It’s pretty likely that no diehard baseball fan ever said, “If they could just cut two or three minutes out of the game, I’d watch more.” However, that’s what Major League Baseball was trying to accomplish with a new rule eliminating a pitcher’s requirement to throw the ball during an intentional walk.
Under the new rule, a manager can signal the umpire for an intentional walk and the batter can take the base. Certainly, we can all get behind this type of efficiency, right? Not necessarily.
During the 2016 season, there were 932 intentional walks in all of Major League Baseball — less than one intentional walk every other game. The time savings is miniscule — approximately one minute for every 400 minutes of play.
And, the change may have unintended consequences. Intentional walks are part of a defensive strategy. However, the new system robs the offense from capitalizing on mistakes that sometimes produce value — like an errant pitch or a deft swing.
The new rule is a solution looking for a problem. It can be argued that Missouri’s move to statewide Medicaid managed care is as well. After all, a growing body of evidence suggests that Medicaid managed care doesn’t produce the expected return and it diminishes the chance of something exciting happening.
The February edition of HIDI HealthStats focused on opportunities to increase value in the Missouri Medicaid program. It demonstrated that despite the extreme differences observed in the Medicaid fee-for-service population — who are more than twice as old, 4.5 times as likely to have chronic comorbidities and twice as likely to have behavioral risk factors — the fee-for-service and managed care hospital cost curves were nearly identical in 2016. Further, the report showed a much higher rate for emergency department utilization for those in Medicaid managed care versus those in fee-for-service. One would think that a managed patient would have less, not more, ED utilization. That’s not the case in Missouri.
There’s little evidence that Medicaid managed care improves care, improves health or reduces health care spending. Missouri-specific research from Mercer found a 1.7 percent cost savings when comparing similar managed care and fee-for-service populations. However, the research failed to adjust costs for rural and urban enrollees under managed care, while inflating rural fee-for-service cost by 5 percent. A similar cost adjustment for managed care would have negated the savings entirely and led to additional cost.
Research from the Kaiser Family Foundation found similar results nationally. According to Kaiser, “Available research does not support most claims of large cost savings or improved quality of care for children and pregnant women as a result of managed care.” The National Bureau of Economic Research agrees — including this ominous note, “the effects of the shift varied significantly across states as a function of the generosity of the state’s baseline Medicaid provider reimbursement rates.” In Missouri, the hospital provider rate for Medicaid is essentially the federal match because of the Federal Reimbursement Allowance. Hospital payments already are constrained without the addition of managed care overhead.
Assuming network adequacy and the appropriate authority to expand from the Centers for Medicare & Medicaid Services, statewide managed care is set for Monday, May 1. Thursday, the Senate Appropriations Committee reversed its earlier position and included funding for managed care for the fiscal year beginning Saturday, July 1.
Next week will bring additional news. The state will assess — one week before the go-live date — the adequacy of the managed care organizations’ networks. Further, since the state didn’t apply for needed federal waivers to expand the program until three weeks ago, it could be launching a program statewide without the necessary federal approval. This leaves a lot of unanswered questions for Missouri’s health care providers and the patients they serve.
Like the move to a pitchless intentional walk, you have to wonder… why? What value is it adding and who does it serve? After all, evidence suggests it doesn’t lead to better care, better health or lower costs. If it was a magical elixir, wouldn’t Iowa and Kansas be good models to follow, rather than cautionary tales?
Baseball aficionados would say that engaged fans gain nothing from the new unintentional walk rule. At the same time, they would argue that it closes the door on real game-changers.
Managed care is an $8 stadium hotdog. Evidence suggests it costs a lot more than it is worth.
Let me know what you’re thinking.
Herb B. Kuhn
MHA President and CEO
In This Issue
CMS Issues Proposed Regulation To Increase Transparency
Research Shows 30 Percent Increase In Appointment Wait Times
April 20, 2017
Senate Committee Supports Medicaid Managed Care Funding
State House Approves Bill On Consent To Treatment
MLN Connects Provider eNews Available
Trump Administration Awards $485 Million In Grants To Combat Opioid Crisis
CMS Announces FY 2018 IPPS Proposed Rule Webinars
AHA Releases Hospitals Against Violence Resource
TJC Announces Pioneers In Quality Discussion
Six Hospital Associations Send Joint Letter To CMS
Hannon Resigns From Bates County Memorial Hospital
April 19, 2017
Legislators To Negotiate Prescription Drug Bill Differences
State House Sends Bills To Senate
HIDI HealthStats — Opioid Mortality Research
CDC Releases Recommendations For Diagnosing And Managing Shigella Strains
CDC Launches Opioid Webinar Series
April 18, 2017
CMS Releases MIPS Fact Sheets
Openings Remain In Show-Me ECHO Child Psych Clinic
April 17, 2017
MHA Submits Comments Supporting CMS EPM Delay
CMS Releases FY 2018 IPPS And LTCH Proposed Payment, Policy Updates
CDC Releases Interim Guidance: Managing Occupational Exposures To Zika
MHA Releases Aim For Excellence Award Application Tutorial
CMS Announces Next Rural Open Door Forum