Thursday, March 31, 2011

Early Intervention Update - 3/31/11

I want to encourage people who are interested in updates on EI and other issues to follow our Facebook page at http://www.facebook.com/ABC.Therapeutics

I'll be posting brief updates there more often than I update the blog - which I generally reserve for longer rants or conversations. Blog traffic has spiked the last couple days so I know there are a lot of people out there looking for information.

The best information that I have available currently is that Senator Ranzenhofer's office confirmed to me that the EI rates have been cut 5%. In brief Facebook exchanges with NYSOTA they are also reporting the same information. A digital news service that covers NYC news is also reporting similar information. I spoke with people in the NYSDOH and EI programs specifically and they are keeping their lips sealed for now.

A 5% cut is better than the originally proposed 10% cut, but it will still create additional challenges for providers who are still accommodating to the 10% cut that occurred last year.

Right on the heels of all this news breaking I received an email from Public Consulting Group, Inc. (PCG) has been contracted by the NYS Department of Health to coordinate and implement a provider cost reporting system for the NYS Early Intervention Program. It involves filling out cost reporting forms and attending webinars on how to fill out their cost reporting forms - real exciting stuff that providers generally get excited over - right?

I called them up and asked what they want cost data on and they told me that it was to help provide data to stakeholders (I suppose that would include the legislature) about what the actual costs of providing EI services are. I fully understand the importance of cost reporting but to be quite frank it is rather ironic that they are gathering information on cost reporting AFTER cuts have already been made that are crippling ability to hire, train, and retain qualified professionals for the EI Program.

The consultant that I spoke to from this group was very pleasant but I gave her a 15 minute speech on the silliness of ex post facto cost reporting. I suggested that a better way to spend time would be to do a deep dive into the recently published early intervention report to the legislature. This report has shocking information about the absolute ineptitude of NYS in collecting money from third party insurers in their already-existing cost sharing allowances.

The report outlines an 85% denial rate that exists because our state government can't figure out how to cost share with commercial insurance - and the shocking 22% denial rate from our own Medicaid program! The primary reason for denials is not even because of exclusionary coverage rules or timely filing problems - but because providers do not 'participate' as credentialed professionals in the insurer's networks. That is a pretty lame reason to not get paid - and is so easily fixed by simply requiring that providers to EIP already be credentialed with Medicaid and whatever private/commercial entities serve their geographic area.

A tremendous amount of revenue is lost because of this - and rather than fix the problem I suppose it is faster to take an axe and lop off 5% of the reimbursement to providers. This has to be the laziest fix to a budget problem that I have ever seen before.

NY State doesn't know how to get paid for the services that are provided. Any private practitioner knows that you can't function if you don't get paid and now that lesson is about to be learned on a much larger scale across the state. You can't deficit fund forever.

One big part of the solution to all this is for everyone to learn how they can engage their own representatives and start talking about cost sharing through private insurance as a more reasonable model to support the costs of the program - unless you all know how to dodge the next clumsy swing of the budget cutting axe.


I guess that the state doesn't like Medicare rate cost reporting and the long-established formula that is already in place that has previously served as the basis of the EI rate. Maybe someone's friend owns this consulting group - I really don't know. I can't imagine why NOW is the time to do cost reporting - now that we are all about to experience another cut to reimbursement. Usually you might expect that they would make everyone do some little song and dance about cost reporting BEFORE they slash rates. That gives people the illusion that their input actually made a difference, a la the much exalted Medicaid Redesign Team. How funny is it that they slash rates first and then ask people to do cost reporting second?

Don't wait for NYS to figure it out - they are off on this new tangent that is best summed up with the phrase 'Ill-Timed.' Only government could be this dysfunctional.

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