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Lawmakers want changes from Community Care health care system

A bill filed yesterday at the state legislature to make the prices hospitals charge for procedures more easily accessible to patients demands significant change to the leadership of Community Care of North Carolina, a health care management system run by providers.

Hospitals would have to be more upfront about what they charge for common procedures, according to an article in today’s Charlotte Observer. The Charlotte Observer, along with the News & Observer, published an investigation “Prognosis: Profits” that found many public hospitals in the state had soaring profits while patients paid exorbitant prices for procedures and required charity care was offered at minimal levels.

But the bill would also change the structure of Community Care of North Carolina, a health care system that works with the state to manage care  on the community level for Medicaid patients.

Community Care has received national praise for its model of care, which sought to reign in Medicaid spending by creating a doctor-run system to match primary-care providers with patients to avoid costly emergency room visits. Senate Bill 473, the “HealthCare Cost Reduction and Transparency Act”  introduced Thursday by Sens. Bob Rucho and Harry Brown, would shift the leadership team of Community Care away from providers and demand that the organization change its board of directors in order to do business with the state.

The bill proposes that the state cap its board at 13 members, with one-quarter or less of its members being providers like doctors, and creating slots for four appointment from the legislature, two from the governor, the head of the state’s Medicaid office, a health actuary, a business owner, a health insurance industry representative and health IT expert.

The board’s current makeup consists largely of doctors and health care directors. The bill would also prevent any providers that are recipients of Community Care work from serving on the board that sets the reimbursement prices for procedures.

9 Comments

  1. Doug

    March 28, 2013 at 4:30 pm

    We need more competition in the medical marketplace. Just imagine if you could get a price list for procedures and combine that with some quality of care information. If facilites had to compete for your business then you would see prices go down. The first step that needs to be done is get rid of health insurance as a pay all concept. Until health insurance is treated like other types of insurance you buy then we are going to continue in this death spiral of higher costs, lower benefit, and lower availability. The free market needs to be allowed to work, and with all the government restrictions on health care that currently exist is holding back the industry.

  2. david esmay

    March 28, 2013 at 9:26 pm

    Once again Doug is completely wrong on every point. No other country in the world treats helthcare as an insurance business, some call it health insurance in a political sense, the same way we call SS social insurance. In countries like Japan, Canada, New Zealand, and Australia people benefit from a system of health service.

    If health care as competitive business worked, it would be a success story and Doug would be right. But that is simply not the case. We would have lower costs, more and better care, but we don’t, we rank well below most of the modern industrialized world.

    We pay more, have shorter lives, and spend all our time filing claims. Doug is just repeating right wing lies that enable insurance companies to enrich themselves from the economic pollution they produce.

    We get less for more and under the system Doug and ignorant caucus of the Right propose, we always will. According to a 2007 Mckinsey Global Institute Americans spend almost 6 times the average that 13 other modern countries do, 86% of this excess cost is because American health care is run like a business instead of a public service.

    Doug and those on the Right will continue to lie and tout the invisible hand of the market as the savior of everything, in the mean time costs will continue to rise and refute every point they make.

  3. david esmay

    March 28, 2013 at 9:34 pm

    Those government restrictions Doug’s talking about do one thing, restrict the profligate fraud perpetrated by people like former Tennessee Republican Senator Bill Frist, Republican Rick Scott, and Mitt Romney, people who controlled HMO’s and committed fraud on a massive scale. Due to lack of over sight Insurance CEO’s have enriched themselves through stock fraud, malpractice fraud and claims fraud to the tune of tens of billions of dollars. This one of the reasons Right wing politicians fight the ACA, they make money from the fraudsters who donate to their campaigns, or simply quit and become lobbyists for them.

  4. Doug

    March 29, 2013 at 8:53 am

    once again….gibberish from dave

  5. gregflynn

    March 29, 2013 at 10:32 am

    It’s only gibberish if you don’t understand it. The original post is about Community Care in North Carolina, a specific program that has improved health care and reduced cost in North Carolina.

  6. Doug

    March 29, 2013 at 1:46 pm

    …and dave woudl have agreed with me instead of putting up his usual gibberish just to be contrary . I was agreeing with the OP in that upfront costs should be there for all to see in order make a step to free market.

  7. david esmay

    March 29, 2013 at 5:08 pm

    If left to the invisible hand of the free market, insurance companies would still conspire to manipulate prices to enrich themselves. The gibberish is all your’s dougy.

  8. Doug

    April 1, 2013 at 10:30 am

    davey, the free market would figure out your manipulation and they would then go out of business. It is the government propping up these companies that allows them to stay in business.

  9. R

    April 11, 2013 at 1:19 pm

    Sarah Ovaska’s last paragraph reports that the Community Care board sets reimbursement prices for procedures, that many providers sit on its board and appears to insinuate malfeasance. It is easy to confuse the two pieces of the SB 473: one dealing with transparency on the price of procedures and the other dealing with controlling a private non-profit’s board. Let’s be clear: the Community Care board does NOT set the price for ANY reimbursement. DHHS and DMA set Medicaid policy and fee schedules which includes reimbursement prices for procedures.