Friday, September 21, 2012

Doctor, DHS elaborate on hospital reimbursement issue

Posted By on Fri, Sep 21, 2012 at 6:12 AM

I mentioned earlier remarks by DHS Director John Selig on NPR. He said they'd discovered hospitals keeping obstretric patients overly long had increased Medicaid spending.

A review by Leslie Newell Peacock and further talks with the doctor involved and DHS reveals different circumstances. Leslie reports:

Department of Human Services Director John Selig said today Thursday that he didn’t mean to imply that hospitals are gaming the system by keeping patients longer than necessary when he spoke yesterday on NPR’s “Diane Rehm” show.

Selig was interviewed in a show on health care expense down because of the state’s new “medical home” strategy to keep Medicaid costs down, an after-the-fact bundling system that will reward doctors whose billings over a year’s time come in under average. The system starts Oct. 1.

As an example of how the strategy will bring down health costs, Selig said one doctor had, by going over a preliminary review of his Medicaid practice with the state, figured out how to bring his costs down: By shortening hospital stays. From the radio interview:

“We had one of our ob-gyns contact us and he said ‘I see a lot of red on this report,’ and he was quite upset because he thought he was a good provider, and we thought he was too. And so we started digging into it with him and it turned out that what was causing his costs to be higher on average than others was the hospital costs. And we dug further and found out that the hospital he was using was keeping patients — the mothers — on average an extra half day or day longer than other hospitals … and that was causing his costs to go up. And he said, ‘Well, I can talk to the hospital about that’ and he did do that and they said, ‘Well we do that because we get paid for it.’ ”

Thursday, Selig said he did not mean to imply that the hospital was “trying to rip off the system; that’s the hospital’s practice,” Selig said.

The ob-gyn, who DHS identified after the program as Dr. Gregory Wood of North Little Rock, emphasized that hospitals don’t decide when to discharge patients: doctors do. He said he’s never had a hospital hold a patient longer than it was supposed to.

Wood also said he hasn’t contacted any hospital, and couldn’t identify which hospital Selig was referring to. He uses Baptist Health mostly and St. Vincent some.

Wood said that obstetric patients may go over the recommended 24-hour stay for vaginal delivery because they check in late at night, and 24 hours later, “bam! Day 2.” Wood said patients know — as is their right — what Medicaid will pay for — 48 hours for a vaginal delivery and 96 for C-section — and that urging them to go home to save money won’t work. The result, he said, is that the “quarterback doctor” will end up paying for his billing in excess of the averages determined by DHS.

Wood noted the Medicaid already bundles what it reimburses for obstetrical care — meaning it pays one fee per patient — so that any savings that are to be had have to come from the hospital or medication.

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