Op-Ed

Managed-care firms strangle Ky. Medicaid

More than half of all Medicaid beneficiaries nationally receive most or all of their care from managed-care organizations that contract with state Medicaid programs to deliver comprehensive services. Kentucky leads the way, providing some of highest profits to MCOs.

This is suffocating the health-care system.

Kentucky HEALTH, the state’s Medicaid reform, clearly decreases access to health-care services to Medicaid beneficiaries. This would have included new requirements for co-pays and work. Currently blocked by federal courts, the plan not only shifts more costs upon the population health-care providers serve, but also ensures greater profit to MCOs.

This could result in dangerous and potentially catastrophic results for our patients. Timeliness in accessing health care would be compromised if patients have not met the work requirements. Further, most Medicaid beneficiaries have limited money to meet co-pay requirements for medication and seeing health-care providers for services.

Stressors to the health-care system and on health-care providers can be avoided. An example is the legislature’s passage of House Bill 69, which addresses service delivery in managed-care networks by requiring a single credentialing authority for all MCOs.

Another significant stress experienced by health-care providers is the failure of payment for covered services rendered in a timely manner. Potentially a single clearinghouse will alleviate this stress.

One result of stressors on health-care providers is suicide. It was reported in May, nationwide suicide rates among physicians is 28 to 40 per 100,000 — more than twice that of the general population.

Suicide is the overall 11th leading cause of death in Kentucky — the second leading cause of death for ages 15-34 years and the fourth leading cause of death for ages 35-54 years. Kentucky’s suicide rate per 100,000 population is 16.79, compared nationally to 13.42.

MCOs have the ability in Kentucky to alleviate stressors on the system by taking a firm stance on profit margins to allocate more funds to the treatment of Kentuckians.

Greed kills. Greed makes Kentuckians sick. Greed asphyxiates health-care providers’ ability to provide care to Kentuckians. It is time managed-care companies give health-care providers the ability to breathe.

Dr. Larry Suess of Hanson is a board certified child psychiatrist.

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