Wednesday, December 17, 2014

Why there is not much more to say about the NYS Early Intervention Program

I got an interesting question in email today so I decided I would answer it publicly.  The email asked:

You used to write a lot about early intervention, but there hasn't been much on that topic lately.  Providers are still struggling, there are provider shortages in some areas, lots of people lost their businesses and either went into agencies or gave up on early intervention.  Are you still working in this area and will you still be writing about how we are struggling with early intervention?

Here is my answer:

The reason why I don't write about early intervention as much anymore is because everything that I predicted about the municipal takeover of the system has come to fruition.  There just isn't anything left to say about it, and now the program will limp along in a reduced capacity just as planned.  The transition to the State Fiscal Agent system was intended to destroy the program as it was previously designed and that objective has been met.  In place of the previous system the new system is served only by larger agencies that have better capacity to withstand the new inefficiencies because those agencies operate on larger volume and have other revenue streams.

The impact on families is significant, particularly for those areas that have had intermittent provider shortages.  In insurance lingo, constricted provider pools are known as 'temporary revenue enhancement functions.'  In family lingo, constricted provider pools are known as "Oh my goodness, what will my child do without their physical therapy sessions???"

Families have been conditioned in our new welfare state to accept what is given, even when what is given is not particularly functional.  This facilitates a two-tiered care system.  The lower tier is populated by people who are conditioned to accept whatever service they can get for free out of a municipality.  The higher tier is populated by people who know that the lower tier solution is only for those families who don't have other options or other resources - and they go and find private solutions.

This was all predicted.

Many MDs in the community who have figured out that it is simply more efficient to refer their patients to me privately and for me to bill insurance directly.  Those families are very happy with that option because they don't have to wade through the bureaucracy of the EI system and they know in advance who they are getting as a service provider.  Unfortunately, many families don't have that option.

So there just is not much to say.  The new system is unwieldy and ineffective and bureaucratically deceptive.  The State Fiscal Agent reports the following statistics for 2014, through the third quarter:

Claims submitted to insurance: $67, 938, 442
Claims paid by insurance: $8, 958, 843
Percent reimbursed: 15%

It must be that new math that I don't understand, but whatever.

Imagine if any private health care practitioner could only collect such a low rate on claims?  And guess who gets to pay for every dollar that this inefficient behemoth can't collect?

This is the pathetic and expensive Early Intervention Program that NY taxpayers are paying for.

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