and the Education Law Project.
Inquirer, Philadelphia, Pa., June 4, 1997
TennCare changes plans on mental health; keeps carve-out for another year
MEMPHIS—Tennessee officials now say they are going to delay plans to let managed care organizations (MCOs) take over behavioral health for Medicaid. The MCOs were supposed to take over these services Jan. 1, 1998, but now the state says it won’t be for another year.
The state’s managed behavioral health carve-out, called
TennCare Partners, is under attack for delays in payments to providers, many of them safety net providers. Health Care Financing Administration officials were in Tennessee in March to do a site review. The closing of one community mental health center, Spectra Behavioral Healthcare Systems, in March focused concerns on safety net providers.
Another community mental health center, the Midtown Mental Health Center, says it is closing its crisis stabilization unit because of a $450,000 loss under the state’s carve-out program. Local officials said the closing would be a major blow to the community and predicted that more mental patients would end up in jail or hospital emergency rooms.
Commercial Appeal, Memphis, TN, May 2, May 17, 1997
Florida HMOs have 72 hours to respond to grievances
TALLAHASSEE, FL—A new law signed by Florida Gov. Lawton Chiles will require an HMO to respond within 72 hours to grievances concerning serious medical treatment. HMOs used to have up to 60 days to respond to all grievances.
Sun Sentinel, June 5, 1997
Involuntary commitments on rise in Massachusetts
BOSTON—In a series that pointed to the dramatic growth in Medicaid/Medicare revenues in Massachusetts psychiatric hospitals, the Boston Globe reports that involuntary commitments are way up in the state. Since 1990, the number of these commitments has grown more than 50% to about 20,0000 per year.
Under state law, a patient may be confined for up to 10 days before a court review, one the nation’s longest periods of commitment without review. The District of Columbia and 25 states require court involvement within 72 hours of an involuntary emergency admission, found a study by the Globe and the American Bar Association. Legislators are calling for a change in the law so that the review periods can be shortened. Massachusetts legislators are calling for a change in the law so that the process can be speeded up.
The newspaper reports that locked wards are exempt from Medicare’s DRG payment method, which has created an incentive for general hospitals to add them and to use involuntary commitments. Massachusetts ranks near the top nationally in growth of Medicare psychiatric admissions and Medicaid payments to mental hospitals, the series reports. Medicare inpatient psychiatric payments have doubled to $145.3 million in Massachusetts in five years, twice the US rate. Medicare and Medicaid now pay for about 72% of admissions at hospitals handling most of the state’s private psychiatric admissions.
Boston Globe, May 11-13, 1997 (series is available on Globe Online at www.boston.com. Keyword is spotlight.)
CO governor signs Medicaid managed care bill
DENVER—Gov. Roy Romer has signed legislation to move the state’s $1.6 billion Medicaid program into managed care. Lawmakers predicted it would save $3 million in the first year and $15 to $16 million a year later on. The savings are expected to be used to increase coverage for children.
Under the newly signed law, about 75% of Medicaid recipients will be shifted into a managed care program over the next three years. But state auditors warned that moving disabled recipients into managed care was uncharted territory.
About half of the state’s Medicaid recipients are already enrolled in managed care, one of the highest rates in the nation. A total of 275,000 Coloradans received Medical assistance last year: 47% of them are children, 20% disabled and 14% elderly.
The issuing of certificates or vouchers to Medicaid beneficiaries so they can purchase their health care themselves is one of the innovative feature of the program.
Rocky Mountain News, Denver, CO, June 4, 1997
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content
