Were providing high quality care, says Michael Lawton, a top executive of a large nonprofit PSN in Jacksonville. We dont have to pay shareholders, so were not trying to squeeze out a profit.
But for-profit PSNs also do well. Better Health in Broward has 39,000 patients in the county, making it the third-largest Broward network. Cabrera, chief executive of a company with a minority interest in Better Health, attributes the success to customer service. We assign an individual to a patient, calling them to make sure they keep appointments, that theyre getting follow-up doctor visits after going to the hospital.
All major PSNs say they are costing the state no more than the HMOs, but Republican lawmakers in Tallahassee have been trying since 2009 to force the PSNs to stop fee-for-service and accept capped rates like the HMOs. The PSNs, lobbying hard, have kept their status.
John Benz, Memorials chief strategic officer, says PSNs work because they share any savings they get with the state. He says they should be allowed to continue with fee-for-service: Since were getting similar or better results, why would you not to allow that to happen?
Negron, the Republican senator championing reform, says the PSNs must change to accept capped rates, so the state can control its costs.
The two large nonprofit PSNs have one strong lure for patients: access to specialists who work for the company.
In the HMOs, many doctors, particularly specialists, refuse to take Medicaid patients because the reimbursement rates are so low.
Aaron Elkin, a Hollywood obstetrician-gynecologist and former president of the Broward County Medical Association, has been outspoken about the problems of the pilot program. He says he gets about $1,350 for a Medicaid pregnancy versus $2,000 to $3,000 from private insurance. The Broward medical association has been opposed to the reforms since they began. One major reason: Only 5.6 percent of Medicaid funds go to doctors.
Cabrera, the HMO executive, acknowledges its a problem finding specialists. We cannot pay the specialists the fees theyre demanding because we dont get paid for these by the state. A lot of specialists say, Hell, no, I wont take the Medicaid rate.
Senior, the Medicaid director, maintains there is no shortage of doctors. We still have a very strong network. Gosh, theres 80,000 to 100,000 providers statewide.
Elkin says he often hears complaints from his Medicaid patients, who he believes are reluctant to make formal protests for fear of alienating the insurers they desperately need. The relatively small number of documented complaints, he wrote in a letter to Medicaid officials in Washington, is absolutely NOT an indication that the Medicaid reform pilot is successful.
During interviews with a half-dozen pregnant Medicaid patients in Elkins office, almost all had complaints, the most common one being how hard it was to get approved for Medicaid.
Ebony Mobley, having her first child at 25, said she struggled for almost four months to get approved. You cant get through on the telephone line.
Mayra Villalobos, a Miami Beach woman having her first baby at 35, called the application process very disorganized. She said she struggled for two months to get a Medicaid card. Her unborn baby got a card three weeks before she did.