But it’s unclear whether the pilot, which is also underway in four other counties, has achieved that. Health professionals here say any savings have come at a high cost: the quality of care. And they are outraged over the legislature’s decision last week to essentially expand the pilot statewide, which will be carefully watched by other financially strapped states across the nation.
“I just don’t understand why Florida is pursuing a failing model,” said Arthur Palamara, a vascular surgeon in the city of Hollywood.
The pending law, which requires the approval of the Obama administration, largely drops the traditional fee-for-service model under which a state reimburses doctors and pharmacies for every procedure or drug provided to a Medicaid patient. Instead, virtually all patients would be required to sign up for a private HMO or similarly run provider-service network set up by hospitals and doctors. These managed-care organizations would be paid a set amount for each patient’s care, taking the hit for any overruns but keeping most of any savings.
Unanswered questions
Florida’s plan would put the state at the extreme end of a national trend: Nearly all states have moved the majority of Medicaid recipients into some form of managed care over the past decade.
But they differ on key questions: Who should oversee management of the care — medical groups or private insurers? Who is covered: Only poor children and their parents, or more costly groups, such as the disabled, the elderly and patients needing long-term care? Should participation be optional or mandatory?
In Florida, private insurers are likely to cover the lion’s share of recipients, who will be required to choose a managed-care plan, exempting only a few groups, such as the developmentally disabled.
Tonya Guerrieri, a medical assistant to a neurologist, Gerald Goldberg, in the city of Sunrise, worries about expanding the private Medicaid HMOs because those in the pilot seem more likely than state-run Medicaid to turn down non-generic drugs even when Goldberg determines they are the only effective option. Among the examples: Nuvigil, a drug that helped one of Goldberg’s patients stave off the drowsiness brought on by Parkinson’s disease.
“We gave her samples, and she was like a different person on it,” Guerrieri said. “But [the HMO] denied it.”
Fear of doctor shortages
Palamara, the vascular surgeon, said the Medicaid HMOs have also exacerbated the doctor shortages by adding to steps and paperwork to get authorizations, prompting many to stop taking new Medicaid HMO patients.
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