Opinion: The wrong treatment plan
by Dr. William Dennis
Wilmington Star News
June 6, 2014
As a family physician, I am trained to process and understand the symptoms my patients present for the sole purpose of making a correct diagnosis. Once the correct diagnosis is made, it becomes my imperative to develop a treatment plan that addresses the underlying health concerns, not just remedy a patient's symptoms. Only then can I deploy the necessary health care resources to ensure the best possible outcomes for my patients. Successful Medicaid reform is no different.
Over the past 16 months the state's health care community, working closely with the General Assembly, the governor, the Medicaid Reform Advisory Group and representative patient advocates, has made tremendous progress in diagnosing the ills of our Medicaid system and proposing priorities for reform and continued investment.
Some of these include:
Improved budget forecasting: The actual spending per Medicaid recipient has been decreasing, with overall claims spending growing at a rate lower than the growth in the number of Medicaid recipients. The most significant cause for continued cost overruns is linked to budgeting inaccuracies, not care delivery.
Continued investment in "medical homes": Community Care of North Carolina's nationally recognized platform of "medical homes" provides services and care that is better coordinated to meet the needs of each patient. They leverage technology and care management to prevent chronic disease where possible, and maintain patient course of treatment where necessary, all of which reduces costly occurrences of hospital re-admissions and unnecessary emergency room visits.
Adoption of new payment mechanisms: Movement away from the current fee-for-service model that ties compensation to volume of patients seen and toward physician-led accountable care organizations that reward improved health outcomes by focusing on prevention and chronic disease management.
But the Senate spending plan is a complete departure from this process and the progress it has yielded. Senate leadership has developed an arbitrary treatment plan for an incorrect diagnosis that will ultimately damage the health care system that serves all North Carolinians.
If the Senate's changes to Medicaid go unchallenged, North Carolina patients and taxpayers can expect three things to happen:
- A decrease in the number of primary care physicians providing preventive care and chronic disease management across North Carolina, especially in rural communities already severely underserved.
- The immediate and irrevocable deconstruction of CCNC's nationally acclaimed Patient Center Medical Home network, a platform of coordinated care that reduces costly occurrences of hospital readmissions and unnecessary emergency room visits.
- Even greater alienation of the sickest segment of our population from the health care and long-term care services they desperately need, and for which we are morally and legally obligated to provide.
The North Carolina Academy of Family Physicians has been a vocal supporter of Medicaid reform. We applaud the governor and General Assembly for taking us on this much-needed and long overdue endeavor.
However, now is not the time to disregard the progress made over the past 16 months. Now is the time for lawmakers and all Medicaid stakeholders to develop and implement a treatment plan that safeguards and improves the health care delivery system for all North Carolinians, especially our most medically needy citizens, the elderly, blind and disabled.
Dr. William Dennis is president of the N.C. Academy of Family Physicians. He practices in Henderson.