In philosophy, you learn about “evidence of absence.” It’s kind of like a logical assumption based on the LACK of evidence. Such as: P implies Q is false, but Q is false, therefore P is false.  Or Knicole takes a break from blogging on the weekends.  Knicole did not blog today, therefore it must be a weekend.

There is also some who say you cannot prove a negative.  You cannot prove that flying reindeer do not exist; it is up to the flying reindeer to prove they do exist.  Personally, I think this way of thinking is pessimistic and leaves little room for faith.  But, in some circumstances, such as…how are my tax dollars being used for Medicaid recipients, I do not want a non-proven negative.  I want proof.

Recently, WFAE, Charlotte’s NPR News station, ran a piece entitled, “Frustrations with MeckLINK Grows as Denials for Care Increase.”

The point of the article was the drastic decrease in behavioral health service authorizations within MeckLINK’s catchment area (Mecklenburg county) for Medicaid services since MeckLINK went live.

Here is the chart WFAE provided in its article:

If this graph is correct, MeckLINK has some serious questions to answer to taxpayers. Within 4 months, the number of mental health Medicaid consumers in Mecklenburg county decreased OVER HALF??!!!  From 1,518 to 689!

Did the 829 people, who were receiving mental health services back in February/March 2013, move from Mecklenburg county/die/heal (in order to not need the mental health services in June)? Or has MeckLINK (and other MCOs) simply begun to deny medically necessary mental health services???

If it is the latter and not the former, I ask, as a taxpayer, where did my Medicaid tax dollars go? To MeckLINK salaries?  And, if it is the latter and not the former, as a person concerned with mental services, especially for Medicaid recipients, I ask, what has happened to the 829 Medicaid recipients no longer receiving mental health services??  Hospitalization? Incarceration? Homelessness? Or just sitting at home depressed…unable to function as they could when they did receive services?

Well, Ben Bradford, of WFAE, asked MeckLINK’s chief financial officer, Ken O’Neil, this question.

O’Neil’s answer? The evidence of absence.

O’Neil revealed that MeckLINK is on tenuous financial footing. It ran a deficit in May and June at a rate that would put it out of business in less than a year.  He also argues those deficits are proof that MeckLINK isn’t sacrificing care for profit.

See Article.

O’Neil argues that MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit.  Proof that flying reindeer do not exist!

O’Neil contends that MeckLINK’s deficit proves that MeckLINK is not denying medically necessary services to mentally ill Medicaid recipients. BTW: O’Neil contends this non-proven negative despite the graph showing that more than half of recipients in Mecklenburg county are no longer receiving services.

O’Neil’s contention (that a deficit proves MeckLINK is not sacrificing care for profit) has a gaping, logistic flaw.

Remember my blog, published June 10, 2013? “Higher Medicaid Administrative Costs = Less Medicaid Money for Providers to Service Recipients”

In this blog, I wrote about CenterPoint’s “hefty salaries to its top-executives.  In addition to these hefty salaries, CenterPoint pays for all employees’ health insurance, as well as the health insurance for all employees’ families!!”

I estimated (and probably underestimated) that CenterPoint, by paying for its employees and employees’ families’ health premiums, was spending approximately $1.5 million in health care premiums…money that should have gone to Medicaid recipients.

So MeckLINK’s (O’Neil’s) contention that MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit is flawed.  Where is the proof that MeckLINK is not over-paying its top executives? Where is the proof that MeckLINK is not over-spending on its employees, i.e., paying for employees’ health care premiums…as well as the families of employees?

Well, I found a few graphs published by DMA that caused me more reason to believe that O’Neil’s “proof of a negative” is flawed.

DMA issues reports on the MCOs.  A recent dashboard report cites that, in its “Trends to Watch,”

1. Behavioral health related claims (e.g., Inpt MH, ICF/MR, CAP-MR and non-physician practitioners) continue to decline with the implementation of BH MCOs. Please note that several of the BH-related types of service have volatile costs per service unit and service units per recipient. This is a consequence of the drastic drop in utilization due to the implementation of MCOs and does not reflect a widespread trend. We will likely remove several of these types of service from the report soon.

I have SO many issues with this “trend.”  Such as: “Continue to decline.” “With the implementation of BH (behavioral health) MCOs.”  “Drastic drop in utilization.”  “Due to the implementation of BH MCOS.”  “Not reflect a widespread???”  (Aren’t the MCOs statewide?).  “We will…remove?… several of these services from the report”….WHY? We don’t want to track the fact that the mentally ill are not receiving Medicaid services?

The DMA Dashboard Report also depicts numerous graphs.  Many of the graphs depict last fiscal years’ Medicaid services’ dollars spent (with a blue line) and this years’ Medicaid services’ dollars spent (with the red line).

Most years, both last fiscal year and this fiscal year, are fairly similar.

Such as Medicaid physicians’ office visits:

Notice the interplay between the red and blue lines.  The expenditures for physicians’ office visits from last fiscal year to this fiscal year is, relatively, similar.

Now let’s look at a behavioral health service (ICF/MR):

See the difference?

The blue line depicts last fiscal year.  The red line depicts the current fiscal year.  The left side of the graph shows dollars, while the bottom side shows months.

As you can see, the blue line (last fiscal year) shows a semi-constant, horizontal line with a small down tick in April 2012.  The red line, however, (this fiscal year) begins where the blue line left off, but, then, in January-ish 2013, a massive decrease in dollars spent.

So….a massive decrease….surely the MCOs were not paid the same…oh, and surely not more!!!???

Because, remember, if an MCO has a deficit, that means that the MCO is “not sacrificing care for profit.”

Here is DMA’s graph on MCO capitation payments per 1000 eligibles:

Now, mind you, I am no math expert, but this chart, to me, appears to show a 700% plus uptick in MCO capitation payments.

So, according to O’Neil, MeckLINK is running at a deficit, at least for a couple of months.  Yet, DMA’s graphs demonstrate a decrease in mental health services and an increase in payments to MCOs.

Hmmmm.

Here are proofs of negatives:

The fact that Knicole did not blog today proves that it is a weekend. (Surely, Knicole was not just too busy on a weekday to get out a blog).

MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit.  (Surely, MeckLINK did not pay hefty salaries to top executives or all health care premiums for employees and families). 

You cannot prove a negative.  But you CAN show proof.