Tim Rogers' Email to Senator Berger - -"misleading percentages"

Carter Wrenn posted on June 30, 2009 00:24

Association for Home & Hospice Care of North Carolina CEO, Tim Rogers' Email to Senator Berger documenting flaws in his review. See Tim's email below:

From: Tim Rogers [mailto:timrogers@homeandhospicecare.org]
Sent: Tuesday, June 09, 2009 5:41 PM
To: 'Sen. Doug Berger'
Cc: 'Melanie Bush (Fiscal Research)'; 'Lisa Hollowell (Fiscal Research)'; 'Sen. William Purcell'; 'Sen. Martin Nesbitt'; 'Amy Fulk (Pres Pro Tem's Office)'; 'Sen. Tony Rand'; 'Rep. Bob England'; 'Rep. Verla Insko'; 'Rep. Beverly Earle'; 'Rep. Jean Farmer-Butterfield'; 'Sen. Debbie Clary'; sharnese.ransome@ncmail.net
Subject: RE: Proposed Cuts to Personal Care Services

Senator Berger:

First, thank you for the email. Thank you for joining with us in trying to get to the bottom of the numbers that the Department has provided to you on PCS. With regard to the one page chart you sent me on Friday, is this part of a CCME report? If so, could you send us a complete copy of the report? A few weeks ago we had asked the Department to give us all written reports and summaries from the CCME reviews of PCS. We never received the document that you e-mailed us on Friday. Instead, we received two eight-page reports and neither included the one-page chart you have.

The percentages shown in the one-page chart are very misleading because there was a second level review that in most cases reversed the CCME preliminary findings. One of our member agencies reports that 10 out of 10 were reversed; another reports 7 out of 7 reversed and several others report 100% reversals. One agency reporting a 100% reversal of CCME findings told us that CCME found that a 90-year old blind man who could not bathe, ambulate or toilet himself did not meet eligibility criteria.

The Department needs to make public the percentage of patients initially found to be ineligible for PCS that are still receiving these services because the findings were reversed after a closer review. Would you please ask Secretary Cansler for this information, and share it with us? How can the Department possibly say that the percentages you have been given are reliable with the CCME findings being reversed most of the time?

Again, thank you for helping us get to the bottom of this.

Most cordially

Timothy R. "Tim" Rogers, CEO

Assoc. for Home & Hospice Care of North Carolina

South Carolina Home Care Association

3101 Industrial Drive, Suite 204

Raleigh, NC 27609

919-848-3450

919-961-3555 cell

Member -State Health Coordinating Council -SHCC

Member -NAHC Board of Directors

Chairman -NAHC Forum of State Associations

[Read the rest of this article...]

Actions: E-mail | Permalink | Kick it! | DZone it! | del.icio.us

29

A Surprise...

Carter Wrenn posted on June 29, 2009 21:39

Mid-June 2009: DHHS response to a Public Information request brought another surprise. Over six weeks before the request, DHHS notified Senate Fiscal Research Staffer, Melanie Bush that the CCME review Berger is referencing - showing that 45% of the Medicaid Home Care patients were ineligible, was inaccurate. Read the email below:

[Read the rest of this article...]

Actions: E-mail | Permalink | Kick it! | DZone it! | del.icio.us

29

From TalkingAboutPolitics.com

Carter Wrenn posted on June 29, 2009 19:02

Senator Doug Berger's Blooper

June 08, 2009

For the past month, State Senator Doug Berger has been telling just about anyone who’ll listen that 45% of the patients who get home care services through Medicaid are ineligible.

He’s gotten so worked up over the whole thing he wrote one lady, who disagreed with him, and told her the ‘ineligible’ patients’ children ought to be supporting their families – just like he supports his mother-in-law, adding: “Our family would like would like the luxury of someone helping us cook her meals and help keep our house clean” too.

Anyhow, Senator Berger got so exercised he rolled legislation out of his Senate Committee to cut the Medicaid budget for home health care a whooping 60%.

Then the whole thing started to come apart on him at the seams.

The Association for Home and Hospice Care of North Carolina wrote the Department of Health and Human Services and asked for a copy of the study Berger claims says that 45% of their members’ patients are ineligible for home care services. They got nothing. Zip. Zero. Nothing. Then they threatened to sue and got an eye full – the study popped out of

HHS and, lo and behold, it didn’t say what Berger claimed.

Senator Berger had said the study – by a state vender – analyzed a cross section of Medicaid patients. It didn’t. The focus was on paperwork and agencies that were out of compliance with paperwork requirements.

What about the claim 45% of the patients are ineligible? Dead wrong. Because the vendor’s preliminary patient reviews were reversed most of the time through a more in-depth review approved by HHS. HHS discovered ineligible patients weren’t ineligible at all.

For instance, a home care agency in western North Carolina had 10 of its 10 patients ruled ineligible by the contractor. Every one was reversed by HHS. Another agency had 7 of 10 patients ruled ineligible. Again, every one was reversed by HHS. A nurse with a third agency, again in western North Carolina, described how the contractor conducted the study: They “found that 85% of our patients did not qualify. One of these patients was a 90 year old blind man who could not bath, ambulate or toilet himself.” HHS decided every one of that agency’s patients were qualified too.

HHS made public detailed data for one month – January 2008. 70% of patients the contractor said were ineligible a year and a half ago are still receiving care today – with HHS approval. (The remaining patients either died, moved into a nursing home or moved off Medicaid – HHS can’t say which.)

Even worse, consider this: When Berger finishes cutting 36,000 patients home care a lot of them are going to be left with only one choice -- to go into rest homes and nursing homes. Let’s say 60% – the same number Berger cuts – do just that. The cost to the state of caring for a patient in home care is $9000 a year. In a rest home or a nursing home the cost is from $21,000 to $48,000. Do the math. That mistake could cost taxpayers almost a billion dollars a year.

Last week at their caucus, according to one legislator, House Democrats threw open the flood gates to increase taxes between $1-2 billion to balance the budget – but unless someone corrects Senator Berger’s mistake a good part of those taxes are going to pay for ‘Berger’s blooper.’

So how did Senator Berger commit such a blooper? Did he just get bad information from HHS Secretary Lanier Cansler, then whip a bill out of his committee that cut 36,000 disabled patients’ home care?

[Read the rest of this article...]

Actions: E-mail | Permalink | Kick it! | DZone it! | del.icio.us

29

Email to Senator Doug Berger from DHHS

Carter Wrenn posted on June 29, 2009 18:17

DHHS to Senator Doug Berger: The review does not show that home care patients are ineligable. Because the 'reviews' did not include a physical examination of a single patient. Read the email below:

From: Gray, Craigan [mailto:craigan.gray@dhhs.nc.gov]
Sent: Fri 6/12/2009 1:31 PM
To: Sen. Doug Berger
Cc: Cansler, Lanier; Feezor, Allen
Subject:

June 12, 2009

Senator Berger:

The first two attachments are the requests and responses. The last three attachments include the summary of the CCME survey where ~41% of surveyed were out of compliance. Keep in mind that of that percentage, some came back in to compliance with proper documentation, some got better and left the program, others moved to other programs, died, or in fact some did not qualify. We are breaking each category down for further analysis presently. The PCS group is anticipating an electronic surveillance tool in the future; however, all metrics are currently manual. I am asking the PCS management group to implement an enhanced metric-based surveillance program as a result of the most recent inquiry to improve the standard of performance from all parties.

I appreciate your interest in the PCS program and we remain available for further questions as needed.

C. Gray, MD

Craigan L. Gray, MD, MBA, JD
Director, Division of Medical Assistance
2501 Mail Service Center
Raleigh, NC 27699-2501
(919) 855-4101 phone, (919) 733-6608 fax
craigan.gray@dhhs.nc.gov

[Read the rest of this article...]

Actions: E-mail | Permalink | Kick it! | DZone it! | del.icio.us