Social Services wants to link Medicaid patients with physicians

Published 12:00 am Wednesday, December 2, 2009

By Kathy Chaffin

Salisbury Post

A state grant may allow the Rowan County Department of Social Services to hire a case manager to help link Medicaid patients with a primary care physician.

Director Sandra Wilkes told the Board of Social Services Tuesday night that the department had received the grant from the N.C. Division of Medical Assistance to cover half the cost of the salary, benefits, supplies and office setup for the case manager. The federal government will pick up the other half, she said.

The board voted unanimously to add the position contingent upon the approval of the Rowan County Board of Commissioners.

Jim Sides, who represents the Rowan commission on the Board of Social Services, asked if the grant was recurring. Wilkes said it was, but if for any reason the funding ended, it was understood that the department would not continue the position.

Having someone to help Medicaid patients sign up for a primary care physician should cut down on emergency room visits and ultimately save on the amount of Medicaid money spent in the county, she said. Chairman Jeff Morris said the cost of a visit with a primary care physician is substantially less than an emergency room visit.

The initial target population for the managed care pilot project to be funded by the $328,000 grant would include elderly and disabled adults not assigned to a primary care physician, high users of Medicaid, frequent users of Rowan Regional Medical Center’s emergency room and patients with such chronic diseases as diabetes and asthma.

Among the projected outcomes of the program are the provision of high quality health care of patients without duplication of health services; recruitment of new health providers; and the implementation of a polypharmacy review to track Medicaid recipients who may be doctor shopping to obtain multiple prescriptions.

Morris asked if the program would include a protocol for referring any Medicaid patients found to be doing this for treatment for addiction to painkillers.

“That will be part of this,” Wilkes said.

“I’m encouraged about that,” Morris responded.

A local attorney, he said he had recently represented a client who had been going to different doctors to obtain prescriptions for painkillers, one of which cost $1,300 a month. Had there been some type of tracking mechanism in place, he said it would have been readily apparent that this person was doctor shopping.

Wilkes said the estimated salary for the case manager is $27,000.

In the late 1990s, she said the state funded a position within the department to sign up Medicaid patients with a primary care physician. When the state withdrew the funds, “We lost the position,” she said. “The county did not pick it up.”

Cabarrus County, which maintained its position, runs about a million dollars less in Medicaid expenses per year, she said. Any savings incurred in Rowan by linking Medicaid patients with primary care physicians would return to the county through future grants.

The county has budgeted $6,984,000 for Medicaid costs during the 2006-2007 fiscal year ending June 30.

Wilkes said the state had set aside $27.4 million for counties that go over their budgets. She said that once that money is depleted, counties will be required to pick up 15 percent of the overage amount.

Based on the first six months, Wilkes said it appears that Rowan County’s Medicaid expenses will go over the budgeted $6,984,000. “We will certainly be tapping into the state’s $27.4 million,” she said.

However, if other counties also go over budget, she said the funds could already be depleted and the county might have to pick up 15 percent of the overage.

Sides asked how much of the $27.4 million had been used. Wilkes said it did not appear that any counties had tapped into the funds yet.

Is it first-come, first-served? Morris wanted to know, adding that that would be rewarding the counties that are the least efficient.