Texas Health Care Briefing No. 8
Medicaid Managed Care’s administrative burden on your neighborhood nursing home
Long term care nurses in Texas spend too much time chasing paper and faxing forms, as a result of Medicaid Managed Care implementation. And that’s time they can’t spend on taking care of their residents.
That was the message Patsy Tschudy, a registered nurse with more than 40 years of experience working in Texas nursing homes, drove home when she testified before the House Human Services Committee April 24.
“This has been a huge administrative burden for the long term care providers to carry on their shoulders,” said Tschudy, Corporate Director of Managed Care at Cantex Continuing Care Network.
Tschudy highlighted the time, trouble and expenses long term care providers have taken on under managed care, noting that nursing homes have had to hire additional non-care staff to process claims in the back office. Despite their efforts, some claims still take five months to be paid, she said.
“We’d rather take those funds and put them into improving the quality of care, setting up special programs,” Tschudy testified.
Tschudy called for more accountability and consistency from the five managed care organizations involved with Texas long term care.
Three years after the implementation of managed care in Texas, just three of the five MCOs have implemented quality incentive payment programs. Despite that, she said that Texas facilities continue to improve their quality measures through other initiatives.
“We believe that this has created missed opportunities over the last three years,” Tschudy said.
The average unpaid accounts receivable balance has more than tripled since the implementation of Medicaid Managed Care, she said. And even when providers are paid, claims payment accuracy is inconsistent.
Tschudy called for better care coordination, including the ability for service coordinators to authorize physician ordered and needed services for their members, such as approvals for custodial therapy, or approval for transport for bed-bound patients who need to go to dialysis. “There needs to be some assistance so we can get those authorizations without having to jump through a lot of red tape,” she said.