Point of View

NC Senate budget mangles a hard-won plan to reform Medicaid

June 4, 2014 

The North Carolina Medical Society’s immediate response to the recent Senate budget proposal was concern for the harm it would cause our state’s aged, blind and disabled residents who would no longer be eligible for Medicaid benefits. The Senate’s budget proposal offers no real solution to the big challenges we’re facing in Medicaid. In fact, it makes Medicaid worse, not better.

As the Senate rushed to pass its budget, our physician and physician assistant members, like our colleagues throughout the health care community, were increasingly frustrated by the seeming disregard of our fruitful work to begin reforming Medicaid over the past year. The Senate proposal fails to act on the solutions that have resulted from that effort.

Reforming this massive state/federal program certainly is a huge challenge. The problems with Medicaid have been years in the making, and changes required by the federal Affordable Care Act have complicated matters even more. Meaningful, positive and lasting Medicaid reform will occur only over time and with the input and engagement of all stakeholders.

Over the past few months, we’ve had some reason for optimism as a result of ongoing dialogue among the health care community, the N.C. Department of Health and Human Services, Secretary Aldona Wos, M.D., and legislators. That effort included the bipartisan work of Gov. Pat McCrory’s Medicaid Reform Advisory Group and produced a strong consensus for how best to reform Medicaid.

The goals of Medicaid reform have always been clear: Make the program financially sustainable and predictable, hold doctors accountable for both the quality of care and cost efficiency, and focus on the health care of the whole person, as opposed to segmented care.

The consensus was that the system should move from the current payment model, in which doctors and hospitals are paid for the volume of tests or procedures they perform, to one in which they are paid for the value they provide – that is, the best possible care at the lowest possible price.

It may seem counterintuitive that doctors would give up the “pay for volume” or fee-for-service approach for a system in which they would be held accountable and rewarded for the quality of the care they provide and the positive outcomes they achieve. Doctors truly care for and about their patients. As a profession, we are motivated by making and keeping people well. We support a system that rewards that purpose.

The advisory group, the governor and DHHS, as well as many members of the N.C. House – Republicans and Democrats alike – support this new approach, and for good reasons.

For one, value-based medicine already exists throughout our state and is showing early signs of success, with better patient outcomes, more satisfied doctors and lower costs. The preliminary infrastructure for a statewide Medicaid program based on these principles is already in place through the nonprofit Community Care of North Carolina.

We look forward to advancing Medicaid reform, which the Senate proposal would impede. McCrory’s value-based proposal is truly innovative. The Senate’s proposal, on the other hand, includes nothing new or ground-breaking. Not only does it shrink Medicaid eligibility for those North Carolina residents most in need, it also eliminates cost-saving CCNC, forbids the DHHS to pursue a value-based health care model and aims to tax doctors while reducing what they would be paid for treating Medicaid patients. By discouraging doctors from treating Medicaid patients, such a short-sighted policy would reduce health care access for those who remain on the Medicaid rolls.

As an organization of over 12,000 physicians and physician assistants in North Carolina, we are committed to the state’s Medicaid reform goals. The experience of our members tells us that reverting to outside, corporate managed care as a way to make costs predictable would turn back the clock at a time when an innovative approach, not a tired old one, is what North Carolina needs.

We urge the House, the Senate and McCrory to build on the strong consensus in favor of true, fundamental Medicaid reform in North Carolina. We are eager to engage in meaningful conversation about this most important issue so that we all arrive at the best solution.

Robert W. Seligson is CEO of the North Carolina Medical Society.

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