[NYAPRS Enews] DN: NY Medicaid Director Favors Managed MH, Home Care

[Harvey Rosenthal]

Taking Our Medicaid Medicine: Attacking N.Y.'S Massive Spending Problem
Will Take Courage In Albany

By Bill Hammond New York Daily News  January 25th 2011

 

The good news for Gov. Cuomo is that experts have come to consensus on
why New York <http://www.nydailynews.com/topics/New+York> 'sMedicaid
<http://www.nydailynews.com/topics/Medicaid>  program is so
off-the-charts expensive.

The bad news is that the major cost driver is long-term care for the
elderly and disabled - which, to date, Albany
<http://www.nydailynews.com/topics/Albany>  has treated as a political
third rail.

And no wonder. We're talking about services aimed at some of the
neediest, most vulnerable citizens of the state - frail grandmothers,
mentally ill uncles, developmentally disabled daughters, sons with HIV
and AIDS.

No elected official in his right mind wants to be accused of denying
necessary care to any of these populations.

But the undeniable numbers - as laid out in a flurry of recent reports -
leave no other choice but to find big savings, and soon. Otherwise,
Medicaid will bankrupt the state.

As most know by now, New York's Medicaid budget - at $50 billion a year
and growing - is by far the costliest in the nation, outstripping even
that of California <http://www.nydailynews.com/topics/California> , with
almost twice the population. The state's program is expensive no matter
how you slice it - offering more services to more people at higher
payment rates than all the national averages.

But where it really enters the stratosphere is long-term care.

Our spending per patient is a modest 10% higher than the national norm
for children on Medicaid and 53% higher for able-bodied adults. But it's
a whopping 77% above the per-patient norm for the elderly, and an
incredible 95% higher for the blind and disabled.

Which is why long-term care accounts for 24% of the patients but 72% of
the spending - or more than $35 billion a year.

Those outlays have been soaring at unsustainable rates for years - and
the first wave of baby boomers is just now hitting 65.

So the urgent need to bring this spending under control is clear.
Whether Albany lawmakers have the stomach for the job is another matter.

When forced to trim Medicaid in the past, legislators have generally
taken the path of least resistance. A favorite tactic is cracking down
on waste, fraud and abuse - because who could be against that? They also
love squeezing discounts from drug companies. They generally settle on
across-the-board cuts to hospitals, nursing homes and other providers -
a clumsy solution that hurts the lean operators just as much as the
bloated ones.

Those tried-and-true steps might well be necessary in the face of a $10
billion deficit. But they won't come close to curing the patient.

What lawmakers also have to do this time is seriously tackle the
fastest-growing areas of spending: specifically, personal care and home
care for the elderly and disabled.

Controlling spending on long-term care "is totally the hardest stuff,"
says Elizabeth Lynam <http://www.nydailynews.com/topics/Elizabeth+Lynam>
of the Citizens Budget Commission
<http://www.nydailynews.com/topics/Citizens+Budget+Commission> . "Yet
that's where the money is."

The original idea of these programs was to give old folks the
housekeeping and medical help they needed to stay out of nursing homes.
It was supposed to improve their lives and save money.

But officials in charge of the programs - especially in New York City
<http://www.nydailynews.com/topics/New+York+City>  - have been so
generous in awarding services that the money-saving goal went out the
window.

According to a recent federal lawsuit, some patients are getting
services at the rate of $150,000 a year - double what a nursing home
would cost.

Adding insult to injury, all those tax dollars are buying care that's
scattershot and piecemeal.

As Cuomo's Medicaid czar, Jason Helgerson
<http://www.nydailynews.com/topics/Jason+Helgerson> , points out, New
York ranks second to worst for hospitalizations that should have been
avoided. Too many people with treatable asthma are winding up in
emergency rooms. And too many patients are checking out of hospitals
with inadequate support - causing them to relapse and check back in a
few weeks later.

A smart solution would be to apply managed-care principles to long-term
care, paying companies a fixed amount to keep elderly and disabled
patients healthy - so providers have an incentive to do the best job at
the least cost.

In the past, lawmakers have balked at such steps under pressure from the
industry players who stand to lose money.

But now, as Helgerson rightly says: "The budget situation is so dire,
the fiscal crisis is so immediate, that we have no choice but to address
things that in the past were left alone."

 
http://www.nydailynews.com/opinions/2011/01/25/2011-01-25_taking_our_med
icaid_medicine_attacking_nys_massive_spending_problem_will_take_co.html

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20110125/d0616b9b/attachment.html>