Julie Hudman, my predecessor as director of the D.C. Department of Health Care Finance (DHCF), would have the world believe that she turned over the keys to a well-oiled Rolls Royce and in just over two months the Gray administration has reduced it to a leaking jalopy [“D.C. residents’ health care isn’t a political prize,” Local Opinions, March 11]. Nothing could be further from the truth.
While Hudman deserves credit for some of the changes carried out during her tenure, her self-reported record of performance had glaring omissions, including the continuation of inappropriate billing practices, payments to unlicensed providers, non-compliance with federal regulations, the termination of the Alliance pharmacy program for more than 23,000 people without an alternative, the failure to use almost $1 million in Electronic Health Records funds, and, most conspicuous, the absence of a strong monitoring program for long-term care.
Especially curious were Hudman’s complaints about the failure of the administration to “contact her” during the transition. From my experience, the job of a politically appointed agency director during a transition in administrations is quite simple. Prepare a detailed policy book on the agency’s operations — budget, staff program descriptions, operational challenges, audit results, performance outcomes, “hot button” issues — and consider your next career move. To expect otherwise reflects either an astonishing naiveté or tremendous hubris.
When I officially joined the agency on Feb. 1, I found an operation nearly flat on its back, with a 40 percent personnel vacancy rate, a talented but dispirited staff, a host of operational problems and a $17.3 million shortfall for the remainder of fiscal 2011.
Hudman speaks proudly of the agency realignment she engineered. But even the most generous accounts of that effort indicate that, while it may have been a structurally sound way to reshape the agency, her implementation left much to be desired. In fact, it was so poorly executed that it created a level of distrust among staff that has yet to subside. Moreover, many of the vacancy problems mentioned preceded Hudman’s departure.
Predictably, the effect of so many open positions has been crippling. How? Changes to the Medicaid program that held the promise of more than $5 million in savings in fiscal 2011 stalled, and program integrity operations were weakened. There was also no planning underway to implement solutions to a fragmented care system for Medicaid and Alliance clients, the Health Care Reform Division was never staffed, and agency operations essentially functioned in silos.
Given these challenges, Mayor Vincent Gray has set four priorities for the agency: improving health outcomes; strengthening program integrity; improving oversight of and increasing Medicaid billing for public providers; and implementing health-care reform. In my first six weeks as acting director, I have focused on executing the mayor’s vision, including taking these steps:
n Gaining approval to fill more than 50 vacancies.
n Responding by the end of March to outstanding letters from the Centers for Medicare and Medicaid Services regarding significant program eligibility issues.
n Working to ensure that proper payments are made to providers.
n Developing a strategy to establish a program to identify “bad apple” providers, as required by federal regulations.
n Requesting and receiving an extension to use federal planning funds for the Electronic Health Records project.
Other efforts will require more time. Principal among these is implementing a strong monitoring program — especially for long-term care. Although more than 76 percent of the agency’s nearly $2 billion in expenditures pay for services to people who are elderly or who have disabilities, at times the agency has had only one or two staff members overseeing these programs. Realistically, this means many of these programs have been unmonitored.
Moreover, strategies used routinely in Medicaid agencies across the country — monthly analysis of program data to support improvement strategies — were not in use in the District. Accordingly, we cannot explain why the District’s health-care programs are among the most expensive in the nation, why there has been such rapid growth in the cost of home health and personal care, and whether there are opportunities with our managed-care providers to pursue more targeted, evidence-based care strategies. We will correct this.
Finally, to Hudman’s central point, there are no “have to” hires at DHCF. As director, I have full authority to build my leadership team. Today, the agency’s senior management staff includes four people with more than 60 years of combined health policy or direct management experience with public health insurance programs, including Medicaid. Together with agency staff, we have embraced the challenge of addressing the many problems encountered at DHCF.
Some believe that wisdom is learning what to overlook. Mayor Gray does not adhere to this philosophy.
The writer is the director of the D.C. Department of Health Care Finance.