TCMH Eyes Managed Medicaid Program with Skepticism

In 2016 Texas County Memorial Hospital will likely not be required to participate in the managed Medicaid program being implemented in Missouri, hospital board members heard at their monthly meeting on Tuesday.

Wes Murray, TCMH chief executive offer, reported that the managed Medicaid program authorized by state legislators in parts of Missouri is not going as well as expected, creating delays for the program’s implementation across the state.

“State legislators have said they won’t expand state Medicaid services under the Affordable Care Act until Medicaid is ‘fixed’,” Wes Murray, TCMH chief executive officer, said, explaining that state legislators determined that a managed Medicaid program would be part of a fix.

Currently, Centene Corporation in Clayton, MO is running the managed Medicaid program. Medicaid recipients are assigned to a certain healthcare facility, and that facility is paid a certain amount per member, per month.

“This managed Medicaid program pays 80 to 90 percent of the current Medicaid reimbursement rates,” Murray said.

Murray explained that Medicaid reimbursement is “pennies on the dollar”. Centene is now taking a portion of those funds, too, as the management firm for the Medicaid patients in the program.

Currently, the managed Medicaid program has been rolled out across central Missouri and is not in place in Southern Missouri. At a recent meeting of Missouri hospital CEOs, Murray learned that rural hospitals that are part of the new managed Medicaid program are not pleased with the program.

“Some healthcare facilities and physicians haven’t been able to get a contract in place with the managed Medicaid program,” Murray said. He added, “The quality data with these managed Medicaid patients is terrible, and the readmission rates are high.”

Murray noted that the cost to the state of Missouri to make the program work properly has been estimated at $100 million.

Ron Prenger, vice president and chief clinical officer at CoxHealth in Springfield, MO, said that officials at CoxHealth have also been looking intently at the managed Medicaid program.

“This takes dollars away from patient care and gives them to someone else,” Prenger said, calling it a practice that CoxHealth does not like.

“The state legislature is clouded on this program,” Prenger added. “They seem to think it’s the answer.”

Murray explained that TCMH, the Missouri Hospital Association and many healthcare facilities across the state have “serious concerns” about the managed Medicaid program.

“We will continue to monitor this, but it doesn’t look like it will be put into place in Texas County as early as planned,” Murray said. He also indicated that none of the hospital state legislators have reached out to him regarding the program and its potential effects—positive or negative–on the county hospital.

Amanda Turpin, quality assurance manager at TCMH, presented a 44-page quality assurance and process improvement report to board members.

“This is our quarterly report detailing specific quality assurance and process improvement data being collected by the various hospital departments,” Turpin said.

The full report will be included quarterly in packets of information provided to board members before monthly board meetings.

“We collect the data monthly and compile it quarterly,” Turpin said. She told board members that she will point out any specific data interest points when the report is provided to them.

Turpin will also oversee the hospital’s participation in the national Hospital Engagement Network (HEN) 2.0 project which began in October and will go through next September.

“We are participating in the HEN 2.0 project with the Missouri Hospital Association on a state level and with the American Hospital Association on a national level,” Turpin said.

The HEN project is funded by the Centers for Medicare and Medicaid Services with the purpose of identifying best practices to reduce hospital-acquired conditions. By participating in the project, TCMH will have access to education and resources to improve patient safety and quality of care.

Through the Missouri Hospital Association portion of HEN 2.0, TCMH will participate in two “immersion projects”.

“These immersion projects will provide a framework to support us in implementing recommended, evidence-based practices for the early recognition and treatment of sepsis and for reducing catheter-associated urinary tract infections,” Turpin said.

Murray reported the TCMH has approximately eight million dollars in the employee retirement account.

“Our employee investment committee recently met to consider some other plan opportunities available, but they have decided to stay with our current plan,” Murray said.

Murray explained that the current plan has a guaranteed three percent interest in the money market portion of the plan.

“Thirty percent of the funds in our overall retirement account are in the money market account, and we haven’t found another plan that can offer that type of return for a money market account,” Murray said.

Linda Pamperien, chief financial officer at TCMH, reported that inpatient and outpatient revenues and expenses were down for the month of September. Swing bed utilization was up with 17 admissions for the month.

TCMH had a negative bottom line in September of $169,145.65 and a negative year-to-date balance of $1,488,265.77.

Pamperien presented data showing general operating and funded depreciation amounts for September 2014 and September 2015. This year TCMH has $580,504.00 more in general operating funds and $12,590.00 more in funded depreciation than at this time last year.

Depreciation expense in 2014 was $1,671,738.00, and $1,667,865.00 this year.

“Our cash flow is still strong, and we actually have more money in the bank right now than we had a year ago,” Pamperien said.

Present at the meeting were Murray; Pamperien; Turpin; Prenger; Joleen Senter Durham, director of public relations; Dr. Jonathan Beers, chief of staff, and board members, Dr. Jim Perry, OD; Omanez Fockler, and Janet Wiseman.

Board members Russell Gaither and Mark Hampton were not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., Nov. 24th at 12 p.m. in the hospital board room.