Doctors who care for low-income people in Maine are threatening to drop Medicaid patients because of the slow progress being made on fixing the state’s computer system, which has stalled millions of dollars in payments since January.

In the meantime, the bill for fixing the problem is adding up.

On top of an estimated $4 million in outside contract and consulting fees already announced – with about half going to the accounting firm of Deloitte-Touche – the state has entered into a separate contract with Deloitte to help redesign the Medicaid department so problems like the computer meltdown don’t happen again. That contract over the next two years is expected to cost an additional $4 million. But money isn’t buying happiness among the state’s healthcare providers.

“It’s not getting better fast enough to prevent a collapse of the system,” said Gordon Smith, vice president of the Maine Medical Association, which represents more than 2,000 doctors in the state. “They just cannot stand it anymore.”

Smith said doctors already have stopped taking new Medicaid patients and now are threatening to stop seeing the ones they already have. “They’re not convinced that everything was being done that could be done,” he said, asking why the state wasn’t suing the vendor to recoup money to reimburse practices for all the time spent tracking unpaid bills.

The state has sent out more than $250 million in interim payments based on the billing history of its more than 7,000 providers. Eventually, providers will have to reconcile those payments with actual bills, many of which are among the hundreds of thousands stuck in the computer system.

Members of the Legislature’s Appropriations Committee are getting fed up, too. During an update last week on the progress the Department of Health and Human Services is making in fixing the computer, several said the horror stories keep rolling in.

“I don’t disbelieve you, but who are you paying?” asked Rep. Joe Brannigan, the House chair of the committee, responding to a report saying more bills are being processed by the system. Brannigan, director of the Shalom House in Portland, which helps adults with severe mental illness, said he knows personally of two providers who haven’t had a single bill paid this year.

Sen. Peggy Rotundo, the Senate chair of Appropriations, said, “My concern is the response.” She told of a provider who sent in a box of bills, as requested by the DHHS, only to have them lost by the department.

When the provider called to inquire, “they were moved to about five different people. They were moved to the person who originally lost the box…and waited two weeks for a call back,” she said.

The issue is a $22 million computer system-funded 90 percent by the federal government – that was turned on in January without being fully tested and hasn’t worked right since. There are close to 400,000 claims still stuck or suspended in the system, although the number is coming down.

The problems, in some cases, are simple, like the computer picking up an incorrect reimbursement rate for a procedure or a provider not giving enough or the wrong information on their vouchers, but the system appears riddled with them. And, the fixes affecting the greatest number of providers are being done first, meaning some others aren’t being addressed at all yet.

Judi Hawkes, vice president of practice management at MaineGeneral Health in Augusta, said MaineGeneral Health Associates, a group of 34 physicians associated with the hospital, is owed $930,000. Hawkes said 60 percent of the outstanding bills are more than 90 days old.

“We belong to a hospital system, so we have a little bit more protection,” Hawkes said, in terms of having the financial resources to pay the bills without prompt Medicaid reimbursement. In fact, her group has declined all but one interim payment from the state because it doesn’t want to deal with the potential nightmare of reconciliation.

Private practices are having a much tougher time because they don’t have a larger organization to fall back on financially, she said.

Hawkes, who along with Smith sits on a providers’ advisory group working with DHHS to try and fix the problems, applauds management changes made in the department to improve accountability, including the hiring of new Deputy Commissioner Mike Hall, who will oversee the restructuring of the Medicaid department.

“They’re listening,” she said, and dealing with problems “in a process-oriented way and are much more organized.” Unfortunately, “the end result isn’t changing that much.”

“Mike Hall is doing a great job. I think it was a terrific change. But, quite frankly, I don’t think they have the resources underneath to get to all the things they need to get to,” Hawkes said.

Smith too said the department was trying, but “I don’t get enough sense of urgency.” He said the ultimate responsibility “stops at the governor. This is being done on his watch.”

Rep. Darlene Curley, R-Scarborough, a member of the Appropriations Committee, asked if headway was being made in terms of getting the right people in the right jobs. “There’s a point when those are just excuses,” she said.

DHHS Commission Jack Nicholas said the solution was not to criticize the staff, but rather provide better leadership.

“We have to lift them up and get them re-inspired,” Nicholas said, and change the structure of the department.

“My successor, even if that person comes here tomorrow,” would have the same problems, he said, if the department is not restructured – a job Deloitte-Touche will help do under its $4 million contract.

Other concerns the providers have raised include:

• The state’s decision not to even run the claims for dual-eligible patients – who get services under Medicaid and Medicare – until February of 2006. Doctors haven’t received Medicaid money for those patients since last December.

• Fear that reconciling the books to justify interim payments with actual bills will cost the doctors even more money on top of the lines of credit they’ve been running to pay the bills.

• A looming 12-month deadline by which all claims have to be submitted under Medicaid rules in order to be eligible for reimbursements. The fear is the state will have no record the claims were submitted in a timely fashion.

“I don’t know if they’ve got all my claims,” Hawkes said, adding that providers were asked by the department to stop sending in duplicate bills when the first one wasn’t paid because they were clogging up the system.

“We’ve never had good luck reconciling financials with the DHHS,” even in normal times, said Mary Lou Dyer, director of the Maine Association for Community Service Providers. “It’s always been painful,” she said, and this year it is expected to be a lot worse.


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