Changes to State Medicaid Program Present Challenges

joleen General Comments Off on Changes to State Medicaid Program Present Challenges

Changes to the state Medicaid program for women and children present challenges for the recipients as well as the clinics and hospital, Texas County Memorial Hospital board members heard at their monthly meeting on May 23rd at TCMH.

As of May 1st, all Medicaid recipients in the Children’s Health Insurance Program (CHIP)–the portion of the state Medicaid program benefiting pregnant women and children–were automatically enrolled in a new managed Medicaid program administered by a secondary party contracted with by the state of Missouri. CHIP recipients were assigned to a specific healthcare provider and received new insurance cards listing the name of the new Primary Care Provider (PCP).

Wes Murray, TCMH chief executive officer, described the changes to CHIP as “confusion”.

“We have spent a lot of time working on this, and this transition period has created a lot of issues and questions and difficulties for our patients,” Murray said.

In order to provide care for patients under the new managed Medicaid program, TCMH was required to contract with one of three state chosen middle administrators for the program.  After spending months in negotiation with the secondary parties, TCMH contracted with Home State Plans.

“Most patients were just auto-assigned a new healthcare provider,” Linda Pamperien, TCMH chief financial officer, said. She explained that some of the healthcare providers assigned to area patients are no longer in practice in the area because they are retired or now practice elsewhere.

“Patients that were already established patients with our providers in our clinics are contacting our clinics and healthcare providers asking where they are supposed to go for care,” Pamperien said.

Most of the affected patients are pregnant women or children that require regular and routine healthcare.

“We are trying to work with the managed care company, but they are making it very difficult for our patients to receive routine healthcare,” Pamperien said.

Pamperien cited delays for patients to receive routine ultrasounds prior to 17 weeks, questioning of physician ordered hospital observation stays for pregnant patients, and questioning whether or not a patient needs a Cesaerean-section for a safe delivery.

“Pre-certifications are a nightmare,” Pamperien said. “The managed care plan wants the physician to personally call to get the patients pre-certified for healthcare services.”

Delays of routine healthcare services are common with the new plans. TCMH is also receiving 20 percent less reimbursement for the same services.

“Our goals have not changed; we are trying to provide the best care we can for our patients,” Murray said. “And we are also doing the same services with more work for less pay.”

TCMH has voiced their frustrations with the Missouri Hospital Association and a new “Medicaid compliance officer” employed by the state to ensure that the managed Medicaid companies provide the services they are contracted to provide.

Medicaid patients are able to change the PCP they were assigned to.  There is also a process for Medicaid patients to change their managed Medicaid insurance provider.

Medicaid patients with Home State Health Plans are able to use any TCMH healthcare provider because the hospital and TCMH clinics in Licking, Houston, Cabool, and Mountain Grove and TCMH Home Health of the Ozarks contract with Home State Health Plans for managed Medicaid services. Home Health of the Ozarks is also contracted with MO Care for managed Medicaid.

Currently, Missouri Medicaid recipients who are aged, blind or disabled, including those with developmental disabilities served through the Missouri Department of Mental Health, are not included in the managed care system and will continue to receive services through the traditional MO HealthNet program administered by the state of Missouri.

In new business, Murray presented MHA data showing the hospital’s area economic impact.

In 2016 TCMH had $17,593,321 in salaries in benefits for 315 full-time equivalent employees. According to the MHA, one full-time hospital job has a 1.63 employment impact multiplier, creating 0.63 jobs in another industry in the area.

“Our 315 FTEs create an additional 198 jobs in the area,” Murray said.

The data showed that the $17.6 million payroll in 2016 has a $5.8 million secondary income impact on other businesses and industries in the area.

“This indirect impact is created by our employees spending money in the community,” Murray said, adding, “We have a total direct, indirect and induced employee compensation impact of $23.4 million on our local area.”

Murray recently met with members of the Houston city council for a hospital tour.  The hospital’s economic impact on the city of Houston was also discussed.

“We know what we do for our area from a healthcare perspective,” Murray said, “But the overall economic impact is often overlooked.”

Dr. Jim Perry, chairperson of the TCMH board of trustees and longtime ophthalmologist and business owner in Cabool, noted that TCMH is frequently thought of as an “always here” business in the community that is taken for granted.

“Just because the hospital is a long tenured business in the county doesn’t mean it will always be here,” Perry said. “The hospital’s impact on all area businesses is not fully realized.”

Murray reported that he recently met at Cox College of Nursing in Springfield with school officials and members of the state department of economic development.

Cox College is seeking a grant from the state to grow the school’s nursing program by an additional 50 students and to renovate the training facilities and classroom capabilities located at Cox North in Springfield.

“Our current nursing turnover at 16 percent is higher than it’s been in recent history, and it’s lower than the state and national averages,” Murray said.

The aging population in the US and particularly in rural America indicates needs for more nurses in the future, too.

Although Cox College of Nursing is located in Springfield, TCMH believes that increasing nursing enrollment in the region will increase the numbers of nurses available to work at TCMH.

Ron Prenger, CoxHealth representative, thanked Murray for his support of their grant efforts.  Prenger explained that Cox College is the only nursing program in the area that is currently seeking enrollment growth.

“We have to have the support of the rural hospitals in our area to receive this grant,” Prenger said.

Turnover for nurses at CoxHealth is higher than at TCMH, and both hospitals cite healthcare facilities offering large sign-on bonuses to recruit nurses and traveling nursing agencies offering higher rates of pay as the main sources for nursing turnover in their respective hospitals.

If the grant is received, Cox College plans to have additional nurses trained and ready to work in about three years.

“The nursing shortage is a growing problem that doesn’t need to grow anymore,” Murray said.

Hospital inpatient and outpatient revenues dropped below below budgeted expectations for the month of April, according to Pamperien’s monthly financial report.

Inpatient admissions at the hospital are up by 88 admits for the year in comparison to 2016, but in April emergency department volume dropped and swing bed admissions dropped.

“The ER drives a lot of our outpatient revenues,” Pamperien explained.

TCMH ended the month of April with a negative bottom line of $243,967.83 and a negative year to date bottom line of $36,009.15.

Present at the meeting were Murray; Pamperien; Prenger; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, public relations director; Amanda Turpin, quality management director; Dr. Jonathan Beers, TCMH chief of staff; and board members Perry; Mark Hampton; Jay Loveland, and Omanez Fockler.

Board member, Janet Wiseman, was not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., June 27 at 12 p.m. in the hospital board room.

  • Let us know what you think

    You can contact us via the email button below or submit online using our Contact Form.

    Contact Us via E-Mail Follow Us on Facebook TCMH Buzz