On Monday morning, Kansas Department of Health and Environment director of Health Care Finance, Kari Bruffett, addressed a packed legislative oversight meeting about issues with Kansas' new privatized Medicaid program, KanCare. Her department oversees the work of the three managed care companies that started administering the program that was rolled out this year.
She said that most of the glitches that came at the start of KanCare have been fixed, and the new system is now working nearly as well as the old Medicaid system.
As of November, says Bruffett, the three companies are paying completed claims on time 98 percent of the time.
But many doctors and hospitals around the state say they are having a different experience with KanCare.
At Southwest Boulevard Family Health Care clinic in Kansas City, Kan., the rosy picture of KanCare presented by the state doesn’t match what Dr. Sharon Lee has been seeing. She says the three managed care companies have done little to improve their service.
“The people from the various KanCare organizations have come out to do some public relations work,” says Lee.
Southwest Boulevard is a safety net clinic that serves mostly the uninsured and Medicaid and Medicare recipients. Lee says that at the clinic, payment for Medicaid services is running about a week or two late.
“So you don’t get the payment. It means you don’t have the money in the bank. It means you can’t use it to pay your staff or to do the other things you do with that income,” she says.
Many Kansas doctors, hospitals and nursing homes continue to report payment delays and other KanCare complications despite the state's data showing major improvements. In September, one hospital in northern Kansas said it had not had a single claim processed correctly by one of the three companies.
Tish Hollingsworth with the Kansas Hospital Association says that payment delays and all the new paperwork of three different companies has been raising the cost of doing business for many Kansas medical providers.
“Some of our hospitals have indicated that they’ve had to add extra staff in order in deal with the sheer volume,” says Hollingsworth.
Potential Impact on Medicaid
A payment delay of a week or a few weeks might not mean much some providers. But these delays can be hard for doctors and hospitals that work with a lot of Medicaid patients.
Lee says that Kansas Medicaid pays her about 40 percent of what private insurance pays for the same treatment. That often doesn’t even cover her costs for treating payments.
Jerry Slaughter of the Kansas Medical Society says that the added problems of payment delays could have an impact on state health care.
“What it could lead to is doctors perhaps taking fewer Medicaid patients,” he says.
While payment delays are mainly just a problem for health providers, other delays are trickling down to patients. The state says prior authorizations are taking about one to three days, but some providers have reported more significant delays for approvals on treatments and prescription drugs.
“It’s been a real problem for certain patients,” says Slaughter.
For HIV patients, for example, missing a few days of a medication due to a prior authorization delay can be a big deal. Lee says these delays have also become a drain on clinic resources.
“I’m not joking when I say this: you can spend an hour and a half on one prior authorization,” says Lee.
Anecdotes Vs. Data
At Monday's meeting, Democratic Rep. Jim Ward joined a handful of groups voicing their concerns about the delays. He talked about problems he had heard about from big hospitals in his Wichita district. During a question and answer session, Ward asked the Health and Environment director Kari Bruffett about where those stories fit into her optimistic assessment of KanCare.
Bruffet acknowledged that some providers had legitimate issues.
“We know this is not the experience for every provider. And we know this is not the experience for every provider type,” she said.
While her numbers argued against the idea that KanCare delays were a big problem, Bruffet admitted that some improvements were still needed. She said the managed care companies would continue to get better due to a payment incentive system built into KanCare.
At the end of the year, the state will withhold 3 percent of the managed care companies’ money if they don’t meet certain performance goals, including on-time payment.
“We know that the Hospital Association and KDHE and managed care organizations continue to work on systems issues that will improve the timeliness of payment," said Bruffet.
The Kansas Hospital Association and Medical Society says the state and the managed care companies have generally been responsive to concerns. The hospital and doctors’ groups are pushing to decrease delays and for the three managed care companies to create a standardized claims process.
The Hospital Association’s Tish Hollingsworth believes problems are solvable by the managed care companies.
“I think they are just as overwhelmed with the transition as maybe what we have been, and maybe what the state has been. This was a huge endeavor to try to do to in a short period of time, and so, as a result of that, I think, we’re seeing a lot of these implementation issues,” said Hollingsworth.
While observers agree that parts of KanCare got off to a rocky start, the managed care companies have an incentive to make to the system work. They’ve got about a month to fix the remaining payment problems or risk losing out on part of the state payments.