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Georgia may need to look to Tennessee for healthcare options

The health care of Georgians is being seriously compromised by shortsighted policies being proposed by the Department of Communities Health. The department plans on handing the Medicaid program over to a so-called "care management organizations" which are really just repackaged, renamed HMOs. To examine how successful managed care organizations are at providing low quality care at a higher rate than the current system, Georgia need only look to the State of Tennessee which has had a 10-year managed care debacle in TennCare.

If Medicaid implements a managed care plan, the entire health care infrastructure would suffer. The Georgia Medicaid program covers more than 1 million Georgians. If health care providers such as physicians, pharmacists, and hospitals, who are currently providing care and services for this fragile population, are excluded from participating in plans offered by managed care organizations, these Georgia-based health care professionals will have to move to other states or shift the costs to other patients. Losing health care providers in a state where access to health care services is already a problem seems shortsighted and ill-advised. However, the Department of Community Health continues to embrace the idea of turning Georgia into the nightmare of TennCare.

Georgia has some first-hand experience with managed care plans and the Medicaid program. On two separate occasions, managed care companies have failed badly. In addition to not saving the state any tax dollars, patient care suffered. Proponents argue that on previous occasions, managed care plans were voluntary and were not actuarially sound from a financial standpoint. Nothing has changed. In other words, DCH officials plan on forcing Medicaid and PeachCare patients into HMOs, and paying those HMOs more money than the department would have paid traditional fee-for-service providers, had they not forced patients into HMOs.

A recent federal study published in the Sept. 17, 2004 issue of The New York Times reveals managed care plans cost more and produce no savings. The study indicates that the Medicare Payment Advisory Commission, an independent federal panel, says in a report to Congress, that Medicare is paying private plans up to 123 percent of what it would cost to cover their patients under the traditional fee-for service program.

DCH officials are apparently willing to destroy the state's fragile health care infrastructure all in the name of "budget predictability." In the case of TennCare budget predictability did not occur, and in fact TennCare continues to cost the state of Tennessee more every year. It is clear that the Georgia is not going to save any money by implementing a managed care plan, which does nothing to correct the budget issues the state is currently facing. However, health care providers may be specifically excluded from participating under the managed care proposal which has the backing of Governor Perdue.

Georgia providers will be left out in the cold if this proposal is implemented. Georgia's Medicaid program encourages local community providers to participate in the Medicaid program. However, without specific requirements forcing CMOs or HMOs to allow local community providers to participate under the managed care plan, Georgia's medical communities could be forced out of the program or have their reimbursement levels slashed so that the state can ensure that CMO's or HMOs can turn a profit. It happened the last time Georgia turned the Medicaid program over to HMOs and it will happen again unless DCH officials require HMOs to allow any willing provider to participate in the plan. And, when TennCare was implemented in the rural communities of Tennessee, scores of community pharmacies in that state were forced to close their doors in the first two years of TennCare.

If the Medicaid managed care proposal is implemented, the non-Medicaid population is in danger of being underserved. Pharmacies, physicians and hospitals could close to their doors not just to Medicaid patients, but to all Georgians. When health care providers are locked out of programs or are otherwise forced to participate in a program at seriously reduced rates, the general public is likely to feel the effects by serious cost shifting, an increase in overall health care costs, or lack of availability of health care services. For most rural counties, such a result could be devastating to economic development as well as the health of Georgia patients.

While DCH officials and Governor Perdue might see the CMOs as a quick fix to the predictability issue, they are leaving many questions unanswered. What we can say for certain is that "Those who can not remember the past are condemned to repeat it." We only need to look back a few years to see that the decision to shift Medicaid patients into managed care will be detrimental to the health care infrastructure of Georgia, and we need only to look to other states' decisions in their recent shifts away from managed care to understand what will happen to all Georgians if this proposal is not reconsidered.



Web posted on Thursday, December 30, 2004











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