Improve Medicaid bureaucracy before cutting services

As we all know, it's not necessarily what you do that matters but how you do it. In response to the Maryland General Assembly's mandate to slash an additional $40 million from this year's fiscal budget, the state's Medicaid Advisory Committee (MAC) and the Department of Health and Mental Hygiene (DHMH) are being forced to consider a series of radical cost-cutting measures for the state's Medicaid program.

Make no mistake: Spending must be curbed. It's how costs are contained that matters. If we get this wrong now, thousands of Marylanders stand to receive inadequate, substandard health care for years to come.


The Medical Advisory Committee and the Department of Health are — very correctly — seeking public input. While they should be commended for their efforts, the hard truth is this: The proposals currently under consideration will hurt the state's most vulnerable citizens in the short term and yield very few cost savings in the long run. In fact, most of the proposals being discussed are likely to result in additional spending — on sicker patient populations — in the future.

Recommendations include removing the kidney disease program, charging co-pays for emergency room visits, reducing reimbursement for durable medical equipment, and placing limits on outpatient hospital visits. Every one of these proposals reduces or denies services to the patients Medicaid is supposed to protect. Eliminating the kidney disease program alone would leave patients stranded without care. The cut is particularly troubling for African-Americans, who are four times more likely than the general population to develop kidney disease, according to the National Kidney Disease Education program. Many of these patients will be forced to skip (or quit) medications and services if the program is cut. Here's the rub: Medicaid will still become responsible for providing care for these patients; it will just be later in the disease process, when they are critically ill and in need of far more complex and costly medical care.

We owe it to them — and to Maryland taxpayers — to look for a better way. For starters, rather than stripping services from Maryland's most at-risk populations, we should instead shore up the infrastructure that supports, facilitates and delivers Medicaid services. Such measures would make the delivery of services more efficient, reduce staggering administrative costs associated with the coordination of care, and improve patient access to Medicaid providers.

Here are just a few ideas:

•Replace Medicaid's outdated Management Information System. It's time to become aggressive in finding a replacement for the notoriously inefficient Medicaid Management Information System (MMIS). The existing MMIS is an ancillary component of almost every other problem that confounds Maryland's Medicaid program. Now, more than ever before, we need innovative thinking in health care delivery. The archaic MMIS is stymieing creativity in the development of payment models that would promote better management of care and costs. Equally troubling, the administrative costs associated with MMIS rob both the Department of Health and its contracting providers of resources that would be better allocated directly to patient care.

•Grant Medicaid physicians access to federal technology incentives. Until the Department of Health establishes the administrative framework set forth by the federal government, Maryland's Medicaid providers can't access federal financial incentives for adopting electronic medical record systems. The department must remain committed to having the necessary framework in place by Oct. 1, as promised by the General Assembly. Increased adoption of electronic medical records among Medicaid contracting physicians will result in more efficient coordination of patient care. That means fewer medical errors and less duplication of services. It also means fewer patients will experience delays or denials in care as communication among providers, pharmacies and Medicaid are streamlined and standardized. Collectively, the changes brought about by widespread adoption of health information technology among Medicaid providers will improve patient outcomes and reduce spending.

•Foster the development of innovative payment models. The development of creative new payment models could ultimately provide some of the greatest permanent cost savings to Maryland's Medicaid program. MedChi is ready to partner with the Department of Health to develop such programs. Payment models — such as the Medical Home Network — that support better care management and reward cost savings will help increase physician participation in Medicaid, improving patient access to care particularly in rural areas, where fewer physicians are currently willing to contract with Medicaid. Medicaid is already participating in the Health Care Commission's patient-centered medical home pilot program, but the Department of Health must also consider other pilot programs based on models that have been successful in saving money, increasing physician participation and improving quality of care.

Medicaid spending must be curbed. How we do this matters. Shoring up Medicaid's infrastructure is the better way to achieve spending reductions. Cuts to services cheat patients and taxpayers.

Gene M. Ransom III is the CEO of MedChi, the Maryland State Medical Society. His email is