Doctors: Medicaid managed care 'not working'

ATLANTA - A rocky transition converting much of Georgia's Medicaid program to managed care is hurting patients by delaying payments to doctors, specialists who serve primarily women and children complained Thursday.

But state health officials downplayed the technical glitches that have plagued the program since its inception in June and said they're more concerned with signing up enough doctors to guarantee adequate patient access to care.

The Medicaid managed care initiative began serving about 600,000 low-income adults and children in metro Atlanta and middle Georgia on June 1.

The state Department of Community Health plans to roll out the program for about the same number of patients in the rest of the state on Sept. 1.

The concept of the initiative is to improve health care quality by steering Medicaid enrollees accustomed to relying on overcrowded hospital emergency rooms to primary care doctors.

Bringing the efficiencies of managed care to the Medicaid population is also aimed at saving tax dollars. This year's state budget projects that the program will save the DCH $80 million.

But on Thursday, a pediatrician, an obstetrician and representatives of several statewide associations of therapists used words including "disaster'' and "crisis'' to describe the transition from traditional fee-for-service to managed care.

Dr. Eric Moore, an obstetrician from Atlanta, said the state has paid out only $47 million of about $200 million in claims that doctors have submitted for their Medicaid patients in the two regions since the program began.

"Most of my colleagues either have not been paid in 10 weeks or have been paid very little,'' he said. "Doctors are going bankrupt and closing their offices ... There's patients who have suffered.''

Dr. Dan Eysie, who owns pediatric practices in Rockdale and Fulton counties, said the managed care company he signed up with informed him in late May that his credentials hadn't been approved. As a result, he said, his patients were assigned to another company without his permission.

"You keep advertising that this worked,'' he told members of the state Board of Community Health. "I'm telling you it is not.''

Kathy Driggers, chief of managed care and quality for the DCH, conceded that payment delays are occurring and that the managed care companies the state has hired for the program need to do a better job educating providers on how to submit claims.

"It's been a bumpy start,'' added David McNichols, chairman and CEO of Peach State Health Plan, one of the companies selected to run the program. "We still have work to do.''

McNichols said Peach State Health is working to clear up a backlog of claims and expects to catch up by next week.

Craig Bass, CEO of Amerigroup Community Care of Georgia, another managed care company brought in for the initiative, said he has added staff to speed up processing of prior authorization forms for therapy appointments and is temporarily relaxing credentialing requirements to get more doctors enrolled in his network.

DCH Commissioner Rhonda Medows said she's confident the delays in payments and credentials will be resolved soon.

She said a bigger issue as the program unfolds is making sure each part of the state has enough doctors enrolled with one or more of the managed care companies to assure patients reasonable access to health care.

"At the end of the day, it's not about payments but indigent medical care,'' said Dr. Robert Lipson, a member of the board.

"What we're really trying to do is provide the right care at the right time and right place to the right people.''