Medicaid bill would reward doctors for patient care

JEFFERSON CITY, Mo. -- Recover quickly from surgery and your doctor could get a bonus.

Although somewhat simplified, that's one of the potential results from a proposed Missouri Medicaid overhaul that would subject physicians, hospitals and other medical providers to new pay-for-performance requirements.

As the Senate debate began Monday on the bill, supporters touted the new payment structure as an incentive to ensure low-income Missourians enrolled in the government health-care program receive high-quality care.

But Senate Majority Leader Charlie Shields envisions a scenario in which surgeons could receive more money if their patients average shorter hospital recovery stays and lower infection rates. Similarly, he said, nursing homes could get higher state payments if their residents don't tend to develop pressure sores from being left too long in the same position in their beds or chairs.

"The better you do, the more money you have the ability to make. That's normal practice everywhere else," said Sen. Brad Lager, R-Maryville, another supporter of the bill.

The proposal to revamp Missouri's Medicaid program also would provide incentives to patients. People who agree to develop a health-improvement plan, try to carry it out and keep their doctors' appointments would earn credits on an electronic debit card that they could use for such things as over-the-counter medicines and health club memberships.

Missouri has about 825,000 Medicaid recipients.

-- down from a peak of 1 million in 2005, when Republican Gov. Matt Blunt and the GOP-led legislature eliminated or reduced certain Medicaid benefits in a budget-cutting move.

Blunt describes the cuts as a first step in health-care reform, with the second step being this year's legislation.

The bill debated Monday would do little to restore coverage to those people who lost it -- a major point of frustration for many Democrats.

The legislation "is a plan to benefit insurance companies and not those who lost their health care in the cuts," said Sen. Joan Bray, D-St. Louis.

Shields, R-St. Joseph, said efforts to restore service to some former Medicaid recipients would be considered as part of separate bill.

Under the bill debated Monday, Medicaid would be renamed "MO HealthNet" and participants would choose a "health-care advocate" such as a doctor, nurse or some other medical professional to help coordinate their care.

The bill would gradually expand across Missouri a managed-care model for health care, which already exists for Medicaid recipients in St. Louis, Kansas City and along the Interstate 70 corridors.

But two senators generally on opposite ends of the political spectrum -- Bray and Sen. Jason Crowell, R-Cape Girardeau -- both complained that the legislation would set up a massive bureaucracy.

"I can tell you right now, managed care don't work in our area. There is no physician that is going to do it," Crowell said.

Crowell also objected to the bill's creation of a special government committee to determine performance-based pay rates for medical providers. He suggested a better approach would be to give patients a greater incentive to hold down their own health care costs and to let them choose their own medical providers.

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Medicaid bill is SB577.

On the Net:

Legislature: http://www.moga.mo.gov