1st data on health pay plan called promising

Preliminary data collected to track the success of Arkansas’ health-care payment overhaul indicate a drop in antibiotics prescribed for upper respiratory infections, fewer births by cesarean section and fewer children diagnosed with attention deficit hyperactivity disorder, Medicaid officials told state lawmakers Friday.

Dawn Zekis, the state Department of Human Services’ director of healthcare innovation, and William Golden, the department’s medical director for health policy, told the state House and Senate public health committees at a joint meeting that the changes are encouraging but it’s too early to give the state’s Health Care Payment Improvement Initiative the credit.

Rep. John Burris, chairman of the House committee, called the drop in attention-deficit hyperactivity disorder diagnoses “a huge deal.”

“I just think there’s a lot more awareness on the part of providers, as far as what they’re doing,” Burris, R-Harrison, said.

Under the initiative, Medicaid and two private insurers track the expenses associated with certain “episodes of care,” such as treating an upper respiratory infection.

Each year, the program will financially reward doctors whose average costs for providing an episode of care for the year fall below a range considered acceptable, and will penalize those who exceed it.

The initiative began in October with three episodes of care: upper respiratory infection, maternity care and attention deficit hyperactivity disorder. Congestive heart failure and total joint replacement were added in February.

On Friday, Medicaid officials briefed the public-health committees on their plans to add four more episodes - chronic obstructive pulmonary disease, coronary angioplasty, asthma, heart bypass surgery and oppositional defiance disorder - starting Oct. 1.

With no legislators objecting, Sen. Cecile Bledsoe, chairman of the Senate committee, deemed the addition of the episodes “reviewed.”

Last month, the committees reviewed plans to add tonsillectomies, gallbladder removal and colonoscopies to the initiative, also starting in October.

Medicaid officials also plan to seek legislative approval to add an episode for patients diagnosed with both attention deficit hyperactivity disorder and oppositional defiance disorder this fall, Zekis said.

She said officials will present plans for one more episode, for neonatal care, in the spring. Officials then plan to “pause” on the roll out of additional episodes while they concentrate on implementing the first 15, as well as on other aspects of the state’s health-care payment overhaul.

Arkansas Blue Cross and Blue Shield and Little Rock based QualChoice insurance are using the payment model for some episodes.

The rewards and penalties based on the first year of claims for upper respiratory infection, maternity care and attention deficit disorder episodes will be issued early next year.

According to a report presented to the committees, drug prescriptions billed to Medicaid for upper respiratory infections dropped 3.3 percent in October through December 2012 compared with the the last three months of 2011.

The percentage of “unspecified” upper respiratory infection episodes treated with prescriptions fell by 5 points, from 46 percent of the 16,782 episodes identified in the last quarter of 2011 to 41 percent of the 15,834 episodes in the last quarter of 2012.

The percentage of infections with sore throats that were treated with prescriptions fell 4 points, from 75 percent of the 15,748 episodes in the last quarter of 2011 to 71 percent of the 14,883 episodes in the last quarter of 2012.

Prescriptions for sinus infection, meanwhile, remained flat, at 91 percent of the episodes in the last quarter of 2011, when there were 6,192 such episodes, and 2012, when there were 6,473.

Medicaid officials say antibiotics are rarely needed to treat upper respiratory infections.

The drop in prescriptions is “a good trend, but we need to have more data,” Golden said.

The report also found that births performed by cesarean section dropped from 40 percent of births from January through February of 2012 to 35 percent during the first two months of this year.

But the percentage was higher than in the first two months of 2011, when 31 percent of births billed to Medicaid were by cesarean section. Golden and Zekis said Medicaid officials are studying the fluctuation in percentages.

Diagnoses of children with attention deficit hyperactivity disorder, meanwhile, have fallen steadily, from 109 in February 2012 to 79 this February.

At the same time, the percentage of such cases that included an additional disorder increased from 25 percent of the cases in February 2012 to 57 percent of the cases in February 2013.

Medicaid officials said after the hearing that the drop in diagnoses for attention deficit hyperactivity disorder could reflect a greater accuracy by doctors. For instance, to be eligible for extra payments, doctors are required to document that patients have been given vision and hearing tests.

Without such tests, children whose behavior issues stemmed from vision or hearing problems might be incorrectly diagnosed as having attention deficit hyperactivity disorder.

Some health-care providers have objected to the requirements imposed by the episode’s implementation.

Starting this fall, Jacksonville-based Pathfinder Inc., which provides mental health-services to Pulaski County Special School District students, no longer will provide in-school therapy for children diagnosed with attention deficit hyperactivity disorder, because of “confusion over whether we’ll get paid,” said Dusty Maxwell, director of intermediate-care programs and government liaison for the nonprofit group.

“Our concern is going to be, in the short run of saving money, are we shortchanging services” to children, Maxwell said.

He said officials with the group have been meeting with Medicaid officials about their concerns.

“We don’t always agree, but we do feel like we have a seat at the table,” he told the committee.

Front Section, Pages 1 on 07/27/2013

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