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Pop singer Prince had a hit song more than 20 years ago that said we should all “party like it’s 1999.” Unfortunately, the managed care organizations running the Kentucky Medicaid system are following the song’s advice and operating in the managed care world of 1999.
Remember those times? Managed care companies repeatedly denied medically necessary tests, medications and procedures. As any physician or hospital operating in that time will tell you, the HMOs’ own inefficiencies made big profits for the companies. “We never got the claim” or “we never got the information you sent” was heard constantly.
All that changed when actress Helen Hunt’s character in the movie “As Good As It Gets” used an expletive about HMOs when frustrated with her child’s medical condition. Audience members across the country reportedly cheered when she said it.
That lament, along with horror stories from patients, spurred politicians — including the Kentucky legislature — to pass laws forcing managed care companies to be more efficient and fair in their dealings with patients and physicians. All of this happened nearly a dozen years ago.
But the companies operating Kentucky’s Medicaid system are operating like it’s 1999. The rules imposed on other managed care companies don’t seem to apply. To save money, they continually deny medically necessary procedures, medications and the like. They force patients to obtain “prior authorization” for most procedures, tests and medications, and they are supposed to reply to such requests within two days.
A recent KMA survey of medical practices found that in a majority of cases, one company takes as long as two weeks to respond. In an era of speedy electronic communications, the Medicaid companies struggle with sending electronic receipts, forcing information to be sent through the mail.
These inefficiencies abound and have been discussed by others in the pages of this paper. But it has been nearly a year-and-a-half and these inefficiencies remain the norm. In contrast to all of this, Kentucky changed its Medicare contractor last year with hardly a problem mentioned by patients or physicians.
The state’s response to these problems has thus far been to give some of the managed care companies more money, reverting to the 1999 practice of financially rewarding inefficiency. But sending our tax money out-of-state hasn’t seemed to help.
Kentucky Medicaid operates like it’s 1999 to the detriment of Kentuckians everywhere. Maybe Hollywood will make a movie about it and decry this sad state of affairs so something will be done to fix it.
Otherwise, 400,000 Kentuckians soon will have a part in Medicaid’s version of “As Good As It Gets.”
William Harrison, M.D., is president of the Kentucky Medical Association and can be reached through the association’s office at 4965 U.S. 42, Suite 2000, Louisville 40222.