Doctors rally against Medicaid managed care

ATLANTA - Doctors are laying off staff and some may be forced to close because of payment delays brought on by Georgia Medicaid's switch to managed care, several physicians warned Wednesday during a rally outside the Capitol.

A series of speakers called on Gov. Sonny Perdue to halt the 21⁄2-month-old initiative in its tracks until technical problems filing, processing and paying claims can be worked out.

"Some doctors in Georgia haven't been paid in three months,'' Dr. Eric Brown, an OB-GYN from Atlanta, told about 125 people sweltering in the mid-day sun, many wearing lime green T-shirts bearing the name of a coalition newly formed to focus on the issue.

"We have a looming health care crisis in Georgia. It's bad now, but it's going to get worse.''

The state Department of Community Health rolled out the program on June 1 in metro Atlanta and Middle Georgia and plans to expand it to the rest of the state at the beginning of next month.

Three "care management organizations'' - similar to HMOs - were brought in to provide health coverage to about 600,000 low-income adults and children.

For $3 billion, those CMOs are supposed to improve the quality of health care for Medicaid enrollees by steering them toward permanent primary care doctors while saving money by keeping them from seeking routine care in costly emergency rooms.

Shane Hix, a spokesman for Perdue, said the initiative is living up to its promise.

"The implementation is going very well and will not be delayed or reversed,'' Hix said.

Wednesday's rally came one day after a dozen doctors and medical offices filed a lawsuit against the three CMOs - WellCare of Georgia, Amerigroup and Peach State Health Plan.

The suit seeks class action status for doctors and other providers affected by delayed payments, so its reach could go far beyond the original plaintiffs.

"We are here for the concerns of our patients,'' Dr. Marion Reynolds, another Atlanta OB-GYN, said during the rally. "We have to be the voices of children, pregnant women, the elderly and the disabled.''

In an e-mail, DCH spokeswoman Julie Kerlin wrote that payments to doctors and other health care providers were delayed by three to four weeks during the program's second month because of problems in both claims submissions by providers and claims processing by the CMOs.

However, she wrote that some doctors were advanced interim payments.

Between June 1 and Aug. 4, the CMOs disposed of 88.7 percent of the claims submitted to the companies either by paying or denying them, according to figures released by the DCH. Of the claims paid, 97 percent were handled within 15 business days.

"WellCare was surprised and disappointed at the allegations in the physicians' lawsuit, since they are not supported by the data,'' WellCare spokeswoman Carol Cassara said in a prepared statement. "We have consistently met or exceeded the payment standards required by our contract.''

Dr. Rhonda Medows, the state's commissioner of community health, met with Brown and Reynolds last week to discuss their complaints.

In a followup letter dated Monday, Medows listed the steps the agency is taking to address their concerns but also asked them for proof to support specific allegations of wrongdoing on the part of the CMOs.