The Arkansas Medicaid program has assessed more than $500,000 in penalties against 49 providers whose costs for treating children with attention deficit hyperactivity disorder or providing maternity care was too high, according to information provided by the state Department of Human Services on Monday.
Meanwhile, two dozen providers who deliver babies or perform hip or knee replacements have received more than $137,000 in bonuses for keeping their costs low.
In addition, 176 other providers with low costs qualified for bonuses totaling $189,237 but need to submit additional information to be eligible to receive the money, according to the Human Services Department.
Started in 2012, the "episodes of care" initiative is meant to help lower the growth of spending in the state's Medicaid program.
The initiative rewards doctors, hospitals and others whose costs for providing an episode of care is below a certain level and penalizes those whose costs are above a level considered acceptable.
The first round of awards and penalties, for doctors who treat upper respiratory infections, was announced in February.
The latest round of awards and penalties were for four additional types of episode: ADHD, congestive heart failure, knee and hip replacement, and maternity care.
Health care providers were notified of the latest bonuses and penalties in late April, Dawn Zekis, the state's interim Medicaid director, said.
She said one provider has appealed its penalty to the state Health Department, and several others have submitted additional information to the Human Services Department and asked for their penalties to be reconsidered.
Most of the penalties -- almost $460,000 -- were assessed against providers who treat children with ADHD.
The company receiving the largest penalty was Maxus Inc., which operates under the name Arkansas Counseling Associates.
It received $113,782.09 in penalties in connection with treatment provided at eight facilities, according to Medicaid records.
Jonesboro-based Life Strategies Counseling Inc. received $106,453.93 in penalties in connection with treatment provided at three facilities.
Julie Mullenix, a consultant to Maxus, said Monday evening that she didn't have information on the reason the company's costs were above the threshold considered acceptable under the initiative.
A call to Life Strategies' headquarters in Jonesboro wasn't returned Monday afternoon.
The ADHD episode targets the treatment of children ages 6-17 with ADHD and no other diagnosed behavioral conditions.
The episode covers the average cost of providing the treatment over a year. For children who respond well to medication, an average cost below $2,223 is considered acceptable.
For children who don't respond well to medication, the acceptable cost threshold is $7,112.
Zekis noted that few providers certified that their patients had not responded well to medication. Medicaid officials are investigating whether some providers inadvertently failed to list other diagnoses in addition to ADHD for some patients.
The costs for patients with multiple diagnoses are not included in calculating the average cost.
No providers received bonuses for keeping their cost of treating ADHD low.
Zekis said some providers had costs low enough to qualify for the bonuses, but needed to submit additional information to the Medicaid program to be eligible.
According to the program's provider manual, providers complete forms listing information about the patients' diagnoses to be eligible for bonuses.
Zekis credited the program with helping reduce the cost of treating ADHD.
At a meeting in April, a consultant to the Human Services Department said payments to behavioral-health organizations for the treatment of children with ADHD, including children who had multiple diagnoses, fell 52 percent, from $64.3 million in the year before the start of the initiative to $31.1 million the next year.
During the same period, payments for the treatment of the disorder to primary-care physicians fell from $2.2 million to $2.1 million, and payments to other providers, including hospitals and rural health clinics, fell from $14.4 million to $11.7 million, the consultant, Betsy Holmberg of McKinsey & Co. said.
She said the drop was due in part to a decreased use of therapy, which is not recommended for children whose only disorder is ADHD.
"We are encouraged by these results for the first wave of episodes," Zekis said in a news release. "We're seeing providers actually change their practice patterns, which is an important first step in moving towards higher-quality and more effective patient care."
Under the maternity care episode, 21 doctors, clinics and hospitals received bonuses totaling almost $135,000, and 14 providers received penalties totaling more than $42,000.
The amount of the bonuses ranged from $271.86 for the Ouachita Valley Family Clinic in Camden to $41,141.54 that went to Searcy Medical Center.
The penalties ranged from $28.89 against the Central Clinic for Women in Little Rock to $17,264.95 that was assessed against Paul Becton Jr., a Paragould gynecologist.
Becton was arrested April 16 and charged with five counts of voyeurism after he was accused of photographing a woman without her consent during an April 1 exam. He pleaded innocent to the charges in Greene County Circuit Court on May 30.
Costs included in the episode include prenatal care and delivery but not medical care for infants.
For knee and hip replacement, three providers shared bonuses totaling $2,692.83. No provider was penalized for that episode.
No providers received penalties or bonuses for the congestive heart failure episode. Zekis said some providers qualified for bonuses but have not submitted the required information.
Metro on 06/24/2014