The Arkansas Foundation for Medical Care has been investigating Medicare beneficiary complaints in the state for about 30 years, but its contract with Medicare will end in July without the option to renew, officials with the foundation said.
Two national companies will start providing complaint services to Medicare beneficiaries beginning Aug. 1, according to Medicare's website. The services historically have been provided by individual organizations, such as the Arkansas Foundation for Medical Care, in each state.
"They decided they didn't want it done in every state," said Ray Hanley, foundation president and executive officer. "There are legitimate concerns about how well the complaint and review process is going to work when folks are using a call center for 30 states versus our workers who know the region."
Hanley said the program was set up for beneficiaries who had concerns about the quality of care they received from health care providers. He said complaints often revolve around errors in prescription medications. He said people also are often concerned that they are released from hospitals too soon.
During the three-year contract period with Medicare, Hanley said, the foundation has investigated more than 1,000 cases during its current contract that began in 2012.
Edward Rogers said he was impressed with the response he received from the organization. Rogers, of Tulsa, had concerns with care his mother received from an Arkansas hospital after she was admitted for chest pain. She later died after heart surgery at the hospital.
"They [the foundation] had their own nurses and doctors on the foundation staff who looked at the medical record," Rogers said. "It was a very serious matter to me; this was my mother's death, and they not only responded to my request, but they took it very serious."
Rogers said he couldn't discuss the case fully but that he felt changes had been made by the hospital after the investigation.
"They are the mouthpiece for the little guy," Rogers said about the foundation. "I think they are a critical piece, they are a necessary piece to assure quality care for the individual."
The restructuring of services by Medicare is a concern, Rogers said.
"There are far too many sentinel events and individuals who receive inferior standards of care in every city and state to rely on a handful of entities to address these issues," Rogers said. "I fear someone is underestimating the need for and value of the services that the AFMC provides."
Kepro, a health care management organization based in Harrisburg, Pa., received the contract from Medicare to cover services for 34 states, including Arkansas. Kepro did not respond to a request for comment by deadline Friday.
Previously, organizations contracted by Medicare also provided educational services for the improvement of health care in the community. He said educating the community about colon cancer is one effort the foundation has taken part in, in the past.
Medicare's restructuring of the program will have separate contractors providing health care quality improvement services, Hanley said. However, Medicare has not granted contracts to these organizations yet. Contracts are expected to be assigned by the end of July.
Hanley said organizations that bid for the contract must serve three to six states. He said his organization has joined forces with organizations in Texas and several other states to apply for the contract.
"We would be doing work for a lot of Arkansas still, but all of the administration, communications and finance would be done out of Texas," Hanley said. "This is the only way to make this work out for our budget."
The organization received about $2.5 million annually to provide quality health care improvement services to the state along with investigating complaints during its current contract, Hanley said. He said he expects funds will be significantly decreased even if the bid is accepted. However, he said, funding for the contract is still unknown.
Hanley said the organization employs nearly 25 people who will be directly affected by the Medicaid restructuring. He said the hope is that jobs will be found for the employees within the foundation organization. However, he said, there is a possibility that there will be some layoffs.
NW News on 06/15/2014