Sunday, July 17, 2005

Connecticut Medicaid HMOs Keep Their Physician Payments Secret

The Hartford Courant reported how Connecticut Medicaid HMOs have tried to keep what they pay doctors secret. The story started when a group of clinics in New Haven found their patients were having trouble getting appointments with cardiologists and gastroenterologists. They wondered if low rates of reimbursement of these services by the patients Medicaid HMOs were deterring doctors from seeing them. But when the clinic doctors asked the state's Department of Social Services (DSS), which administers the state Medicaid progam, what its HMO contractors paid for sub-specialty services, the Department refused. The clinics' attempt to force the state to reveal these rates using the state Freedom of Information Act is pending. The state attorney general said, "as a matter of policy, I disagree with the DSS position." The article noted that "lawyers for the HMOS - Community Health Network of Connecticut, Health Net of Connecticut, FirstChoice Health Plans of Connecticut and WellCare of Connecticut, decline to comment for this story, but referred a reporter to legal papers filed with the Freedom of Information Commission. In the papers, the HMOs claim that disclosing the amount they pay doctors would reveal commercial secrets."
There they go again. The biggest secrets in health care these days, it seems, are what some organizations charge or pay for specific services. (See our post here about how hospitals keep their "list prices" secret.)
This secrecy seems to contradict claims made by some of the HMOs, for example, that "our members are very important to us, (by Community Health Networks of Connecticut), or to "be responsible for the commitments we make and the results we deliver," by (WellCare, in its statement of values.)
Prices paid for physicians services hardly seem like trade secrets like Coca-Cola's secret syrup formula. So inquiring minds want to know what it is about these prices that the HMOs so strongly want to keep secret.

1 comment:

InformaticsMD said...

I wish them luck.

Heck, in Connecticut I couldn't even use the FOI act to cause the State Bar Committee to divulge how they arrived at a "slap on the wrist" as the response to a Yale associate general counsel's unauthorized practice of law (they had not passed the Bar exam).

http://www.state.ct.us/foi/1999fd/19991027/FIC1999-090.htm

This "associate general counsel" was involved in attempts to misappropriate my intellectual property and was refusing to release confirmation of my education and faculty employment to other organizations "until the I.P. issues were settled" (i.e., making an offer I couldn't refuse).