by Andrew Walden
In a panel discussion May 10, led by Hawaii Department of Human Services Med-Quest Administrator, Dr. Kenneth S. Fink and DHS Director Patricia McManaman, panelists were asked again and again about the Abercrombie administration’s proposed new requirement for annual “Administrative Renewal” of Medicare and Medicaid patients.
Currently renewal is “passive.” Every year, Medicare and Medicaid patients are mailed a form at their last known address. If there are no changes, no action is required. Those who do not respond to the mailer are kept on the rolls year after year.
The questions came repeatedly from community clinics and focused on the details of whether the clinics themselves would be allowed to carry out the renewals, or whether patients would have to handle renewal independently.
The reason for the intense interest in this seemingly petty issue did not emerge until nearly the end of the 90 minute discussion. Asked one time too many, an exasperated Dr. Fink finally spilled the beans:
“To my knowledge we are the only state in the the country that has passive renewal as its shaped in which we don’t require anything from our patients. So we don’t know if someone has moved out of state or died—or carefully reviewed their information and made a conscious decision that nothing has changed and chosen to not return the form. By not receiving any documentation--this is actually an error under another federal program…. So we are working to become complaint with the … program and insure the integrity.
“Where we are required to do sampling and have found that of those in our sample who can be identified, roughly 7% to 10% of them are not eligible. In an additional large number of cases, we are unable to receive information to make a determination. So it could be much greater.”
According to Dr. Fink, Hawaii has 271,000 Medicare and Medicaid beneficiaries. Ten percent is 27,100 ineligible. Dr. Fink did not estimate a percentage for “an additional large number of cases.” Could the total of fakes and ineligibles exceed 100,000? That would require only 27% of the sample be ghost names on top of the 10% ineligible.
DHS Director Patricia McManaman seconded the point:
“…We have a choice. Do we continue to fund people who have moved out of state or are no longer eligible because they’re receiving healthcare insurance for their children now through their employer. People whose income is far above the 300% of federal poverty guideline. Do we continue to fund those families who no longer need MedQuest services at the expense of individuals who do need it? ….”
Many doctors statewide refuse to take on Medicaid Patients. One of them, Dr. Linda Rasmussen, an orthopedic surgeon from Kailua, spoke up at the forum:
“Is there any effort to speed up or at least timely reimburse the providers because we have a small orthopedic group and get a lot of patients from one mental health center and from other places and the problem is the reimbursement is slow but then the number of staff I have to hire to fight for that reimbursement and the delays in payment make one want to pull out their hair. I mean its almost easier to take care of them for free and be rid of all that. So is there any effort in that area?”
Rasmussen was immediately followed by another Oahu MD, Dr. Kemble:
“As far as I can see a large part of the problem with access to care, particularly outpatient care in the private sector is as a result of inappropriate application of managed care policies by the Medicare and Medicaid managed care Plans. Which has had the effect of imposing very burdensome, senseless and unreasonable policies on providers, has driven them out of taking Medicaid patients. Even if they sign a participating agreement, they won’t take any new patients because they’ve had so much trouble with managed care problems. Until you do something about that you will not solve the access to care problem. You will not be able to reduce ER visits and you won’t be able to implement medical homes, coordination of care and medical record incentives because you won’t have the provider participation that makes all those things possible. You have to do something about the managed care problem.”
These types of concerns were expressed by several private-practice MDs—but not a single clinic worker or doctor asked about slow reimbursements or low reimbursements. Instead they all focused intently on wheedling permission to fill out the “Administrative Renewal” forms on behalf of their patients.
It is not difficult to see what is going on here. A substantial portion of Hawaii’s 271,000 Medicaid and Medicare patients are ghost beneficiaries, on the list solely to help clinics pad their books. This explains how the clinics seek out patients that other doctors shun.
But now the rules are changing and the devil is in the details. If clinics are allowed to fill out the annual renewal forms on behalf of these ghost patients, they will continue to rake in the bucks. If they aren’t, and the patient is required to do it on their own, the clinics will suddenly see a “large number of cases” simply vanish into thin air because they do not exist.
In a speech to the May 10 DHS forum, Governor Abercrombie announced his desire to control decisions to “extend life.” Instead of taking orders from Governor Kevorkian, lets stop “extending life” for the ghost patients.