The gray-suited factotums and Grand Vizier’s over at the DHHS headquarters on the old Dorothea Dix Campus have come up with a new mantra: ‘We’re going to give patients what they need, not what they want.’  

That sounds reasonable until you get past the ‘spin.’

Let’s say for simplicity’s sake there are two kinds of people who work in health care: The nurses and doctors and nurses aides who sit by beds and care for patients, and the administrators who sit in offices and manage health care programs for DHHS.

CCME is an example. CCME is a private company. DHHS pays it to manage North Carolina’s Home Care program. There are a lot of other private companies – like CCME – who manage health care programs for the state and when it comes to getting state contracts they’re wired into the Department of Health and Human Services like the military-industrial complex is wired into the Pentagon.

CCME’s main work is reviewing providers’ record keeping, interviewing patients  then reporting back to DHHS.

CCME just renegotiated its contract with DHHS and received a 29% pay increase for its patient interviews.

At the same time DHHS just cut what it pays the people who provide home care to elderly patients 4.9% .Meaning the brunt of the cuts will be borne by home care aides who work by the patient’s bedside – instead of managers who don’t provide care to anyone.

If a CCME manager interviews just two patients in a day – and they will interview thousands of patients – those two interviews at $450 a piece will cost the state more in one day than what it costs the state to cover an entire month of services for the average patient.Now why is CCME’s fee going up from $350 to $450 for each patient ‘interview’ – while the folks providing care are being cut?

Well, DHHS Secretary Lanier Cansler’s former lobbying partner is a consultant with CCME. Maybe that’s just an accident. Or coincidence. But, either way, it doesn’t look good. And it certainly looks like an example of a health care management company snuggling up to the folks in DHHS who grant the contracts.

Whatever the reason, money’s tight at DHHS and when they spend more on managers – like CCME – it means spending less for care. So, CCME’s new contract cuts the ground out from under DHHS’s new mantra.

It’s not giving patients the care they need instead of what they want. 

Instead, what it’s really saying is, We’re going to give patients the care we want them to have – and if it’s not what they need they’ll just
have to adjust

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I thought politics worked like this: We elect people, they pass laws, things happen.

 

I learned back when Reagan was President a lot less might happen than hoped for – because the entire American political system is built to prevent anyone getting enough power to ever say, Here’s what we’re going to do – and doing it.

 

But studying how health care works in North Carolina government, the legislature and the private sector has added a whole new dimension to my perspective.

 

It turns out the legislature passes laws – but what happens when the state goes to implementing them can be something entirely different.

 

If anyone breathed a sigh of relief the day the legislature left town it was elderly Medicaid patients – for the old and infirm it was a trying eight months while the General Assembly was in Raleigh.

 

Right out of the hat Senator Doug Berger introduced a bill to cut home care for 20,000 Medicaid patients. The bill passed the Senate as part of the budget and went over to the House – where patients got a worse shock.

 

DHHS Secretary Lanier Cansler asked the House to add a new law to the budget to make it harder for every Medicaid patient to receive home care.

 

Cansler’s new law worked like this: If an elderly patient has just two handicaps he (or she) would lose their home care. They wouldn’t qualify any longer for care. In other words, if an eighty-year old woman was receiving care because she had had difficulty eating alone and had incontinence – she’d lose her care. Unless she had a third handicap. Like trouble bathing alone.

 

Cansler’s law would have cut more patients’ care than Berger’s bill.

 

But, then, something happened Secretary Cansler and his Department hadn’t counted on.

 

President Obama’s Administration told DHHS changing the eligibility requirements for home care – which is exactly what Cansler was doing – to cut 20,000 patients’ care could cost the state $2 billion in ‘Stimulus Money’.

 

Cash from Washington speaks louder than words – so legislators took Cansler’s provision out of the budget. Then they trimmed back Berger’s cuts. And added a provision to the budget that said no one anywhere in state government was to do anything that could cost the state ‘Stimulus Money.’ Then they adjourned.

 

That left DHHS in a quandary.

 

To ‘balance the budget’ the legislature had cut home care for 15,000 patients. But they hadn’t changed the eligibility requirements. So, legally, every one of the patients was still eligible for care. Plus the Obama Administration was telling DHHS not to change the eligibility requirements. Plus the legislature was telling DHHS not to even try because it could cost the state ‘Stimulus Money.’

 

So DHHS had to figure out how to cut 15,000 patients care – with no legal way to do it.

 

In effect legislators had plugged a number - $45 million – into the budget, said, There, it’s balanced, and adjourned. But it wasn’t really balanced. Because DHHS had no way to make the cuts.

 

So, now, the Grand Viziers at DHHS are trying to figure out how to cut the home care of 15,000 patients who’re legally eligible – which, of course, can’t be done without an end run around the law. And the Obama administration.

 

On top of that, to add the ludicrous to the preposterous, to pass his bill Senator Berger told legislators it would save taxpayers millions – but, in fact, his bill’s almost bound to backfire and cost money. When an elderly patient can’t get the care she needs to stay at home that only leaves her one choice: To go into a Nursing Home for care. Nursing Homes cost a lot more than home care. A recent study [link] says $44,000 a year more. And Berger’s final bill cut 15,000 patients.

 

So we’ve got the legislature passing a budget that’s not balanced; DHHS trying to figure out how to cut patients who’re legally eligible for care – and if it succeeds taxpayers lose money.

 

Whoever said politics makes sense.

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