Study warns data missing in Fla. Medicaid pilot

By Kelli Kennedy
Associated Press Writer

MIAMI -- "Much critical information is lacking" about Florida's Medicaid privatization experiment, including whether it has saved money or if patient care has suffered, according to a Georgetown University study released Tuesday.

The study comes as Florida lawmakers are poised to expand the controversial Medicaid privatization program statewide. The Republican led House approved a bill to do so last week, despite opposition from Democrats who voiced concern at the lack of data gauging a five-county pilot program. Proponents warn Medicaid must be overhauled or it will consume the state budget and estimate managed care will save about $1 billion a year, but those savings would not be immediate.

Besides, how will giant tax refunds be available for the wealthiest 1% and corporations if we don't stop "bleeding" cash to Medicaid patients who are just going to die anyway and probably don't vote anyway?

"There was no encounter data, at least none publicly available, and that had been promised and really no up-to-date data on cost savings," said Joan Alker, who co-wrote the report.

Encounter data measures what services and medications patients are receiving and which ones are being denied--accountability that health advocates say is critical to ensure for-profit HMOs aren't lining their pockets at patients' expense.

Little data has emerged since the pilot program began in 2006 in Broward and four counties in the Jacksonville area. A 2009 University of Florida study revealed a small decrease in expenditures, but it was unclear if that was because patients got less care or because it was delivered more efficiently. The study did not account for increased administrative costs.

About 275,000 people were enrolled in the pilot program in 2011. The largest group of beneficiaries is children.

Children? Good news, Republicans. Those little scallywags won't fight back!

Rep. Elaine Schwartz, a Democrat opposing the expansion, has repeatedly asked lawmakers, state health officials and health care plans for the data to no avail.

"If there was good encounter data why not give it to the press. Why not shout it from the rooftops," Schwartz said. "I've had appointments with people who said they would bring it to me, but still no encounter data."

The Agency for Health Care Administration, which oversees the program, did not immediately comment about the data on Tuesday.

Doctors have dropped out of the pilot program, complaining of red tape and that HMOs deny the tests and medicine they prescribe. Patients say they can't get appointments with specialists and have lapses in care because they are being switched among plans.

Oh, the old "now you see it, now you don't" routine. Luckily, Medicaid patients are patient!

Several providers also bailed saying they couldn't make enough money. Wellcare, Amerigroup, United Healthcare, Vista and Buena Vista all withdrew from Broward County.

Each time a plan pulls out, patients are enrolled into another plan that may not cover the same doctors and medications.

Oh, my bleeding gums!

Georgetown's research showed many patients are trying to avoid the disruptions with HMOS by enrolling in a Provider Service Network, a group of hospitals or doctors, instead of staying with HMOs.

About 45 percent were enrolled in PSNs in 2011, up from 28 percent in 2008.

Lawmakers have stressed privatization doesn't just include HMOs, saying PSNs could also win contracts. Lawmakers propose dividing the state into regions and allowing providers to bid for contracts to deliver services within that region.

But advocates for those doctor's networks say they would have trouble competing initially because their expertise centers more on patient care than administration.

Medicaid costs about $20 billion to serve nearly 3 million people and is forecast to grow to $28 billion by 2014-15. Georgetown advisers say those costs are inflated because it assumes everyone that is eligible for the program will enroll, which is unlikely.

Hmmm. Maybe some of these patients could get on line at the next "free clinic" Ed Schultz has been televising. They were for poor people in poor countries. Wait! We fit that qualification.